RESUMO
BACKGROUND: Outcomes of unplanned excisions of extremity soft tissue sarcomas (STSE) range from poor to even superior compared with planned excisions in developed countries. However, little is known regarding outcomes in low-to-middle-income countries. This study aimed to determine whether definitively treated STSE patients with a previous unplanned excision have poorer oncologic outcomes compared with those with planned excisions. PATIENTS AND METHODS: Using the database of a single sarcoma practice, we reviewed 148 patients with STSE managed with definitive surgery-78 with previous unplanned excisions (UE) and 70 with planned excisions (PE). RESULTS: Median follow-up was 4.4 years. UE patients had more surgeries overall and plastic reconstructions (P < 0.001). On multivariate analysis, overall survival (OS), local recurrence-free survival (LRFS), and distant metastasis-free survival (DMFS) were not worse among UE patients compared with PE patients. Negative predictors for LRFS were high tumor grade (P = 0.031) and an R1 surgical margin (P < 0.001). High grade (P <0.001), local recurrence (P = 0.001), and planned excisions (P = 0.009) predicted poorer DMFS, while age over 65 years (P = 0.011) and distant metastasis predicted poorer OS (P < 0.001). CONCLUSIONS: We recommend systematic re-excision for patients with unplanned excisions. Our study shows that STSE patients with UE, when subjected to re-excision with appropriate surgical margins, can achieve oncologic results similar to those for PE patients. However, there is an associated increased number of surgeries and plastic reconstruction for UE patients. This underscores the need, especially in a resource-limited setting, for education and collaborative policies to raise awareness about STSE among patients and physicians.
Assuntos
Sarcoma , Neoplasias de Tecidos Moles , Humanos , Idoso , Resultado do Tratamento , Estudos Retrospectivos , Extremidades/cirurgia , Extremidades/patologia , Reoperação , Sarcoma/patologia , Neoplasias de Tecidos Moles/patologia , Margens de Excisão , Recidiva Local de Neoplasia/cirurgia , Recidiva Local de Neoplasia/patologiaRESUMO
Background The use of the fibula autograft has been a reliable method in the reconstruction of long bone defects after tumor resection. The objective of this study was to report the outcomes fibular grafting in terms of graft union, functional score, complications, and oncologic outcome. Methods A retrospective review of patients with fibular grafting after tumor resection was done from January 1, 1993 to December 31, 2013. The primary outcome was graft union and the revised musculoskeletal tumor society scoring system (MSTS score). The secondary outcomes were oncologic outcomes, complications, and the factors associated with graft union. Results A total of 52 patients with a mean follow-up of 42 months (SD, 33; range, 12-132 months) were included. The overall union for all fibular grafts was 37 of 52. The use of vascularized free fibula flaps had a higher union rate compared with nonvascularized fibula grafts. The use of a vascularized free fibular flap was four times likely to unite (95% CI 1.1-12.8, p = 0.039) compared with nonvascularized fibular grafts. The mean MSTS score in 36 patients was 82.5 (SD, 12.9) at 35 months from surgery (SD, 30). A total of 39 complications were present in 29 patients. On final follow-up, 45 of 52 patients were alive, six patients had died of disease and one died of other causes. Conclusion A higher union rate was achieved using vascularized free fibular flaps compared with nonvascularized fibular grafts for long bone reconstruction after tumor resection. There was no difference in terms of MSTS score between the two types of grafts.
Assuntos
Neoplasias Ósseas/cirurgia , Ossos da Extremidade Inferior/patologia , Ossos da Extremidade Superior/patologia , Fíbula/transplante , Retalhos de Tecido Biológico/irrigação sanguínea , Osteossarcoma/cirurgia , Procedimentos de Cirurgia Plástica , Neoplasias Ósseas/fisiopatologia , Transplante Ósseo/métodos , Ossos da Extremidade Inferior/cirurgia , Ossos da Extremidade Superior/cirurgia , Feminino , Seguimentos , Humanos , Masculino , Osteossarcoma/fisiopatologia , Procedimentos de Cirurgia Plástica/métodos , Estudos Retrospectivos , Resultado do Tratamento , Adulto JovemRESUMO
BACKGROUND: Recent studies have suggested that the presence of a pathological fracture does not impact on oncologic outcomes and the feasibility of limb salvage surgery (LSS) in appropriately selected patients when combined with neoadjuvant chemotherapy. These have largely been single institutional studies with limited numbers. The Eastern Asian Musculoskeletal Oncology Group reviewed the data from three large volume Asian orthopedic oncology centers to determine whether the presence of a pathologic fracture affected outcomes in osteosarcoma patients. METHODS: A retrospective review of the data was conducted. Ninety-five cases of nonmetastatic extremity osteosarcoma with a pathological fracture and 887 cases without fracture treated during the same period were compared. RESULTS: In the fracture group, the LSS rate was 62.1%, and the rate of amputation was 37.9%. In the nonfracture group, the LSS rate was 74.7%, and the amputation was 25.3%. In patients with a pathologic fracture, the rate of local recurrence for LSS and amputation groups was 8.5% and 2.8%, respectively. In this group, the 5-year survival in the LSS group was 66% as against. 46.8% in the amputation group. CONCLUSIONS: Our study suggests that surgically treated patients with pathologic fractures in osteosarcoma have adequate local control and do not have a poorer outcome compared to patients without a fracture. Though osteosarcoma with a pathologic fracture is not a contraindication for limb salvage, appropriate case selection is important when deciding local control options to ensure adequate oncologic clearance.
Assuntos
Osteossarcoma/cirurgia , Adolescente , Adulto , Idoso , Neoplasias Ósseas/complicações , Neoplasias Ósseas/cirurgia , Criança , Pré-Escolar , Extremidades/patologia , Extremidades/cirurgia , Feminino , Fraturas Espontâneas/etiologia , Fraturas Espontâneas/cirurgia , Humanos , Salvamento de Membro , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/complicações , Recidiva Local de Neoplasia/cirurgia , Osteossarcoma/complicações , Estudos Retrospectivos , Adulto JovemRESUMO
BACKGROUND: Synovial haemangioma is a rare type of tumour for which only around 200 cases have been reported worldwide. It usually occurs in the female population during the second decade of life and most commonly affects the knee joint. Patients can complain of pain, recurrent knee swelling and limitation of motion. Since these lesions are uncommon and radilogical findings are nonspecific, physician awareness is low and diagnosis is often delayed, leading in turn to treatment delays and irreversible complications of the affected joint. MATERIALS AND METHODS: We report four cases of synovial haemangioma of the knee seen over a period of 20 years (1993-2013). Age at presentation ranged from six to 43 years (mean of 22.7 years) with an equal male-to-female ratio. Average duration of symptoms prior to treatment was three years--patients were often misdiagnosed and appropriate treatment was subsequently delayed. Radiographs showed moderate to severe degenerative changes. Magnetic resonance (MR) imaging revealed poorly defined intra-articular contrast-enhancing lesions, all of which were of the localised type. Three patients underwent open synovectomy and en bloc excision of the lesion; the fourth deferred surgery but continues to be monitored. Follow-up ranged from one to 11 years; all four patients are doing well, with no signs of symptom recurrence or progression. CONCLUSIONS: Synovial haemangioma is a rare but treatable condition. It should remain a differential for any patient with recurrent knee-joint symptoms.
Assuntos
Erros de Diagnóstico , Hemangioma/diagnóstico , Artropatias/diagnóstico , Articulação do Joelho/patologia , Membrana Sinovial/patologia , Adolescente , Adulto , Criança , Diagnóstico Tardio , Progressão da Doença , Feminino , Hemangioma/cirurgia , Humanos , Artropatias/cirurgia , Articulação do Joelho/cirurgia , Imageamento por Ressonância Magnética , MasculinoRESUMO
BACKGROUND: Elderly patients with osteosarcoma (OSA) are no longer uncommon; however, many questions remain regarding this population. We investigated the clinicopathological characteristics and prognostic factors of OSA in an Asian population over the age of 40 years. METHODS: This was a multi-national, multi-institutional study by the Eastern Asian Musculoskeletal Oncology Group (EAMOG). RESULTS: A total of 232 patients were enrolled (116 males and 116 females), with a median age of 50 years at diagnosis; 25 (10.8 %) patients exhibited initial metastasis. Median follow-up was 52 months for survivors. We observed 102 osteolytic and mixed radiographic findings for 173 lesions. Histological subtypes other than osteoblastic type were frequent. Radiation-associated OSA was seen in seven patients, with a 5-year overall survival (OS) of 16.7 %. No Paget's OSA was observed. High-grade spinopelvic OSA was seen in 29 (12.5 %) patients. The 5-year OS was 59.4 % in patients without initial metastasis and 45.2 % in patients with spinopelvic OSA. While surgery and initial metastasis were common prognostic factors for OS, chemotherapy was not. Histologic response to neoadjuvant chemotherapy was poor in 61 of 83 patients. CONCLUSION: This study revealed distinct clinicopathological features of OSA patients over 40 years of age compared with younger patients, such as the high incidence of axial tumors, common osteolytic and mixed radiographic findings, the high frequency of unusual histologic subtypes, and poor prognosis. Contrary to Western elderly patients with OSA, there was no Paget's OSA in this study, which may result in a lower incidence of secondary OSA. Prognostic factor analyses demonstrated chemotherapy did not influence OS.
Assuntos
Antineoplásicos/uso terapêutico , Neoplasias Ósseas/patologia , Neoplasias Ósseas/cirurgia , Osso e Ossos , Neoplasias Induzidas por Radiação/patologia , Osteossarcoma/secundário , Osteossarcoma/cirurgia , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Povo Asiático , Neoplasias Ósseas/tratamento farmacológico , Quimioterapia Adjuvante , Feminino , Fêmur , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Terapia Neoadjuvante , Gradação de Tumores , Neoplasias Induzidas por Radiação/tratamento farmacológico , Neoplasias Induzidas por Radiação/cirurgia , Osteossarcoma/tratamento farmacológico , Ossos Pélvicos , Prognóstico , Estudos Retrospectivos , Sacro , Neoplasias da Coluna Vertebral/tratamento farmacológico , Neoplasias da Coluna Vertebral/patologia , Neoplasias da Coluna Vertebral/cirurgia , Taxa de Sobrevida , TíbiaRESUMO
BACKGROUND: To decrease the recurrence rate after intralesional curettage for aneurysmal bone cysts, different adjuvant treatments have been recommended. Liquid nitrogen spray and argon beam coagulation have provided the lowest recurrence rates, but unlike the high-speed burr, these adjuvants are not always available in operating rooms. QUESTIONS/PURPOSES: We asked: (1) Is high-speed burring alone sufficient as an adjuvant to curettage with respect to recurrence rates? (2) What is the complication rate from this technique? (3) What are the risk factors for local recurrence? METHODS: A retrospective review of the database of the University Musculoskeletal Tumor Unit and the private files of the senior author (EHW) for a period of 19 years (1993-2011) was performed to identify all patients histologically diagnosed with primary aneurysmal bone cyst. During that period, patients with aneurysmal bone cysts were treated with intralesional curettage, burring, and bone grafting if the lesions showed an adequate cortical wall or a wall with thinned out portions which could be reconstructed with bone grafting. Based on those indications, we treated 54 patients for this condition. Of those, 18 were treated using approaches other than burring because they did not meet the defined indications, and an additional five patients were lost to followup before 2 years, leaving 31 patients for analysis, all of whom were followed up for at least 2 years (mean, 7 years; range, 2-18 years). RESULTS: Of these 31 patients, one had a recurrence (3.2%). Complications using this approach occurred in three patients (9.7%), and included growth plate deformity (1) and genu varus (2) secondary to collapse of the reconstructed condyle. With only one recurrence, we cannot answer what the risk factors might be for recurrence; however, the one patient with recurrence presented with a large lesion and a pathologic fracture. CONCLUSIONS: Curettage, burring, and bone grafting compare favorably in the literature with other approaches for aneurysmal bone cysts, such as cryotherapy and argon-beam coagulation. We conclude that high-speed burring alone as an adjuvant to intralesional curettage is a reasonable approach to achieving a low recurrence rate for aneurysmal bone cysts. LEVEL OF EVIDENCE: Level IV, therapeutic study. See the Instructions for Authors for a complete description of levels of evidence.
Assuntos
Cistos Ósseos Aneurismáticos/terapia , Curetagem , Adolescente , Adulto , Coagulação com Plasma de Argônio , Cistos Ósseos Aneurismáticos/complicações , Cistos Ósseos Aneurismáticos/diagnóstico , Cistos Ósseos Aneurismáticos/patologia , Cistos Ósseos Aneurismáticos/cirurgia , Transplante Ósseo , Criança , Crioterapia/métodos , Curetagem/efeitos adversos , Medicina Baseada em Evidências , Feminino , Seguimentos , Fraturas Espontâneas/etiologia , Fraturas Espontâneas/prevenção & controle , Genu Varum/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Nitrogênio/administração & dosagem , Recidiva , Estudos Retrospectivos , Resultado do Tratamento , Adulto JovemAssuntos
Amoxicilina/administração & dosagem , Antibioticoprofilaxia/métodos , Cefuroxima/administração & dosagem , Infecções por Clostridium/prevenção & controle , Gentamicinas/administração & dosagem , Fraturas do Quadril/cirurgia , Infecção da Ferida Cirúrgica/prevenção & controle , Feminino , Humanos , MasculinoRESUMO
BACKGROUND: Giant-cell tumor (GCT) of bone is a common primary benign tumor with high local recurrence and potential distant metastasis or malignant transformation. We have investigated the clinical behavior of recurrent GCT of bone in the extremities. METHODS: We retrospectively reviewed 110 patients with recurrent GCTs of bone in the extremities treated by the Eastern Asian Musculoskeletal Oncology Group. The factors that affected the number of recurrences and distant metastasis were analyzed. RESULTS: The median interval between initial surgery and the first recurrence of GCT was 16 months (2-180 months). All patients received additional surgery for first recurrence. Twenty-five patients had a second recurrence and 6 patients had a third recurrence. The mean interval between the initial surgery and the first recurrence correlated with the eventual number of recurrences-14.1 months for the repeated recurrence groups (two and three recurrences) and 28.3 months for the single recurrence group (p = 0.016). Campanacci grade did not correlate with repeated recurrence (p = 0. 446). The venue of the initial surgery did not correlate with recurrence but did affect preservation of the adjacent joint (chi-squared test; p = 0.046). Campanacci grade II and III also correlated with sacrifice of the adjacent joint (p = 0.020). The incidence of lung metastasis and malignant transformation were 7.5% (8 out of 107 patients) and 2.7% (3 out of 110 patients), respectively. Repeat recurrence was associated with lung metastasis (p = 0.018). CONCLUSIONS: Early local recurrence of GCT is a risk factor for repeat recurrence. Repeat recurrence also correlates with lung metastasis. Recurettage with meticulous adjuvant treatment to completely preclude recurrent lesions is a reasonable method for preserving the adjacent joint. However, a continuous careful follow-up is mandatory.
Assuntos
Neoplasias Ósseas/diagnóstico , Tumor de Células Gigantes do Osso/diagnóstico , Recidiva Local de Neoplasia/epidemiologia , Sociedades Médicas , Adolescente , Adulto , Idoso , Neoplasias Ósseas/epidemiologia , Neoplasias Ósseas/cirurgia , Criança , Intervalo Livre de Doença , Ásia Oriental/epidemiologia , Feminino , Seguimentos , Tumor de Células Gigantes do Osso/epidemiologia , Tumor de Células Gigantes do Osso/cirurgia , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/diagnóstico , Prognóstico , Estudos Retrospectivos , Fatores de Tempo , Adulto JovemRESUMO
BACKGROUND: Hip disarticulation and hemipelvectomy are alternatives to limb-salvage procedures for patients with extensive tumors of the upper thigh and buttocks. In cases when neither the conventional posterior gluteus maximus flap nor the anterior quadriceps flap can be used because of the location of the tumor, a medial adductor myocutaneous flap may be an alternative. DESCRIPTION OF TECHNIQUE: The flap is outlined over the anteromedial thigh. The distal extent is at the level of the adductor hiatus. The common femoral vessels and nerve are traced, preserved, and protected. The adductor muscles then are divided above their insertions on the femur and preserved with the flap. En bloc removal of the tumor is performed by either hip disarticulation or hemipelvectomy. The long adductor myocutaneous flap is brought up laterally and proximally to close the wound. PATIENTS AND METHODS: We reviewed four patients who underwent a medial adductor myocutaneous flap after either hip disarticulation or hemipelvectomy. The medical records and radiographs were analyzed. These patients were followed up for at least a year or until death. RESULTS: Wide surgical margins were achieved in all four patients and the flap remained viable, with no skin necrosis or flap breakdown. The patients were able to sit on the flap, and one patient was able to wear a prosthesis. CONCLUSIONS: In patients undergoing hip disarticulation or hemipelvectomy where tumor infiltration or inadvertent contamination by previous surgery will not allow the traditional posterior gluteus maximus or anterior quadriceps flap, this unconventional medial adductor myocutaneous flap is a feasible, technically simple option. LEVEL OF EVIDENCE: Level IV therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
Assuntos
Neoplasias Ósseas/cirurgia , Desarticulação , Articulação do Quadril/cirurgia , Músculo Quadríceps/cirurgia , Sarcoma/cirurgia , Neoplasias de Tecidos Moles/cirurgia , Retalhos Cirúrgicos , Adulto , Membros Artificiais , Neoplasias Ósseas/patologia , Nádegas , Feminino , Neoplasias Femorais/patologia , Neoplasias Femorais/cirurgia , Articulação do Quadril/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Invasividade Neoplásica , Ossos Pélvicos/patologia , Ossos Pélvicos/cirurgia , Filipinas , Músculo Quadríceps/patologia , Sarcoma/patologia , Neoplasias de Tecidos Moles/patologia , Tíbia/patologia , Tíbia/cirurgia , Fatores de Tempo , Resultado do TratamentoRESUMO
We describe a rare case of primary squamous cell carcinoma of the cuneiform bone of the foot in a 57-year-old man. In the appendicular skeleton, epithelial carcinomas of bone are usually metastatic deposits, primary squamous cell carcinomas of bone being found more frequently in the skull. A review of the English literature revealed only two other reported cases of primary squamous cell carcinoma outside the skull--one in the ilium and one in the tibia. In our patient, extensive metastatic workup and monitoring during more than 2 years showed no primary focus, supporting the rare presentation of a primary squamous cell carcinoma of bone in the appendicular skeleton.
Assuntos
Neoplasias Ósseas/patologia , Carcinoma de Células Escamosas/patologia , Ossos do Tarso/patologia , Biópsia , Neoplasias Ósseas/diagnóstico por imagem , Neoplasias Ósseas/cirurgia , Transplante Ósseo , Carcinoma de Células Escamosas/diagnóstico por imagem , Carcinoma de Células Escamosas/cirurgia , Diferenciação Celular , Curetagem , Humanos , Ílio/transplante , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Radiografia , Ossos do Tarso/diagnóstico por imagem , Ossos do Tarso/cirurgia , Resultado do TratamentoRESUMO
Cancer is the third leading cause of morbidity and mortality in the Philippines. Leading cancer sites/types are lung, breast, cervix, liver, colon and rectum, prostate, stomach, oral cavity, ovary and leukemia. There is at present a low cancer prevention consciousness and most cancer patients seek consultation only at advanced stages. Cancer survival rates are relatively low. The Philippine Cancer Control Program, begun in 1988, is an integrated approach utilizing primary, secondary and tertiary prevention in different regions of the country at both hospital and community levels. Six lead cancers (lung, breast, liver, cervix, oral cavity, colon and rectum) are discussed. Features peculiar to the Philippines are described; and their causation and prevention are discussed. A recent assessment revealed shortcomings in the Cancer Control Program and urgent recommendations were made to reverse the anticipated 'cancer epidemic'. There is also today in place a Community-based Cancer Care Network which seeks to develop a network of self-sufficient communities sharing responsibility for cancer care and control in the country.