A multidisciplinary team of 14–16 super-specialists at HCG Cancer Centre, Bangalore, combined their expertise to save a 28-day-old baby girl battling Infantile Fibrosarcoma, one of the rarest soft-tissue cancers seen in newborns.
The baby was born with a small swelling on her right forearm that grew alarmingly within days into a massive tumour measuring 11.3 cm × 9.8 cm, engulfing her tiny forearm and hand. Multiple hospitals where she was evaluated recommended amputation as the only option, leaving her parents devastated.
At HCG Cancer Centre, Bangalore, however, a multidisciplinary team of 14–16 super-specialists, supported by engineers and advanced surgical planning technologies, came together to deliver a life-saving, limb-preserving treatment valued at around Rs 30–35 lakh.
As the family struggled to afford the treatment, the hospital led a fundraising initiative, with friends, well-wishers, and the HCG team contributing funds and support.
How the HCG team saved the child
According to HCG, the baby was brought to the hospital in a critical condition, with low haemoglobin, functional compromise of the limb and a rapidly growing fungating mass.
Dr Pramod S Chinder, Director and Head – Orthopaedic Oncology, HCG Cancer Centre, along with Dr Sunil Kumar H R, HOD Anaesthetist, and the plastic and reconstructive surgery team, conducted a detailed assessment. The tumour was found to surround major blood vessels and nerves, making the limb extremely fragile and the surgery exceptionally high-risk.
Genomic testing revealed an NTRK gene fusion, a rare genetic alteration that drives the rapid growth of cancer, with an incidence of just 0.3 per 100,000 population.
Given the complexity and rarity of the case, the HCG team consulted and discussed the treatment strategy with internationally renowned orthopaedic oncology experts, Dr Marco Manfrini and Dr Laura Campanacci, distinguished International Faculty from the Rizzoli Orthopaedic Institute, Italy. Their expert inputs helped validate the limb-salvage strategy and staged surgical approach, reinforcing confidence in pursuing a function-preserving plan for the neonate.
Step-by-step treatment
Given the baby’s fragile physiology and the tumour’s extreme vascularity, the treatment was planned as a multi-stage approach over one week, ensuring maximum safety at every step.
The process began with a critical preparatory step led by Dr Indu Shekar, Interventional Radiologist, who performed super-selective embolisation by guiding micro-catheters through the newborn’s tiny vessels to block the tumour’s blood supply. This prevented catastrophic bleeding and made the subsequent surgery significantly safer.
At the same time, Dr Kumar developed and executed a highly specialised neonatal anaesthesia protocol. Managing a critically ill neonate during prolonged surgery required meticulous micro-dosing, strict thermoregulation and continuous haemodynamic monitoring, making it one of the most challenging aspects of the procedure.
Dr Chinder then led a 7–8-hour high-precision tumour resection. Because the newborn’s blood vessels and nerves were microscopic in size, the surgery demanded ultra-fine dissection supported by 3D-printed planning models developed by The Purple Spark Bioengineering, Digital Twin technology, and specialised micro-instruments. This enabled complete tumour removal while preserving critical anatomical structures.
The surgical team also used Digital Twin technology to create a three-dimensional virtual reconstruction of the baby’s anatomy using MRI and CT imaging. This allowed surgeons to visualise the tumour and surrounding structures in detail before surgery, facilitating meticulous planning and minimising intraoperative surprises.
Two days later, the plastic and reconstructive surgery team performed what is believed to be one of the youngest microvascular free flap surgeries ever reported worldwide. A small flap of tissue from the baby’s thigh was transplanted to the right forearm, followed by microvascular anastomosis to restore blood flow and preserve long-term hand function. Careful postoperative wound management and close monitoring ensured gradual healing.
Following surgery, the baby was started on a child-safe dose of Entrectinib, an NTRK-targeted inhibitor, to reduce the risk of recurrence.
Now, nearly 18 months after surgery, the child has retained full use of her limb, continues to gain strength, shows no signs of recurrence, and is growing like any healthy child.
Expert Comments
Dr Chinder said, “To encounter Infantile Fibrosarcoma, an aggressive tumour covering the right forearm and half the hand in a 28-day-old infant, is to face a battle for life itself. This was a race against time and extreme tissue fragility, where only a multidisciplinary approach and molecular precision could prevail.”
“The rapid genomic diagnosis, pinpointing the critical NTRK gene fusion, was our turning point. It empowered us to execute a meticulous, multi-staged surgical plan not just to save her life, but to preserve the future function of her hand.”
He also acknowledged Dr Sunil Kumar’s expertise in managing the physiological fragility of the 28-day-old patient, ensuring haemodynamic stability and continuous, nuanced support throughout the high-risk surgery.
“This victory is a profound testament to medical innovation, turning despair into a miracle of hope,” Dr Chinder added.
Manisha Kumar, COO, Karnataka, HCG Cancer Hospitals, said, “This journey is a testament to what can be achieved through innovation, collaboration, and compassion.”
Nearly 300–400 individuals came together to support the family through contributions from The Yellow Ribbon (Orthopaedic Oncology Unit), HCG Foundation, AaroCare Foundation, Milap crowdfunding, doctors, hospital staff, friends, well-wishers and even around 10 students who donated nearly Rs 20,000 from their personal savings.
The baby’s parents said, “When we were told that our baby’s arm might have to be amputated, we felt completely helpless. Today, seeing her move her fingers and grow like any other child is nothing short of a miracle.”
