Local control of extra-abdominal desmoid tumors: systematic review and meta-analysis.

The local control of desmoid tumors constitutes a continuing treatment dilemma due to its high recurrence rates. The purpose of this systematic review was to critically examine the current treatment of these rare tumors and to specifically evaluate the local failure and response rates of surgery, radiation and systemic therapy. We comprehensively searched the literature for relevant studies across Cinahl, Embase, Medline and the Cochrane databases. Articles were categorized as surgery, radiation, surgery + radiation and systemic therapy (including cytotoxic and non cytotoxic). Methodological quality of included studies was assessed using the Newcastle-Ottawa Scale. Pooled odd ratios (OR) for comparative studies and weighted proportions with 95% confidence intervals (CI) are reported. Thirty-five articles were included in the final analysis. Weighted mean local failure rates were 22% [95% CI (16-28%)], 35% [95% CI (26-44%)] and 28% [95% CI (18-39%)] for radiation alone, surgery alone and surgery + radiation respectively. In the analysis of comparative studies, surgery and radiation in combination had lower local failure rates than radiation alone [OR 0.7 (0.4, 1.2)] and surgery alone [OR 0.7 (0.4, 1.0)]. Weighted mean stable disease rates were 91% [95% CI (85-96%)] and 52% [95% CI (38-65%)] for non cytotoxic and cytotoxic chemotherapy respectively. The current evidence suggests that surgery alone has a consistently high rate of local recurrence in managing extra-abdominal desmoid tumors. Radiation therapy in combination with surgery improves local control rates. However, the limited data on systemic therapy for this rare tumor suggests the benefit of using both cytotoxic and non cytotoxic chemotherapy to achieve stable disease.

Synovial chondromatosis of the shoulder: open synovectomy and insertion of osteoarticular allogaft with internal fixation to repair intraoperative glenohumeral joint instability.

Synovial chondromatosis is a rare benign disorder characterized by chondroid metaplasia with multinodular proliferation of the synovial lining of a diarthroidal joint, bursa, or tendon sheath. These cartilaginous nodules may become embedded within the proliferating synovium and may extend into the surrounding soft tissues. They also can detach from the synovium, where they can calcify and may present as intra-articular loose bodies. Presence of these nodules leads to joint pain, dysfunction, and ultimately, destruction. Clinically, patients often present with a chronic monoarthropathy. In this article, we report a case of extensive synovial chondromatosis of the right shoulder and surrounding soft tissues with extensive erosion of the humeral head, discuss combined anterior and posterior surgical excision of the cartilaginous fragments, and describe insertion of an osteoarticular allograft to repair the humeral head defect and secondary anterior glenohumeral joint instability.

A systematic review and meta-analysis of intralesional versus wide resection for intramedullary grade I chondrosarcoma of the extremities.

BACKGROUND: The surgical management of grade I intramedullary chondrosarcoma of bone remains controversial. The purpose of this study was to perform a systematic review and meta-analysis of published data to determine the oncologic outcomes of intralesional versus wide resection for grade I intramedullary chondrosarcoma. METHODS: Literature searches were performed through Medline, EMBASE, and the Cochrane Database. Cohort studies in which one patient group with grade I chondrosarcoma underwent wide resection and one underwent intralesional curettage were included. Two reviewers independently assessed all eligible papers with the Newcastle-Ottawa Quality Assessment Scale for Cohort Studies. The outcome measures were the pooled odds ratio and 95% confidence intervals for the risk of local recurrence and metastasis calculated through the random-effects method. RESULTS: Five eligible studies were identified including a total of 190 patients, 78 of whom underwent intralesional resection and 112 of whom underwent wide resection. Only one pelvic lesion was identified, which underwent wide resection. There were a total of five local recurrences and three metastases. The risk for local recurrence and metastasis did not differ significantly between the two groups, with an odds ratio for intralesional resection of 2.26 (95% confidence interval, 0.41-12.62) and 0.44 (95% confidence interval, 0.04-5.21) respectively. CONCLUSIONS: Intralesional curettage as an alternative to wide resection for extrapelvic grade I chondrosarcoma of bone does not greatly increase the risk for local recurrence or metastasis. Overall effect estimates, however, should be interpreted with caution as a result of the relatively small number of events.