RESUMEN
BACKGROUND: Survival in patients who have Ewing sarcoma is correlated with postchemotherapy response (tumor necrosis). This treatment response has been categorized as the response rate, similar to what has been used in osteosarcoma. There is controversy regarding whether this is appropriate or whether it should be a dichotomy of complete versus incomplete response, given how important a complete response is for in overall survival of patients with Ewing sarcoma. The purpose of this study was to evaluate the impact that the amount of chemotherapy-induced necrosis has on (1) overall survival, (2) local recurrence-free survival, (3) metastasis-free survival, and (4) event-free survival in patients with Ewing sarcoma. METHODS: In total, 427 patients who had Ewing sarcoma or tumors in the Ewing sarcoma family and received treatment with preoperative chemotherapy and surgery at 10 international institutions were included. Multivariate Cox proportional-hazards analyses were used to assess the associations between tumor necrosis and all four outcomes while controlling for clinical factors identified in bivariate analysis, including age, tumor volume, location, surgical margins, metastatic disease at presentation, and preoperative radiotherapy. RESULTS: Patients who had a complete (100%) tumor response to chemotherapy had increased overall survival (hazard ratio [HR], 0.26; 95% CI, 0.14-0.48; p < .01), recurrence-free survival (HR, 0.40; 95% CI, 0.20-0.82; p = .01), metastasis-free survival (HR, 0.27; 95% CI, 0.15-0.46; p ≤ .01), and event-free survival (HR, 0.26; 95% CI, 0.16-0.41; p ≤ .01) compared with patients who had a partial (0%-99%) response. CONCLUSIONS: Complete tumor necrosis should be the index parameter to grade response to treatment as satisfactory in patients with Ewing sarcoma. Any viable tumor in these patients after neoadjuvant treatment should be of oncologic concern. These findings can affect the design of new clinical trials and the risk-stratified application of conventional or novel treatments.
Asunto(s)
Neoplasias Óseas , Sarcoma de Ewing , Humanos , Sarcoma de Ewing/tratamiento farmacológico , Sarcoma de Ewing/cirugía , Sarcoma de Ewing/patología , Terapia Neoadyuvante/efectos adversos , Neoplasias Óseas/patología , Recurrencia Local de Neoplasia/tratamiento farmacológico , Recurrencia Local de Neoplasia/etiología , Necrosis/etiología , Estudios RetrospectivosRESUMEN
Los xantomas intraóseos son lesiones líticas expansibles compuestas por histiocitos cargados de lípidos. Usualmente son secundarios a enfermedades endocrinas, metabólicas o como hallazgo incidental ante una fractura patológica no asociada a enfermedades sistémicas. En este último caso se denomina xantoma intraóseo primario. Describimos el caso de una mujer de 32 años con clínica de 4 meses de evolución de dolor en cadera derecha, con imágenes y biopsia de la zona intertrocantérica derecha, compatible con un quiste óseo simple residual. Se realizó tratamiento intralesional con relleno de matriz ósea desmineralizada, aloinjerto de peroné segmentario y osteosíntesis con patología quirúrgica que reportó xantogranuloma óseo en paciente con niveles de colesterol normal con adecuado control de la enfermedad, consolidación y recuperación funcional. Presentamos este reporte dada la baja incidencia de dicha patología y se discuten los diagnósticos diferenciales.
Intraosseous xanthomas are expandable lytic lesions composed of lipid-laden histiocytes. They are usually secondary to endocrine or metabolic diseases or as an incidental finding in a pathological fracture not associated with systemic diseases. In the latter case it is called primary intraosseous xanthoma. We describe the case of a 32-year-old woman with a 4-month history of pain in the right hip, with images and biopsy of the right intertrochanteric area, compatible with a residual simple bone cyst. Intralesional treatment was performed with demineralized bone matrix filling, segmental fibula allograft and osteosynthesis with surgical pathology that reported bone xanthogranuloma in a patient with normal cholesterol levels with adequate disease control, consolidation and functional recovery. We present this report given the low incidence of said pathology and the differential diagnoses are discussed.
RESUMEN
This is a case report that includes an analysis about extrapulmonary tuberculosis and his singularities, cause can be confused with cancer. Our patient an 83-year-old woman from Pasto-Colombia presents a mimicking metastasis with melanoma. This guides us to understand that extrapulmonary tuberculosis is a rare pathology, but it should be considered as a potential differential diagnosis of any osteolytic lesion. That is the reasons for to be one of the great imitators in medicine, we come up with are totally necessary in a differential diagnosis with malignancies, a high index of suspicion.
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An 18-year-old male patient with a high-grade osteosarcoma was initially treated with resection and reconstruction using an osteochondral allograft. The allograft collapsed after five years, and thus a revision with a constrained knee prosthesis was performed. After one year, the implant failed due to a fracture, requiring another revision with a new allo-prosthetic composite. The long-term results were satisfactory. Allo-prosthetic composites may offer good long-term results after sarcoma resection. The failure of a massive bone allograft does not preclude the use of another allograft to maintain the bone stock and preserve the function.
RESUMEN
Las neoplasias óseas son infrecuentes, con una incidencia menor del 0,01%. Por esta razón, el ortopedista general puede tener dificultad en identificar los síntomas y signos que sugieren una neoplasia ósea y practicar un tratamiento inapropiado o tardío. El propósito de este artículo es presentar una serie de casos de pacientes con complicaciones oncológicas y su manejo.
Asunto(s)
Neoplasias Óseas , Oncología Médica , Enfermedades Musculoesqueléticas , Procedimientos Ortopédicos , Ortopedia/educaciónRESUMEN
Introducción: el manejo de la fractura de acetábulo ha cambiado considerablemente, tanto así que el manejo ortopédico está reservado a un grupo muy reducido de patologías con características especiales. El propósito de este estudio fue evaluar y analizar la experiencia del Hospital Universitario de la Samaritana, durante los últimos cinco años, en el manejo de las fractura de acetábulo. Materiales y métodos: se diseñó un estudio descriptivo tipo serie de casos. Entre enero del 2002 y el primer semestre del 2008, ingresaron 164 pacientes, de los cuales 120 se intervinieron quirúrgicamente. Predominó el sexo masculino (68,3%) sobre el femenino (31,6%), con un grupo de edad promedio de 38,9 años. Se utilizó la clasificación de Letournel y Judet. Resultados: el mecanismo de trauma que predominó fue el accidente de tránsito (80,8%), seguido de automóvil (45%) y motocicleta (35,8%). La principal vía de abordaje fue la de Kocher-Langenbeck (65,8%), seguida del abordaje ilioinguinal (26,6%). Se encontraron las siguientes complicaciones neurológicas posquirúrgicas: neuropraxia del nervio ciático (13,3%), infección total (8,3%), infección superficial (5,8%) e infección profunda (2,5%). Un paciente requirió una artroplastia de resección tipo Girldestone. Discusión: la elección adecuada del abordaje y del material quirúrgico, la preparación óptima del paciente y la experticia del cirujano son factores fundamentales para la obtención de buenos resultados en el manejo de fracturas del acetábulo.
