American Oncology Institute – a Center for precision Cancer Care, performed a complex ‘Total Femur replacement of Enneking Stage IIB Osteosarcoma femur‘ on a patient from Bangladesh. Specialists led by Dr. Kishore B. Reddy, Musculoskeletal Oncosurgeon, American Oncology Institute (AOI); performed the surgery on a 25 year old male patient presented with a massive swelling and excruciating pain in the left thigh, while he was enduring the trauma for over ten months. He has since recovered fully, able to stand on his feet, walk without support and is set to go back to his country. Also present at the press conference were Dr M. Ravikiran, Facility Director & Medical Superintendent, AOI; Dr Sanjay, Anesthetist, AOI; Dr Raghu, Plastic Surgeon, AOI and patient’s father Mr Abulhassan.
The patient Mr. Sunaullah, serving in the police department in Dhaka, Bangladesh, was suffering from Bone Cancer called Osteosarcoma, though a very rare, but most common type of bone cancer. The incidence of osteosarcoma is three cases per million, each year. Osteosarcoma is usually found at the end of long bones, often around the knee joint, though occasionally seen manifesting around hip and arms. Osteosarcomas are usually high grade tumors that require an aggressive treatment regimen. It is a life threatening condition, as the tumor can spread rapidly to other organs if not treated in the early stages of disease. Patients who land up in stage 4 tend to have a life span of few months. The cause is unknown, but generally thought to be due to radiation exposure, genetic inheritance or mutation. Currently there is no prevention strategy or prophylactic treatment available for this condition. Patient may generally present with an history of trauma or fall. From the day of onset of symptoms the swelling will increase at relatively rapid pace and pain increases progressively. In some instances there could be injury or splitting of the bone. Patients tend to stop working or going to school because of the unbearable pain. Within few weeks their daily routine is affected, leading to a sense of depression and declining hope of getting back to normality.
For Mr. Sunaullah, it all began with a minor swelling in the knee area, which despite seeking medical attention saw a gradual progression and increasing pain. In due course it impacted his daily routine and reached a stage of immobility, with he being in bedridden for over three months. Simultaneously the condition led to he losing appetite and rapid weight loss. As the problem started becoming acute, he approached specialists and tertiary care hospitals in his country, with little respite. One of the reputed hospitals he approached in Bangladesh, prior to coming here, started him on chemotherapy. He was suggested amputation from hip. On the recommendation of some senior specialists in Bangladesh, for better care, he approached American Oncology Institute, as a last resort on 15th December, 2019 for limb salvage surgery.
We had a dual challenge, the primary being to save his life from the advanced stage of cancer, which seemed possible by simply amputating his limb. But the patient being young, our quest was also to salvage the limb and ensure he leads a qualitative life post-treatment, this is what led us to opt for a complex and arduous Total Femur replacement surgery. The advanced stage of the ailment compounded the effort and made things difficult, but with dexterity and finesse we could accomplish what we aimed for, says an elated Dr. Kishore B. Reddy. The tumor is massive, one of the biggest I have seen, weighing 10 kgs. The patient was able to walk within 3 days of surgery. He can walk like a normal person without crutches after six weeks.
When he came to us, the disease was in an advanced Stage IIB, where the tumor cells are of higher grade and have spread beyond the bone. Into the surrounding muscles and soft tissue. The obvious option would have been amputation of the limb to prevent the risk of cancer spreading to other parts of the body and proving fatal to him in due course. Dr. Kishore B Reddy and his team are experts in dealing with such cases. Wanted to explore an alternative treatment by which they could salvage the limb to the extent possible and thereby restore the quality of life, as the patient is young. The Doctors finally decided to replace the patient’s femur with a femora prosthetic implant. It took the experts team 6 hours to remove the 10kgs thigh bone tumor and reconstruct with total femur prosthesis, the patient after being in ICU for two days, was put on a intensive physiotherapy and rehabilitation program for 15 days. The physiotherapy and rehabilitation will have to be continued in his hometown under the guidance of our physiotherapists, before he completely recovers. He also needs to visit American Oncology Institute in future too at regular intervals for review and assessment for any relapse of the tumor. There are chances of developing tumors in the lungs or other bones, but tumor relapsing in the same location is ruled out. The chances of relapse is 10% in the next two years and post which 1% in the next five years, after that there is no scope of he getting a tumor.