[Is there a magic bullet for sarcomas? : Personalised treatment for maligant tumours of bone and soft tissue]. / Gibt es eine Magic Bullet für Sarkome? : Personalisierte Therapie von malignen Tumoren des Stütz- und Bewegungsapparates.

BACKGROUND: Personalised tumour therapies aim to selectively target pathways and structures to which a tumour shows an oncogenic addiction. OBJECTIVE AND METHOD: This article aims to provide an overview of relevant genetic alterations in bone and soft-tissue tumours, which might serve as potential therapeutic targets for personalised medicines in the future. Recent approaches towards a personalised treatment of various tumours of bone and soft tissues are reviewed. RESULTS: Molecular diagnosis has become an essential tool for the characterisation of bone and soft-tissue tumours. Currently, no targeted therapies are routinely available for bone sarcomas. Denosumab is merely a symptomatic treatment for giant cell tumours of the bone. Imatinib has become the paradigm of a targeted treatment for subgroups of malignant gastrointestinal stromal tumours (GISTs) and dermatofibrosarcoma protuberans. Antiangiogenic multikinase inhibitors, various other tyrosine kinase inhibitors (TKIs) and monoclonal antibodies are currently being evaluated in several (sub-)types of soft-tissue sarcomas. Sorafenib showed promising results in the treatment of aggressive desmoid-type fibromatosis. Histology-tailored chemotherapies did not yield superior results in a prospective randomised multicentre trial. CONCLUSION: More in-depth knowledge is required for many sarcomas to link their genetic alterations to tumorigenesis in order to develop efficient personalised treatment strategies. Clinical trial designs need to be adapted to evaluate new therapeutic strategies in these ultra-rare tumours and their various sub-types more efficaciously.

[Evaluation of macroamputations of the upper extremity in the management of primary malignant bone and soft-tissue tumours using the DASH score]. / Evaluation von Makroamputationen der oberen Extremität bei primär malignen Knochen- und Weichteiltumoren mittels DASH-Score.

PURPOSE/BACKGROUND: The purpose of this retrospective analysis was to identify patients with macroamputations of the upper extremity due to malignant bone or soft-tissue tumours at a single institution. The German DASH score (Disability of Arm, Shoulder, Hand) was obtained in order to measure how patients manage their daily activities. PATIENTS AND METHODS: Between 1998 and 2005, 1652 patients were operated due to a bone or soft-tissue tumour, 370 of these due to a malignant one (22 %). The tumour was localised in the lower extremity or in the pelvis in 246 cases, in the trunk in 38 and in the upper extremity in 86 cases. These 86 primary malignant tumours comprised 22 bone and 64 soft tissue tumours. Amputations had to be performed in the lower extremity in 14 % (35/246) and in the upper extremity in 7 % (6/86). Six patients with macroamputations of the upper extremity were identified and in five of these the DASH score was obtained. RESULTS: The mean DASH score for the module 1 (disability/symptom) was 75.1 points ([sum of responses - 30]/1.2), for module 2 (work) 92.4 ([sum of responses - 4]/0.16), and for module 3 (sports/performing arts) 90 points ([sum of responses - 4]/0.16). Only two patients worked again and only one played an instrument. CONCLUSION: Despite neo-/adjuvant therapeutic options and modified reconstructive procedures 7 % of patients with malignant bone or soft tissue tumours of the upper extremity had to undergo an amputation. The DASH score is an appropriate instrument to measure the disability after upper limb amputation due to tumour.