Malignant bone tumors around the knee: A single-center experience

Year 2022, Volume: 5 Issue: 5, 1345 - 1350, 25.09.2022

Selami Karadeniz Furkan Erdoğan Alparslan Yurtbay İsmail Büyükceran Cahit Şemsi Şay Nevzat Dabak

https://doi.org/10.32322/jhsm.1132982

Abstract

Aim: This study aimed to determine the frequency of malignant bone tumors (primary and metastatic) seen around the knee in our region, the patients’ type and demographic characteristics, and the treatments’ outcomes.
Material and Method: A retrospective analysis of the patients who were diagnosed and treated with histopathologically malignant tumors in the knee region in our hospital between 2004-2021 was performed from the hospital database. Patients’ complaints, demographic information, and diagnostic and imaging findings were examined. In addition, tumor types, tumor localization, and treatments applied were analyzed.
Results: Malignant bone tumor was detected in 88 (35.7%) of 246 patients included in the study. The patients were 48 women and 40 men, with a mean age of 39.72±21.8 (6-76 years). A total of 88 patients were divided into the pediatric group (<18 years; n=39) and the adult group (≥18 years; n=49). The most common tumors were osteosarcoma in 54 (61.3%) and metastatic tumors in 22 (25%) patients. The most common localization of tumors was the distal femur with a rate of 75%. Metastasis was detected in 12 (18.2%) of 66 patients treated and followed up for primary malignant bone tumors. Limb sparing surgery was performed in 70 (79.5%), and various levels of amputation were performed in 14 (15.9%). Palliative radiotherapy was applied to two patients with metastatic lesions, while two patients who were in the neoadjuvant chemotherapy period died. The 5-year overall survival was 63.7%. Pediatric and adult age groups did not differ significantly in terms of survival (p=0.74), gender (p=0.585), and metastasis development (p=0.53).
Conclusion: The knee is a region that requires attention regarding bone tumors around it. As malignant bone tumors are rarely seen around the knee, a misdiagnosis may be made, and appropriate treatment may be delayed. Although the first diagnosis to come to mind for patients presenting with knee pain is trauma and growing pains, it must not be forgotten that a tumor could be the cause.

Keywords

Bone tumors, malign, knee, surgery

References

• Enneking WF, Spanier SS, Goodman MA. A system for the surgical staging of musculoskeletal sarcoma 1980. Clin Orthop Relat Res 2003: 4-18.
• Siegel RL, Miller KD, Fuchs HE, Jemal A. Cancer statistics, 2021. CA Cancer J Clin 2021; 71: 7-33.
• Mamdani H, Grethlein SJ. Pulmonary metastases from chondroblastic osteosarcoma. N Engl J Med 2018; 378: 1429.
• Kelley LM, Schlegel M, Hecker-Nolting S, et al. Pathological Fracture and Prognosis of High-Grade Osteosarcoma of the Extremities: An Analysis of 2,847 Consecutive Cooperative Osteosarcoma Study Group (COSS) Patients. J Clin Oncol 2020; 38: 823-33.
• Heymann D. Metastatic osteosarcoma challenged by regorafenib. Lancet Oncol 2019; 20: 12-4.
• Lozano Calderón SA, Garbutt C, et al. Clinical and Molecular Analysis of Pathologic Fracture-associated Osteosarcoma: MicroRNA profile Is Different and Correlates with Prognosis. Clin Orthop Relat Res 2019; 477: 2114-26.
• Öztürk R, Arıkan ŞM, Bulut EK, Kekeç AF, Çelebi F, Güngör B. Distribution and evaluation of bone and soft tissue tumors operated in a tertiary care center. Acta Orthop Traumatol Turc 2019; 53: 189-94.
• Whelan JS, Davis LE. Osteosarcoma, chondrosarcoma, and chordoma. J Clin Oncol 2018; 36: 188-93.
• Bielack SS, Kempf-Bielack B, Delling G, et al. Prognostic factors in high-grade osteosarcoma of the extremities or trunk: an analysis of 1,702 patients treated on neoadjuvant cooperative osteosarcoma study group protocols. J Clin Oncol 2002; 20: 776-90.
• Marko TA, Diessner BJ, Spector LG. Prevalence of metastasis at diagnosis of osteosarcoma: an international comparison. Pediatr Blood Cancer 2016; 63: 1006-11.
• Kleinerman E. Maximum benefit of chemotherapy for osteosarcoma achieved-what are the next steps? Lancet Oncol 2016; 17: 1340-2.
• Meyers PA, Gorlick R. Osteosarcoma. Pediatr Clin North Am 1997; 44: 973-89.
• Simon MA, Aschliman MA, Thomas N, Mankin HJ. Limb-salvage treatment versus amputation for osteosarcoma of the distal end of the femur. J Bone Joint Surg Am 1986; 68: 1331-7.
• Stiller CA, Passmore SJ, Kroll ME, Brownbill PA, Wallis JC, Craft AW. Patterns of care and survival for patients aged under 40 years with bone sarcoma in Britain, 1980-1994. Br J Cancer 2006; 94: 22-9.
• Duchman KR, Gao Y, Miller BJ. Prognostic factors for survival in patients with high-grade osteosarcoma using the Surveillance, Epidemiology, and End Results (SEER) Program database. Cancer Epidemiol 2015; 39: 593-9.
• Yao W, Cai Q, Wang J, Gao S. Treatment of osteosarcoma around the knee in skeletally immature patients. Oncol Lett 2017; 14: 5241-8.
• Aponte-Tinao L, Ayerza MA, Muscolo DL, Farfalli GL. Survival, recurrence, and function after epiphyseal preservation and allograft reconstruction in osteosarcoma of the knee. Clin Orthop Relat Res 2015; 473: 1789-96.
• Balamuth NJ, Womer RB. Ewing’s sarcoma. Lancet Oncol 2010; 11: 184-92.
• Gaspar N, Hawkins DS, Dirksen U, et al. Ewing Sarcoma: Current Management and Future Approaches Through Collaboration. J Clin Oncol 2015; 33: 3036-46.
• Andrade Neto F, Teixeira MJ, Araújo LH, Ponte CE. Knee bone tumors: findings on conventional radiology. Radiol Bras 2016; 49: 182-9.
• Bernstein ML, Devidas M, Lafreniere D, et al. Intensive therapy with growth factor support for patients with Ewing tumor metastatic at diagnosis: Pediatric Oncology Group/Children’s Cancer Group Phase II Study 9457--a report from the Children’s Oncology Group. J Clin Oncol 2006; 24: 152-9.
• Leavey PJ, Mascarenhas L, Marina N, et al. Prognostic factors for patients with Ewing sarcoma (EWS) at first recurrence following multi-modality therapy: A report from the Children’s Oncology Group. Pediatr Blood Cancer 2008; 51: 334-8.
• Coleman RE. Metastatic bone disease: clinical features, pathophysiology and treatment strategies. Cancer Treat Rev 2001; 27: 165-76.
• Selvaggi G, Scagliotti GV. Management of bone metastases in cancer: a review. Crit Rev Oncol Hematol 2005; 56: 365-78.