Effects of time to treatment initiation on outcomes for soft tissue sarcomas.

BACKGROUND AND OBJECTIVES: Few studies have investigated the effects of time to treatment initiation (TTI) for soft tissue sarcomas (STS). Our objective was to investigate the risk factors for prolonged TTI and the effects of prolonged TTI on local recurrence free survival (LRFS), distant metastasis free survival (DMFS), and disease specific survival (DSS). METHOD: Patients diagnosed with high-grade STS of the extremities and trunk from 2011 to 2020 were included. TTI was grouped into two groups (treatment provided in less than vs. more than or equal to 30 days). Two-year and 5-year survival probabilities were calculated for LRFS, DMFS, and DSS. Cox regression and Kruskal-Wallis tests in univariate analysis were conducted to find risk factors affecting TTI and the survival outcomes. RESULTS: In the univariate analysis, diagnosis in the later 5-year period of the study, tumor size, and treatment modality were associated with prolonged TTI. TTI ≥30 days was associated with higher DMFS but no association was found with LRFS or DSS. Tumor size, surgical margins, and provision of surgery were associated with DSS. CONCLUSION: Despite the delay in treatment for STS patients caused by the COVID-19 pandemic, our study showed TTI of more than 30 days does not negatively impact patients.

Refer prior to biopsy of suspected appendicular soft tissue sarcoma.

AIM: Appendicular soft tissue tumours are rare and inappropriate investigation can result in unnecessary loss of limb or life. We reviewed the investigation and referrals of patients to our institution. METHOD: This is a review of prospectively collected data stored in a tumour registry database. We included all patients (126) referred to the service for investigation and management with a primary soft tissue tumour in 2006 and 2007. RESULTS: There was a highly significant association (RR=6.2) between pre referral procedures (PRPs) and suffering a complication (P<0.0001) in comparison to non-biopsied referrals (NBRs). Those referred by general surgeons were more likely (RR=2.6) to have undergone PRP (p<0.0017). The median interval between referral and senior author review was 8 days for the PRP group and 10 days for the NBR group (P=0.2574). CONCLUSION: Biopsy of suspected appendicular soft tissue sarcoma should be performed by a tumour specialist or in prior consultation with, to minimise adverse outcomes. There was minimal delay till review by an orthopaedic tumour specialist at Middlemore Hospital and achieving a tissue diagnosis does not expedite this.

Musculoskeletal CPD revision: cases from the New Zealand bone and soft tissue tumour registry.

The following case report was selected from the New Zealand Bone and Soft Tissue Tumour Registry to highlight some key concepts and findings in musculoskeletal imaging with radiological-pathological correlation. The presentation follows a question and answer format followed by clinical information, selected images, diagnosis, discussion and teaching points.

Design and synthesis of HCV agents with sequential triple inhibitory potentials.

The union of HCV-796, a potent selective HCV NS5B polymerase inhibitor, and Ribavirin, a molecule with activities against a wide spectrum of viruses, resulted in a class of new anti-HCV agents with a sequential triple inhibitory mechanism.

Revision of the deficient proximal femur with a proximal femoral allograft.

UNLABELLED: Substantial bone loss is frequently encountered with revision hip arthroplasty. A proximal femoral allograft may be used to reconstitute bone stock in the multiply revised femur with segmental bone loss of greater than 5 cm. We retrospectively reviewed 92 patients (93 hips) who underwent such proximal femoral allografts. The average age at the surgery was 61 years. The average number of previous revision procedures was 2.5. Six patients were lost to followup. Thirty-four of 36 deceased patients had the original proximal femoral allograft at the time of death. The minimum followup for the 50 remaining patients was 15 years (average, 16.2 years; range, 15-22 years). Analysis included survivorship and radiographic assessment. Of the 50 patients reviewed, two had a failed reconstruction due to infection, six for aseptic loosening, three for nonunion, and four for dislocation. Revision of the proximal femoral allograft for all reasons excluding the acetabulum was performed in seven patients. At last followup, 42 patients (84%) had a well-functioning construct. Proximal femoral allograft for revision hip arthroplasty in femoral segmental bone loss is a durable alternative in most patients for a complex problem. LEVEL OF EVIDENCE: Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.

Two-stage revision of infected uncemented lower extremity tumor endoprostheses.

We reviewed our experience with 2-stage revision of uncemented Kotz Modular Femoral and Tibial Replacement System prostheses from 1989 to 2004. A total of 180 lower extremity tumor prostheses were inserted, 15 of which underwent removal of the prosthesis for infection. Eleven patients underwent subsequent second-stage revision, and 4 underwent amputation. Of the 11 patients who underwent revision, 8 continue to be free of infection an average of 33 months postoperatively. Of these 8 patients, 6 were revised without removal of the diaphyseal anchorage piece, which were all well ingrown. Most successful revisions were in the group that developed infection within 6 months of their original procedure. Two-stage revision of uncemented tumor endoprostheses with retention of a well-ingrown stem can be associated with successful eradication of infection.

Aseptic loosening is uncommon with uncemented proximal tibia tumor prostheses.

UNLABELLED: Aseptic loosening is a frequent cause of failure of cemented proximal tibia tumor endoprostheses. Uncemented prostheses may lessen this risk. We identified complications including aseptic loosening that affected prosthetic survival, limb survival and functional outcome for 44 consecutive patients after sarcoma resection from the proximal tibia and uncemented endoprosthetic reconstruction. At a mean final followup of 60 months (range, 9-152 months), there were no cases of aseptic loosening. Twelve (27%) patients suffered 14 complications leading to prosthetic failure due to infection (n = 7), stem fracture (n = 2), rotational instability (n = 1), vascular compromise (n = 2) and local tumor relapse (n = 2). However, limb salvage was successful in 37 of 44 (84%) patients. Functional assessment for 35 patients revealed a mean Toronto Extremity Salvage Score of 77/100 (range, 33-98) and Musculoskeletal Tumor Society 1987 and 1993 scores of 25/35 (range, 13-31) and 75/100 (range, 33-97), respectively. Mean knee joint flexion was 91 degrees (range, 0-110 degrees ) and knee extension lag was 6 degrees (range, 0-30 degrees ). Three patients with knee extensor complications had inferior functional outcomes. Aseptic loosening is uncommon with uncemented proximal tibia reconstruction, but decreasing other complications at this location remains challenging. LEVEL OF EVIDENCE: Therapeutic study, level IV-1 (case series).