(Disclaimer: This article is for scientific use only, and the information in the following content has been processed to protect the privacy of the child)
Abstract: A 9-year-old boy had knee pain for more than 1 month. At first, he thought the pain was caused by too much activity at school, but as the pain worsened, he went to the hospital and found a malignant bone tumor in the distal femur, which was confirmed to be osteosarcoma by puncture pathology, but fortunately, no metastasis from other sites was found by performing a systemic examination. According to the standard treatment procedure for osteosarcoma, chemotherapy combined with surgery was adopted. At the end of the treatment course, the child recovered well and resumed normal walking function.
Basic information】Male, 9 years old
Disease Type】Malignant bone tumor of distal femur, osteosarcoma
Hospital】People’s Hospital of Peking University
Date of Consultation】July 2021
Treatment plan】Medication (injectable epirubicin hydrochloride + injectable cisplatin + high-dose injectable methotrexate + injectable isocyclophosphamide) + surgery (pediatric-type knee arthroplasty + limb lengthening)
[Treatment cycle] 2 weeks of hospitalization, regular inpatient chemotherapy and surgery
Treatment effect] The whole course of treatment was completed, the limb recovered good function, and the tumor did not recur or metastasize
I. Initial consultation
The child had knee pain during school activities, which started with intermittent pain and nighttime pain. However, the pain gradually worsened, so she went to the hospital to have a radiograph, which revealed a malignant bone tumor in the distal femur. For further consultation, after coming to our department, he was promptly given hospitalization, local CT and MRI examinations, and the diagnosis of osteosarcoma was confirmed by biopsy, while a whole-body examination was performed, and no multiple lesions were found in the lungs or other organs or bones. In addition, osteosarcoma of the distal femur with no metastasis on chest examination.
II. Treatment history
Preoperatively, we fully communicated with the parents of the child to develop the best treatment plan, and adopted preoperative chemotherapy, surgery and postoperative chemotherapy methods for treatment. The standard, recognized and most effective chemotherapy regimen at this stage was used, including epirubicin hydrochloride for injection, cisplatin for injection, high-dose methotrexate for injection, and isocyclophosphamide for injection.
In addition, because the child is relatively young and skeletally immature, a pediatric-type knee arthroplasty is required. The advantage of this joint is that it can preserve the proximal tibial growth function, and at the same time the joint stability is very good, which is conducive to the recovery of the child’s postoperative function. Considering the future limb growth of the child, in order to reduce the postoperative distant limb inequality, the limb on the operated side is lengthened by 2 cm, which can reduce the degree of inequality during limb development.
III. Treatment effect
The pain of the knee joint was significantly reduced after the preoperative chemotherapy of the child. Preoperatively, we planned the extent of tumor resection and prepared to extend the length of the prosthesis by 2 cm. intraoperatively, we resected the tumor according to the preoperative plan and performed pediatric tumor-based joint replacement. functional knee exercises were started on 3 days, and the child was discharged from the hospital at 2 weeks. He was able to walk independently on his own 2 months after surgery. By the time all chemotherapy was completed, the child was able to live completely on his own and regain near-normal limb function. Although the limb on the affected side is slightly longer than the healthy side, it has no significant impact on the child’s activities. Later on, as the child’s body develops, the length of the healthy limb will gradually catch up. This pre-determined, planned limb lengthening will help eliminate the effects of later limb inequality. Planned limb lengthening of the child reduces the problem of unequal limb length later on.
IV. Precautions
We are glad that the patient’s symptoms have improved after treatment, but clinical follow-up for malignant bone tumors after surgery is a very important component of the treatment plan. Follow-up within 2 years after treatment must be performed every 3 months, and then gradually extend the time, and after 5 years, annual examination is performed. The examination will include a physical examination, local X-ray, CT and MRI, chest X-ray or chest CT, and if necessary, a bone scan or PET-CT for a complete examination. In addition, post-operative functional exercises are very important for the timely recovery of joint function after joint replacement. Planned postoperative exercises can effectively improve postoperative function and promote functional recovery of the knee joint.
V. Personal insight
Children and adolescents are the age when malignant bone tumors are prevalent, which can seriously affect the health of the affected children and the whole family. The area around the knee joint is the most common site for malignant bone tumors, and the common tumors include osteosarcoma and Ewing sarcoma. Because malignant bone tumor is a rare disease, children and their families generally lack knowledge about the disease, and there are many kinds of information nowadays, sometimes it is difficult to distinguish the truth from the falsehood, and there are many misunderstandings among the families of children about the disease, even some still think that malignant bone tumor is an incurable disease, which leads to the delay of the disease. In fact, most of the malignant bone tumors can be cured, but to achieve good treatment effect, timely detection, early treatment and no detours are needed.
Since bone tumor specialists play a very important role in guiding the active treatment process of children, they need to communicate with their families about the condition in time to develop the optimal plan. In addition, because limb preservation in children and adolescents with malignant tumors is a relatively specialized and complex technique, it is necessary to fully consider the child’s age, skeletal development, the recent effects of various limb preservation and long-term complications in order to restore the child’s function as much as possible and reduce unnecessary long-term complications. As in the case of this child, effective clinical treatment has resulted in effective control of the condition.