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Management of musculoskeletal tumours of the extremity in low-resource settings

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Abstract

Background

Management of extremity tumor is particularly challenging in low-resource settings where patients are often referred with late presentations. First, diagnostic means are limited, with CT scan, MRI, and pathology usually not being available. Limitations are also related to therapeutic means, as the absence of adjuvant therapy (chemotherapy and radiotherapy) may preclude any improvement in overall survival despite a curative surgical treatment.

Objective

The authors suggest a kind of “toolbox” combining a diagnostic guide, based on clinical examination and X-rays, and therapeutic advice adapted to this context of care. The objective is to help the surgeon to better categorize the tumor to decide whether or not to operate or act in a relevant way.

Conclusion

The authors do not aim to provide recommendations but rather an inventory of what the isolated surgeon should know to decide on the best treatment strategy which, however, can only be symptomatic.

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References

  1. Lozano Calderón SA, Raskin KA, Hornicek F, Schwab JH (2015) What’s new in orthopaedic oncology. J Bone Joint Surg Am 97:2061–2067. https://doi.org/10.2106/JBJS.O.01015

    Article  PubMed  Google Scholar 

  2. Lewin J, Puri A, Quek R et al (2013) Management of sarcoma in the Asia-Pacific region: resource-stratified guidelines. Lancet Oncol 14:e562–e570. https://doi.org/10.1016/S1470-2045(13)70475-3

    Article  PubMed  Google Scholar 

  3. Siegel GW, Biermann JS, Chugh R et al (2015) The multidisciplinary management of bone and soft tissue sarcoma: an essential organizational framework. J Multidiscip Healthc 8:109–115. https://doi.org/10.2147/JMDH.S49805

    Article  PubMed  PubMed Central  Google Scholar 

  4. Choi K-Y, Jost E, Mack L, Bouchard-Fortier A (2020) Surgical management of truncal and extremities atypical lipomatous tumors/well-differentiated liposarcoma: a systematic review of the literature. Am J Surg. https://doi.org/10.1016/j.amjsurg.2020.01.046

    Article  PubMed  Google Scholar 

  5. Marcove R, Miké V, Hajek J et al (1970) Osteogenic sarcoma under the age of twenty-one. A review of one hundred and forty-five operative cases. J Bone Jt Surg Am 52:411–423

    Article  CAS  Google Scholar 

  6. Aina OJ, Adelusola KA, Orimolade AE, Akinmade A (2018) Histopathological pattern of primary bone tumours and tumour-like lesions in Ile-Ife Nigeria. Pan Afr Med J 29:193. https://doi.org/10.11604/pamj.2018.29.193.13111

    Article  PubMed  PubMed Central  Google Scholar 

  7. Odetayo OO (2001) Pattern of bone tumours at the National Orthopaedic Hospital, Lagos, Nigeria. West Afr J Med 20:161–164

    CAS  PubMed  Google Scholar 

  8. Omololu A, Ogunbiyi J, Ogunlade S et al (2004) Primary malignant bone tumour in a tropical African University Teaching Hospital. West Afr J Med 21:291–293. https://doi.org/10.4314/wajm.v21i4.28001

    Article  Google Scholar 

  9. Mohammed A, Isa H (2007) Pattern of primary tumours and tumour-like lesions of bone in Zaria, Northern Nigeria: a review of 127 cases. West Afr J Med 26:37–41

    CAS  PubMed  Google Scholar 

  10. Obalum D, Giwa S, Banjo AF, Akinsulire A (2009) Primary bone tumours Iin a tertiary hospital in Nigeria: 25 years review. Niger J ofClinical Pract 12:169–172. https://doi.org/10.1007/s00264-007

    Article  CAS  Google Scholar 

  11. Bahebeck J, Atangana R, Eyenga V et al (2003) Bone tumours in Cameroon: incidence, demography and histopathology. Int Orthop 27:315–317. https://doi.org/10.1007/s00264-003-0480-7

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  12. Eyesan SU, Obalum DC, Nnodu OE et al (2009) Challenges in the diagnosis and management of musculoskeletal tumours in Nigeria. Int Orthop 33:211–213. https://doi.org/10.1007/s00264-007-0475-x

    Article  CAS  PubMed  Google Scholar 

  13. Larsson S-E, Lorentzon R (1974) The incidence of malignant primary bone tumours in relation to age, sex and site. J Bone Joint Surg Br 56-B:534–540. https://doi.org/10.1302/0301-620X.56B3.534

  14. Damron TA, Ward WG, Stewart A (2007) Osteosarcoma, chondrosarcoma, and Ewing’s sarcoma. Clin Orthop Relat Res 459:40–47. https://doi.org/10.1097/BLO.0b013e318059b8c9

    Article  PubMed  Google Scholar 

  15. Kotz RI (2014) Progress in musculoskeletal oncology from 1922–2012. Int Orthop 38:1113–1122. https://doi.org/10.1007/s00264-014-2315-0

    Article  PubMed  PubMed Central  Google Scholar 

  16. Enneking WF, Spanier SS, Goodman MA A system for the surgical staging of musculoskeletal sarcoma.

  17. Lex JR, Gregory J, Allen C et al (2019) Distinguishing bone and soft tissue infections mimicking sarcomas requires multimodal multidisciplinary team assessment. Ann R Coll Surg Engl 101:405–410. https://doi.org/10.1308/rcsann.2019.0040

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  18. Umer HM, Umer M, Qadir I et al (2013) Impact of unplanned excision on prognosis of patients with extremity soft tissue sarcoma. Sarcoma 2013:498604. https://doi.org/10.1155/2013/498604

    Article  PubMed  PubMed Central  Google Scholar 

  19. Tedesco NS, Henshaw RM (2016) Unplanned resection of sarcoma. J Am Acad Orthop Surg 24:150–159. https://doi.org/10.5435/JAAOS-D-15-00074

    Article  PubMed  Google Scholar 

  20. Sawamura C, Matsumoto S, Shimoji T et al (2012) What are risk factors for local recurrence of deep high-grade soft-tissue sarcomas? Clin Orthop Relat Res 470:700–705. https://doi.org/10.1007/s11999-011-2017-5

    Article  PubMed  Google Scholar 

  21. Rath B, Hardes J, Tingart M et al (2019) Resektionsgrenzen bei Weichteilsarkomen. Orthopade 48:768–775. https://doi.org/10.1007/s00132-019-03795-6

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Clinic of Orthopedics, Traumatology and Reconstructive Surgery, Percy Military Teaching Hospital, 92140, Clamart, France

    Nicolas de l’Escalopier & Laurent Mathieu

  2. Orthopedic Department, Cochin Hospital, AP-HP, 75014, Paris, France

    Nicolas de l’Escalopier, Philippe Anract & David Biau

  3. French Military Health Service Academy, Ecole du Val-de-Grâce, 75005, Paris, France

    Laurent Mathieu

Authors
  1. Nicolas de l’Escalopier
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  2. Laurent Mathieu
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  3. Philippe Anract
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  4. David Biau
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Contributions

Nicolas de l'Escalopier: Writing, submission of the article.

Laurent Mathieu: Conception, writing and correction.

Philippe Anract: Conception, writing, correction.

David Biau: Conception, writing, and correction.

Corresponding author

Correspondence to Nicolas de l’Escalopier.

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The authors declare that they have no conflicts of interest regarding the data presented in this article. The authors state that these are their ideas and do not reflect the official position of the French Military Health Services.

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de l’Escalopier, N., Mathieu, L., Anract, P. et al. Management of musculoskeletal tumours of the extremity in low-resource settings. International Orthopaedics (SICOT) 46, 371–379 (2022). https://doi.org/10.1007/s00264-021-05207-x

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