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EXTRA CORPEAL RADIATION AND REIMPLANTATION (ECRT) FOR BONE SARCOMA

Harini (name changed) was like other girls of her age, until she developed pain in left thigh bone when she was 14 years old. She took treatment for weeks without relief and noticed a rapidly growing swelling in left lower thigh. Alarmed, her parents accompanied her to Comprehensive Cancer centre, Manipal Hospitals, Bengaluru where she was investigated and diagnosed to have Osteosarcoma of left Femur bone. Further tests indicated no evidence of spread of cancer to other parts of the body. 3 cycles of Neo- Adjuvant Chemotherapy was provided by the Medical Oncology team of Doctors and she was referred to Musculoskeletal Oncology Unit in Department of Surgical Oncology for limb salvage surgery.

Saving the limb was a challenge and required extensive planning involving special custom designed plate. The bone tumour was removed and high dose radiation therapy was provided by the Radiation Oncology team during the surgery. After the radiation, the bone becomes free of cancer. This bone was then reimplanted into Harini’s thigh with the help of the special plate. The surgery was conducted for 6 hours. After surgery the patient recovered well and she was made to walk with help of support. Post operative chemotherapy was restarted after sufficient wound healing.

Osteosarcoma is a rare cancer affecting the bone particularly in children. If not detected early this cancer can spread to lungs and bones and can be life threatening. Most of these patients undergo amputation surgery due to late presentation and lack of expertise. Today with better awareness, availability of experts, better technology involving multidisciplinary team of cancer specialists it is not only possible to save their lives but also their limbs. In this process, it is also possible to customise the surgical treatment based on age and the bone involved which allows maximum degree of functional benefit.

Extracorporeal Radiotherapy is a safe and established method of sterilising the cancer affected bone and making it free of cancer cells. Thus treated bone when reimplanted will be incorporated by the body gradually and with time, the bone is restored to normalcy. This is an economically viable reconstruction option in countries like India where affordability is a challenge. The advantage with this reconstruction method is three-fold; the patient has bone instead of prosthesis (biological reconstruction), it does not need repeated revision surgeries and importantly the growing ends of the bone are preserved allowing natural growth.

The availability of extracorporeal radiation and reimplantation prevented what would have been an ideal indication of Amputation in her due to the extent of bone involvement by the cancer. Harini got back to her study and other recreational activities. The process of curing the cancer and saving a limb has a profound psycho-social impact on the future development, especially in children and adolescents. It has been 6 years since she underwent treatment and she is pursuing her post graduate masters course.

Dr Srimanth B S

Musculoskeletal Oncosurgeon

Comprehensive Cancer Centre

Manipal Hospitals

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