High long-term local control with sacrectomy for primary high-grade bone sarcoma in children

Abstract

Background: Sacrectomy may offer curative potential for primary sarcomas of the sacrum. However, it is unclear whether and to what extent sacrectomies achieve local control.

Questions/purpose: We therefore determined the curative potential, walking ability, continence control, and quality of life for children after sacrectomy for primary bone sarcoma.

Methods: We retrospectively reviewed eight children with high-grade primary bone sarcomas treated with sacrectomy. The average age of the patients was 14 years (range, 4-18 years). There were six Ewing sarcomas and two osteosarcomas. Five patients underwent partial and three underwent total sacrectomies with all resection margins free of tumor. We recorded local and distant recurrences, functional (Musculoskeletal Tumor Society [MSTS] score) and oncologic outcome (survival), walking ability, bladder and bowel control, independence, and reintegration in society. The average followup was 80 months (range, 54-204 months).

Results: Six patients were alive without evidence of disease at last followup. Three patients had metastases develop and two died of disease 3 and 25 months postoperative. MSTS scores among survivors averaged 17.5 points (range, 5-25 points). Seven of the eight patients were able to ambulate, two independently. All initially were incontinent, but at last followup, two were continent and two were incontinent only under stress. Complications occurred in seven of eight, five of whom required additional surgery.

Conclusion: Despite the high incidence of neurologic deficits and complications, sacrectomy achieved local control in patients with high-grade bone sarcomas. Our observations suggest long-term survival and adequate quality of life are possible in the pediatric population.

Level of evidence: Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

Fig. 1A–D

A16-year-old male presented with a 3-month history of increasing pain in the lower back and right hip. (A) A CT scan of the lumbosacral spine and pelvis showed an aggressive, ill-defined, lytic lesion of the hemisacrum, sacrum ala, and ilium. After the biopsy, osteogenic sarcoma was confirmed and the patient underwent inductive chemotherapy, followed by surgical resection. (B) AP and (C) lateral radiographs of the lumbosacral spine show the resection, followed by instrumentation. (D) With time, compensatory scoliosis developed owing to pelvic obliquity that did not need formal treatment. (Images reproduced with permission from Children’s Orthopaedic Center, Children’s Hospital Los Angeles, Los Angeles, CA, USA.)