Nashik, Aug 27: For eight–year–old Sumit from Surat, playing with friends and enjoying a carefree childhood suddenly came to a standstill when he began experiencing pain and difficulty while walking. The routine complaint soon led to a devastating diagnosis – osteogenic sarcoma, a rare and aggressive bone cancer. Investigations revealed a tumour in the bone around the knee, which had also extended beyond the bone into the surrounding soft tissues. The diagnosis meant that the young boy faced not only a prolonged cancer treatment journey but also the possibility of losing his leg. After undergoing four cycles of chemotherapy at a renowned hospital in Mumbai, the family was advised to consider amputation of the affected leg from above the knee. For his parents, the prospect of seeing their child lose his leg was heart-breaking.
Determined to explore every possible option, they sought a second opinion at HCG Manavata Cancer Centre (HCGMCC) – Nashik, a decision that would change their lives. Here, Dr Raj Nagarkar – Chief of Surgical Oncology and Robotic Services carefully reviewed Sumit’s medical reports, comparing his older PET-CT and MRI scans with new ones. Remarkably, after four cycles of chemotherapy, the tumour had shrunk significantly and its Standardized Uptake Value (SUV), a measure of cancer activity had dropped to zero, indicating a complete metabolic response to chemotherapy.
“When the family came to us, the child was smiling, a beautiful smile that masked the storm within. After reviewing his scans, we found that the cancer appeared to be metabolically inactive. I told the parents that we will try our best to save your child’s leg. That glimmer of hope was all they needed,” says Prof Dr Raj Nagarkar, Chief of Surgical Oncology & Robotic Services and Managing Director, KIMS Manavata Hospitals, HCG Manavata Cancer Centre and Six Sigma, Nashik.
The Multidisciplinary team discussed the case and concluded that surgery was essential. However, instead of proceeding directly to amputation, the doctors decided to attempt a limb-sparing procedure, with the final decision to preserve the leg dependent on intraoperative assessment of whether any viable cancer cells remained.
“For Sumit’s parents, the possibility of amputation was extremely difficult to accept and we wanted to explore whether there was a medically sound way to preserve his leg. His scans showed an excellent response to chemotherapy, but we could not make the final decision based on imaging alone. We therefore planned the surgery in such a way that we could assess the tumour and the surrounding bone during the procedure and decide whether limb preservation was safe,” adds Dr Nagarkar.
During surgery, the affected portion of the bone was removed and immediately sent to the pathology team for rapid intraoperative assessment. Within approximately 15 to 20 minutes, the team confirmed that no viable cancer cells remained in the sampled tissue. With this critical confirmation, the doctors proceeded with limb preservation rather than amputation. The affected bone was further prepared and subjected to high dose radiation in the radiation department to eliminate any microscopic residual cancer cells. The treated bone was then returned to the operating theatre and reconstructed and fixed back into the child’s leg. The complex procedure lasted approximately four hours.
“Sumit’s recovery was remarkably swift. He was shifted to his room the following day and began walking with the support of a walker by the third day. He was discharged shortly thereafter and continues to undergo the remaining stages of his cancer treatment. The final pathology report gave us further reassurance indicating the tumour had shown a complete response to the first five cycles of chemotherapy, confirming that the decision to attempt limb preservation had been appropriate. At HCG Manavata Cancer Centre, our focus is not only on treating cancer but also on preserving and improving each patient’s quality of life,” adds Dr Nagarkar.
For Sumit and his family, the outcome has meant much more than avoiding an amputation. It has given the young boy the opportunity to look ahead to a future where he can once again run, play and grow up with greater independence. He is currently undergoing continued treatment and physiotherapy and with appropriate rehabilitation, the child may gradually regain the ability to walk over the coming year.
“In paediatric cancer, every decision has consequences that extend far beyond the treatment itself. For an eight–year–old, preserving a limb can mean preserving independence, mobility and the ability to return to school, play and everyday life. This was a carefully planned decision based on the child’s response to chemotherapy, intraoperative pathology and the expertise of a multidisciplinary team. While not every child with bone cancer will be a candidate for limb-sparing surgery, cases like Sumit’s demonstrate why a detailed evaluation and an expert second opinion can sometimes open up possibilities that families may not have considered,” concludes Dr Nagarkar.