Pediatric Bone Sarcomas: Epiphysiolysis before excision

Sparing of the growth plate is an early feature of diaphyseal and meta-diaphyseal osteosarcoma. Capitalising on this characteristic, Jose Canadell has developed an innovative technique to preserve the epiphysis while resecting primary bone malignancies lying adjacent to the growth plate of skeletally immature patients. Using external ? xation devices, controlled distraction of the epiphysis from the growth plate permits iatrogenic separation of the epiphysis from the affected region. Subsequent resection is enhanced by a safe distal margin and Canadell's local control rates attest to the success of the procedure as an oncologically sound technique. The Canadell technique has been developed through rigorous examination of the behaviour of osteosarcoma, as well as an interrogation of the best modalities for assessing tumour invasion of the growth plate. Combining an innovative treatment philosophy with a sound knowledge of the behaviour of osteosarcoma and basic bone and growth plate biology, as well as an extensive experience with ancillary investigations and adjuvant therapies, Canadell has developed a robust surgical technique for the management of a challenging tumour in selected patients. This book is the culmination of Canadell's endeavours over the last two decades. It traces the steps that he has taken to validate the safety and ef? cacy of the Canadell technique as we know it today.