Orthopedics - Oleksa A.P. 2006

Tumor-like lesions and bone tumors
Basic principles of tumor treatment

Patients with benign tumors are generally treated in orthopedic departments, whereas those with malignant tumors are managed in oncological dispensaries and institutes. Treatment modalities include surgery, Radiation therapy, and Chemotherapy. Surgery remains the primary treatment for both benign and malignant tumors.

Surgical treatment of Patients with Benign Tumors

Benign tumors are treated surgically on an elective basis. The Scope of the surgical intervention depends on the localization, nature, and size of the tumor. The oldest surgical technique is tumor excochleation using a Volkmann bone curette, which is indicated for localized benign tumors centrally situated within the bone. The resulting cavity is then packed with a pedicled Muscle flap or filled with a bone graft. Experience demonstrates that excochleation cannot be considered a radical Procedure, as it is frequently followed by recurrences and potential malignant transformation of the tumor process, particularly after the curettage of osteoblastoclastoma and chondroma foci. Therefore, for benign tumors, it is advisable to perform a radi-

cal operation, specifically bone resection within healthy tissue margins. If the tumor is superficially located, marginal resection is performed with the mandatory excision of a wide base within healthy bone (as seen in osteomas and osteochondromas). It is crucial to remove the osteochondroma along with its soft-tissue capsule, which should not be incised to maintain ablasticity.

For centrally located small-sized osteoblastoclastomas, radical surgery is achieved via marginal resection, whereas larger lesions require segmental bone resection. The resulting defect is filled with an autograft or allograft. Segmental resection without defect reconstruction is performed on the Fibula and Ribs. Given that in children osteoblastoclastoma does not invade the epiphyseal Cartilage, the procedure is performed extra-articularly, consistently yielding favorable anatomical and functional outcomes.

In cases of total destruction of the articular end of a bone in adults, it must be resected and replaced with an appropriately sized allograft (a "hemi-joint"), accompanied by the restoration of muscle attachment sites and ligamentoplasty, or through arthroplasty (endoprosthesis placement). Long-term outcomes of such surgeries remain entirely satisfactory, even many years later.

Surgical Treatment of Patients with Malignant Tumors

When selecting a treatment strategy for such patients, it is advisable to utilize the TNM staging system. Indications for surgery and the extent of the intervention depend on the tumor's nature (histological Structure), localization, and dissemination, as well as the status of regional Lymph Nodes. In the presence of distant metastases, surgical intervention is generally inappropriate.

In the Cytology/cytology/16.html">Early stages of a malignant tumor process, following angiographic identification of the feeding artery, closed transcatheter embolization is occasionally performed. Most commonly, limb-salvage (organ-preserving) surgeries are employed—such as radical bone resection combined with bone grafting or endoprosthetics—integrated into a multimodal protocol with radiotherapy and chemotherapy. For osteogenic sarcomas and chondrosarcomas, amputation or disarticulation is indicated. If these tumors are localized in the proximal Femur or pelvic bones, particularly in rapidly metastasizing lytic forms of osteosarcoma, surgical intervention is discouraged. Similarly, Ewing's Sarcoma and reticulosarcoma are not treated surgically, as they respond favorably to radiation therapy and cytostatic agents; consequently, amputation offers no advantage in cases of reticulosarcoma.

Pathological fractures of long bones frequently occur As a result of Cancer metastasis from other Organs (such as the prostate, Stomach, or breast). Bone healing cannot be expected in these situations; therefore, it is advisable to perform resection of the affected bone combined with intramedullary osteosynthesis and defect reconstruction using acrylic cement prepared intraoperatively, a custom endoprosthesis, or a tubular bone graft over a rod. Despite the poor overall prognosis, this approach enables patients to quickly regain mobility and walk with crutches.