Evidence-Based Medicine
Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Orthop. Sep 18, 2018; 9(9): 173-179
Published online Sep 18, 2018. doi: 10.5312/wjo.v9.i9.173
Is there consensus regarding surgical treatment of bone sarcomas?
Thomas Baad-Hansen, Sarah Stammose Freund, Bodil Hammer Bech, Johnny Keller
Thomas Baad-Hansen, Sarah Stammose Freund, Johnny Keller, Department of Orthopaedic Oncology, Aarhus University Hospital, Aarhus C8000, Denmark
Bodil Hammer Bech, Department of Public Health, Aarhus University, Aarhus C8000, Denmark
Author contributions: Baad-Hansen T and Keller J designed the study; Baad-Hansen T, Bech BH performed data analysis; Baad-Hansen T, Keller J, Bech BH and Freund SS wrote the paper.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
Open-Access: This article is an open-access article, which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Thomas Baad-Hansen, PhD, Chief Doctor, Consultant, Department of Orthopaedic Oncology, Aarhus University Hospital, Nørrebrogade 44, Aarhus C8000, Denmark. baadhansen@dadlnet.dk
Telephone: +45-28603490
Received: April 10, 2018
Peer-review started: April 10, 2018
First decision: May 15, 2018
Revised: May 20, 2018
Accepted: June 27, 2018
Article in press: June 27, 2018
Published online: September 18, 2018
Research background

Reconstructive surgery using megaprosthesis is widely applied as a treatment for bone sarcomas of the lower extremities. Even though reconstructive surgery has been used for several decades it seems that there is no clear consensus in surgical treatment strategies for this group of patients.

Research motivation

The low number of bone sarcomas limits the possibility to run randomized clinical trials. This is in contrast to non-surgical treatment of bone sarcomas, where standard protocols are available to test new treatment regimes since the sites of the sarcoma are of less significance. Only a few international randomized studies have been initiated to gain new evidence on the surgical treatment of bone sarcoma patients. This is due to the difficulty in achieving sufficient sample sizes due to the rarity of the disease.

Research objectives

The goal of this study was to identify common strategies in the surgical treatment of patients with bone sarcomas of the lower extremities in terms of surgical/technical considerations, choice of antibiotics, dosage, and duration of treatment, and choice of antithrombotic drug, initial start-up, dosage, and duration.

Research methods

The study was based on an internet-based survey on the surgical management of bone sarcomas in the lower extremity amongst sarcoma surgeons in the Scandinavian countries.

Research results

This study demonstrates a large variation in the treatment of patients with bone sarcomas located in the lower extremities. With regard of implant fixation, the Danish and Swedish sarcoma centers tended to consider a cemented prosthesis not only for the older patients but also for the youngest patients below 20 years old, contrary to the rest of the Scandinavian centers. All participants would administer intravenous prophylactic antibiotics regarding endoprosthetic reconstructive surgery. First choice of antibiotics was cephalosporin. Less commonly used were glycopeptide, penicillin, or a combination. The duration of prophylactic antibiotic treatment ranged from less than one day to more than four days. All participants would administer heparins as antithrombotic prophylaxis. Fifty-five percent of the participants answered that initial treatment was started preoperatively, 3% perioperatively and 42% postoperatively. Range of antithrombotic treatment went from 5-28 d.

Research conclusions

Today, patients diagnosed with bone sarcomas of the lower extremity are to a great extent offed treatment with a resection prosthesis. The treatment is well established, however, there is a significant inconsistency in the surgical treatment algorithm between sarcoma centers. Still the treatment is primarily based on best clinical practice, due to the absence of evidence-based medicine in the surgical management of bone sarcomas.

Research perspectives

The current study elucidates, that the surgical sarcoma community needs to support the ongoing randomized control trials and encourage the initiation of new randomized studies to gain knowledge of the surgical treatment of bone sarcoma patients based on evidence-based medicine.