Case Study: Osteosarcoma and Limb Salvage Surgery

A collapsed lung led to a shocking diagnosis for 16-year-old Connor: What he thought was sports-related swelling in his thigh was actually a malignant bone tumor. He underwent chemotherapy and then surgery to replace a section of his femur and the knee joint with a metal prosthesis. Immediately after recovering from the surgery, he started physical therapy. “He works his tail off,” says his father, Matt, making for a rehabilitation journey that his surgeon calls “spectacular.”

Connor is an outstanding high school athlete, both the quarterback of his football team and — his true passion — pitcher for the baseball team. While warming up for a football game, his lung suddenly collapsed, leaving him gasping for breath. At a local hospital, Connor mentioned pain and swelling in his right thigh that he had not previously told his parents or coaches about. “He hadn’t complained about the leg at all,” says Matt. “He had played in a football game the week before and was warming up for another game.”

Doctors inserted a chest tube and X-rayed the leg, which revealed a large mass. Connor was immediately transported to Children's Hospital of Philadelphia (CHOP).

Two #1 ranked programs collaborate on a treatment plan

At CHOP, an Emergency Department doctor was waiting for the family, and Connor was admitted. He was seen by Rochelle Bagatell, MD, a pediatric oncologist specializing in solid tumors, and Alexandre Arkader, MD, an attending surgeon in the Division of Orthopaedics and Division of Oncology specializing in the treatment of bone and soft tissue tumors. CHOP’s orthopaedics and oncology programs are both ranked #1 pediatric specialty programs in the nation by U.S. News & World Report and have exceptional experience collaborating on cases like Connor’s.

Bone tumors can look like simple swelling caused by muscle bruising. “The tumors start at the bone but rapidly grow around the bone and form a soft tissue mass, so most patients describe it as swelling,” says Arkader. “But it’s actually the tumor increasing the limb circumference.”

Bagatell and Arkader immediately suspected osteosarcoma, a rare and aggressive form of bone cancer. A minimally invasive biopsy performed by CHOP’s Interventional Radiology team quickly confirmed the diagnosis. Because of the collapsed lung and also to check whether the cancer had spread to other parts of his body, Connor had chest imaging that unfortunately showed the cancer had traveled to his lungs. A PET scan showed the cancer had not spread anywhere else.

Connor was started on 10 weeks of what Bagatell calls “a very toxic and difficult regiment” of chemotherapy, but he handled it remarkably well, says Matt: “For a day or two he’d feel lousy, but then he’d rebound.”

The next step was limb salvage surgery. Arkader removed he tumor and about 40% of Connor’s femur, and reconstructed the bone and knee joint using a metal prosthesis.

Matt finds it difficult to explain how it felt to see his son be diagnosed and treated for cancer: “You don’t know how to respond or react.” But he’s in awe of how his son handled the ordeal: “He’s showed so much resilience and toughness.”

Connor’s optimism about his future was given a major boost when his high school football coach arranged for a phone call between Connor and Casey O’Brien, a University of Minnesota placeholder who was diagnosed with osteosarcoma in his left femur at 13 and underwent the same surgery as Connor did.

A ‘most remarkable’ recovery after chemo and surgery

Shortly after recovering from surgery, Connor began the remainder of his chemotherapy regiment and simultaneously started physical therapy. “He was so committed to his rehab,” says Bagatell.

Arkader is effusive in his praise: “The spectacular part is his recovery — one of the most remarkable I’ve ever seen in terms of speed, determination and dedication.”

The family has similar praise when talking about the care Connor received: “Our CHOP experience has been phenomenal,” says Matt.

Connor continues to be monitored for evidence of cancer, and a scan a few months after the leg surgery detected two cancerous lung nodules that needed to be surgically removed. But nine months after undergoing limb salvage, he is participating in non-contact football practices and going for runs. The lung surgery has limited his throwing abilities for the time being, but he’s determined to play baseball in college. “He’s never once wavered,” says Matt.