Recent Advances in Malignant Bone Tumor Treatment

Kang, Yong Koo; Chung, Yang Guk

Abstract

The treatment of malignant tumors of the pelvic bone has been considered difficult. Many authors have reported lower rates of patients survival and high rates of complications after treatment of the malignant bone tumors of the pelvis. The size of the tumors often much greater than in other sites. Surgical resection and reconstruction often are more complex, based on the proximity of neurovascular structures. Resection of the tumor varies widely in size, type and location of the lesion. After resection of the tumor, reconstruction restoring anatomy of the pelvis and hip, maintaining the limb length and retaining function of the hip joint are challenging procedures. Reconstructions depend on extent and types of resection, type I(iliac). type II(periacetabular) and type III(pubic or ischial) and combined resection. Although limb salvage procedures are advisable in most of patients, there are times when external hemipelvectomy should be considered the treatment of choice. If surgical margin is not safe, or if major neurovascular structures are sacrificed for the wide resection, and consequently residual limbs are functionless, external hemipelvectomy should be considered. Once limb salvage surgery with resection is chosen as the most appropriate treatment for the patient, careful decision should be made whether reconstruction is necessary and what type of reconstruction is necessary. Most of type I resection could be reconstructed with sacroiliac arthrodesis with a recycled autograft or allograft. The vascularized bone graft may be augmented. Type II resections could be reconstructed with saddle prosthesis or recycled autograft with prosthesis composite. Type III resections are usually not necessary for reconstruction due to little functional impairment. However, most of type I, II combined resection and type I, II, III combined resection are almost impossible to solid reconstruction, and are not advisable to reconstruction. At times, it is appropriate to leave patients with a pseudarthrosis. Reconstruction should be individualized by types and extent of resection.