An 8-year-old Master Ranjan (name changed) from Andhra Pradesh developed a sudden limp and unexplained pain in his right leg. Hoping that it would be some minor bone trauma-related pain, the parents along with Ranjan consulted experts at Manipal Hospital Vijayawada. At Manipal, they were confronted with a life-altering diagnosis of Ewing’s Sarcoma, a rare and aggressive bone cancer. The tumor had spread alarmingly, engulfing nearly 23 centimeters of his thigh bone, covering almost two-thirds of the bone.
Despite a devastating diagnosis, little Ranjan and his parents found hope in the hands of a collaborative team of experts spanning two premier Manipal Hospitals—Vijayawada and Old Airport Road, Bengaluru—who came together to not only save his life but also preserve his limb, functionality, and childhood.
A Personalised, High-Intensity Chemotherapy Plan
Ranjan’s treatment began with a meticulous chemotherapy protocol—a crucial treatment strategy in paediatric sarcoma management. A high intensity neoadjuvant VAC+IE regimen chemotherapy was initiated under the leadership of Dr. Krishna Reddy, Director of Oncology Services and HOD & Chief Consultant and Dr. Sravan Rao, Consultant – Medical Oncology and Bone Marrow Transplant Physician.
“Such high intensity regimen is generally not tolerated well by children. But Ranjan’s tumor required aggressive treatment. We administered 14 cycles over 9 months, each requiring precision in dosing, monitoring of organ function, nutritional support, and proactive management of side effects,” said Dr. Krishna Reddy. Emphasizing the complexities involved in managing the chemotherapy, Dr. Sravan Rao shared, “It wasn’t just about giving chemotherapy. It was about executing a plan that had no room for error. Every week, every test, every decision was calibrated with precision. Ranjan was monitored for any complications and the tumor response was constantly tracked.”
Such a meticulously planned, complex chemotherapy regimen was possible due to the Vijayawada oncology team’s decades of experience in handling complex cancer cases, including rare pediatric tumors. The hospital’s cancer care unit is recognized for its expertise in high-dose chemotherapy administration, comprehensive toxicity management, and multispecialty coordination, making it one of the few centers equipped to take on such a demanding protocol.
Ranjan responded remarkably well. By third month of chemotherapy, imaging showed significant regression of the tumor—setting the stage for the next critical step: limb salvage surgery.
Limb-Saving Surgery with Bone Recycling
The surgical plan was crafted by Dr. Srimanth B S, Lead Consultant – Orthopaedic Oncology, Manipal Hospital Old Airport Road, Bengaluru, in collaboration with the Orthopaedic team led by Dr. G V Reddy, Senior Consultant – Orthopaedics, at Manipal Hospital Vijayawada. At just 8 years, Ranjan had a lot of growth potential, and hence, for any treatment measures it was crucial to ensure the solution would support long-term limb function, allow for growth, and maintain structural integrity without compromising cancer control. “In orthopaedic oncology, our goal is always to preserve the limb without compromising on oncologic safety. In Ranjan’s case, the tumor was extensive, but with precise surgical margins and modern reconstruction, we could save his leg,” said Dr. Srimanth B S
Considering the location and size of the tumor, conventional implants weren’t ideal for a growing child. That’s when the multidisciplinary team opted for an advanced and rare approach—limb recycling using the patient’s own bone, a process known as bone recycling or extracorporeal irradiation. “During the surgery, the tumor-bearing segment of the femur was resected, irradiated outside the body to eliminate microscopic cancer cells, and reimplanted. This advanced method allows us reduce the need for foreign implants and improving compatibility,” said Dr. Ramakrishna Vangara, Consultant – Radiation Oncologist at Manipal Hospital Vijayawada.
The irradiated bone was then re-implanted with millimetre precision due to application of implants generated from 3D imaging and printing technology, ensuring perfect alignment and structural integrity. The surgery, while executed locally, was planned with inputs from Bengaluru—showcasing Manipal Hospitals’ ability to bridge geographic boundaries through shared expertise, digital integration, and a unified vision for patient-centric care.
One Story Among Many
Ranjan’s journey mirrors countless others at Manipal Hospital Vijayawada. Among the other patients are 18-year-old Ms. Shravani (name changed), who received treatment funded by hospital grants, and others like 71-year-old Mr. Rajashekar Rao (name changed), 34-year-old Mr. Balaji Rao (Name changed), 52-year-old Mr. Prakash Babu (Name changed), and 10-year-old Shreeharsha (name changed)—each with a distinct cancer journey, have received personalised multidisciplinary care at Manipal Hospital Vijayawada. “True cancer care involves more than just medicine; it requires access, empathy, and collaboration. By means of philanthropic grants and a commitment from institutions, we’ve made sure that patients like Shravani don’t suffer due to financial limitations. When clinical expertise, infrastructure, and funding converge, outcomes improve,” stated Dr. V Dharmendra Kumar, HOD and Chief Consultant – Surgical Oncologist at Manipal Hospital Vijayawada.
The strategic partnership between Manipal Hospital Old Airport Road in Bengaluru and the Vijayawada unit, which began in 2024, has enabled Manipal Hospital Vijayawada to provide advanced orthopaedic oncology services. As a result, intricate sarcomas in both adults and children can be managed at the Vijayawada facility, which has become a regional referral centre for uncommon soft tissue and bone cancers—conditions that usually necessitate treatment at specialized cancer institutes.
By establishing a genuinely interconnected network that delivers top-notch cancer treatment to cities such as Vijayawada, Manipal Hospitals is reshaping patient-centered healthcare. By integrating advanced surgical and radiation oncology with inter-state clinical expertise and a compassionate approach, Manipal is bridging the gap between accessibility and excellence.