Neoadjuvant stereotactic ablative radiotherapy (SABR) for soft tissue sarcomas of the extremities.

BACKGROUND: Soft tissue sarcomas (STS) comprise a diverse group of mesenchymal malignancies that require multidisciplinary care. Although surgery remains the primary form of treatment for those with localized disease, radiation therapy (RT) is often incorporated either in the neo- or adjuvant setting. Given the development of modern RT techniques and alternative dosing schedules, stereotactic ablative radiotherapy (SABR) has emerged as a promising technique. However, the current role of SABR in the treatment of STS of the extremities remains uncertain. METHODS AND MATERIALS: This was a single-center, prospective, single-arm phase II trial. Patients with localized STS who were candidates for limb-preservation surgery were included. Experimental treatment consisted of SABR with 40 Gy in 5 fractions, administered on alternate days, followed by surgery after a minimum interval of 4 weeks. The primary outcome was the rate of wound complication. Secondary outcomes included 2-year local control (LC), metastasis-free survival (MFS), cancer-specific survival (CSS), and overall survival (OS) rates (and other toxicities). RESULTS: Twenty-five patients were enrolled between October 2015 and November 2019 and completed the treatment protocol. The median rate of histopathologic regression was 65% (range 0-100) and 20.8% of tumors presented pathologic complete response (pCR). Wound complications were observed in 7/25 patients (28%). Three patients underwent disarticulation by vascular occlusion after plastic reconstruction and one patient was amputated by grade 3 limb dysfunction. After a median follow up of 20.7 months, the 2-year estimated risk of local recurrence, distant metastasis and cause-specific death were 0%, 44.7% and 10.6% respectively. CONCLUSIONS: Neoadjuvant SABR appears to improve the pCR for patients with eSTS, with acceptable rate of wound complications. Nevertheless, this benefit should be weighed against the risk of late of vascular toxicity with SABR regimen since, even in a short median follow-up, a higher rate of amputation than expected was observed. A larger sample size with longer follow-up is necessary to conclude the overall safety of this strategy.

UNCEMENTED ARTHROPLASTY AFTER HIP METASTATIC DISEASE AND MULTIPLE MYELOMA

ABSTRACT Objective: To describe a case series using a combination of narrative, graphical exploratory analysis and Bayesian Network modeling. Methods: Case series with 34 patients undergoing uncemented and hybrid arthroplasty procedures secondary to hip pain or fracture secondary to metastatic disease or multiple myeloma. Results: The most common tumors included gastrointestinal, multiple myeloma and breast cancer. Most devices were total arthroplasty (n = 16, 84.2%) rather than partial and uncemented arthroplasty (n = 12, 63.2%) rather than hybrid. The average time between surgery and deambulation was 20 days, the average length of hospital stay was 13 days, and the average patient survival was 589 days. Only one infection was reported. Uncemented and hybrid arthroplasty devices did not differ regarding time to walk, as well as the length of hospital stay in this sample. Conclusion: Our model may be used as a prior for the addition of subsequent patient samples, personalizing, thus, its recommendations to other patient populations. Level of Evidence IV, Case series.

UNCEMENTED ARTHROPLASTY AFTER HIP METASTATIC DISEASE AND MULTIPLE MYELOMA.

OBJECTIVE: To describe a case series using a combination of narrative, graphical exploratory analysis and Bayesian Network modeling. METHODS: Case series with 34 patients undergoing uncemented and hybrid arthroplasty procedures secondary to hip pain or fracture secondary to metastatic disease or multiple myeloma. RESULTS: The most common tumors included gastrointestinal, multiple myeloma and breast cancer. Most devices were total arthroplasty (n = 16, 84.2%) rather than partial and uncemented arthroplasty (n = 12, 63.2%) rather than hybrid. The average time between surgery and deambulation was 20 days, the average length of hospital stay was 13 days, and the average patient survival was 589 days. Only one infection was reported. Uncemented and hybrid arthroplasty devices did not differ regarding time to walk, as well as the length of hospital stay in this sample. CONCLUSION: Our model may be used as a prior for the addition of subsequent patient samples, personalizing, thus, its recommendations to other patient populations. Level of Evidence IV, Case series.

GCT: What happened after 10 years of curettage and cement? Retrospective study of 46 cases.

OBJECTIVE: To compare the functional outcome of patients with and without arthrosis, and to determine whether the development of arthrosis is related to the distance of the tumor from the subchondral bone. METHODS: Forty six patients treated for Giant-cell tumor (GCT) between 1975 and 1999 met inclusion criteria. GCT was diagnosed by percutaneous biopsy and confirmed after resection, in all cases. Campanacci's and Kellgren's classification, the distance of the cement to the articular surface and MSTS score were obtained throughout the sample. RESULTS: The distance of the cement to the subchondral bone was associated with greater risk of developing arthrosis, but there was no difference in MSTS scores between patients with or without arthrosis. CONCLUSION: We found that the distance from the cement to the subchondral bone has a prognostic value regarding future arthrosis, but it does not impact on the functional outcome. Level of Evidence IV, Therapeutic Study.

Gct: what happened after 10 years of curettage and cement? Retrospective study of 46 cases

Comparar o resultado funcional de pacientes tratados portumor de células gigantes (TCG) que evoluíram com e sem artrose, edeterminar se o desenvolvimento da artrose está relacionado à distânciaentre o tumor e o osso subcondral. Métodos: 46 pacientes tratadospor TCG entre 1975 e 1999 preencheram os critérios de inclusão. OTCG foi diagnosticado por biópsia percutânea e confirmado após aressecção em todos os casos. As classificações de Campanacci eKellgren, a distância do cimento para o osso subcondral e o escorede MSTS foram obtidos para todos os casos. Resultados: A distânciado cimento para o osso subcondral está associada ao maior risco dedesenvolver artrose, mas não houve diferença nos escores funcionaisde MSTS entre os pacientes com e sem artrose. Conclusão: A distânciaentre o cimento e o osso subcondral tem valor prognóstico comrelação ao aparecimento de artrose, mas isso não acarreta impactono resultado funcional. Nível de Evidência IV, Estudo Terapêutico...

To compare the functional outcome of patients with andwithout arthrosis, and to determine whether the development of arthrosisis related to the distance of the tumor from the subchondralbone. Methods: Forty six patients treated for Giant-cell tumor (GCT)between 1975 and 1999 met inclusion criteria. GCT was diagnosedby percutaneous biopsy and confirmed after resection, in allcases. Campanacci’s and Kellgren’s classification, the distance ofthe cement to the articular surface and MSTS score were obtainedthroughout the sample. Results: The distance of the cement to thesubchondral bone was associated with greater risk of developingarthrosis, but there was no difference in MSTS scores betweenpatients with or without arthrosis. Conclusion: We found that thedistance from the cement to the subchondral bone has a prognosticvalue regarding future arthrosis, but it does not impact on thefunctional outcome. Level of Evidence IV, Therapeutic Study...

Validation of the Brazilian version of the musculoskeletal tumor society rating scale for lower extremity bone sarcoma.

BACKGROUND: The Musculoskeletal Tumor Society (MSTS) rating scale is an English-language instrument used worldwide to assess functional evaluation of patients with musculoskeletal cancer. Despite its use in several studies in English-speaking countries, its validity for assessing patients in other languages is unknown. The translation and validation of widely used scales can facilitate the comparison across international patient samples. OBJECTIVES/PURPOSES: The objectives of this study were (1) to translate and culturally adapt the MSTS rating scale for functional evaluation in patients with lower extremity bone sarcomas to Brazilian Portuguese; (2) analyze its factor structure; and (3) test the reliability and (4) validity of this instrument. METHOD: The MSTS rating scale for lower limbs was translated from English into Brazilian Portuguese. Translations were synthesized, translated back into English, and reviewed by a multidisciplinary committee for further implementation. The questionnaire was administered to 67 patients treated for malignant lower extremity bone tumors who were submitted to limb salvage surgery or amputation. They also completed a Brazilian version of the Toronto Extremity Salvage Score (TESS). Psychometric properties were analyzed including factor structure analysis, internal consistency, interobserver reliability, test-retest reliability, and construct validity (by comparing the adapted MSTS with TESS and discriminant validity). RESULTS: The MSTS rating scale for lower limbs was translated and culturally adapted to Brazilian Portuguese. The MSTS-BR proved to be adequate with only one latent dimension. The scale was also found to be reliable in a population that speaks Brazilian Portuguese showing good internal consistency (Cronbach's alpha = 0.84) and reliability (test-retest reliability and interobserver agreement of 0.92 and 0.98, respectively). Validity of the Brazilian MSTS rating scale was proved by moderate with TESS and good discriminant validity. CONCLUSIONS: The Brazilian version of the MSTS rating scale was translated and validated. It is a reliable tool to assess functional outcome in patients with lower extremity bone sarcomas. It can be used for functional evaluation of Brazilian patients and crosscultural comparisons.

Comparacao da resistência à tracao da âncora metálica rosqueada inserida no osso cortical e no osso esponjoso / Comparison of the tensile strength of threaded metal anchors inserted on cortical and spongy bones

A rotura do manguito rotador é uma afeccao freqüente com repercussao na vida diária do paciente causando incapacidade funcional e dor. Um número considerável de pacientes necessita de reparacao tendínea. A tendência atual na cirurgia do ombro é a utilizacao de técnicas minimamente invasivas com menor morbidade operatória e reabilitacao mais precoce. A partir dos anos 90 houve um grande desenvolvimento da artroscopia do ombro e na utilizacao de âncoras para fixacao das suturas tendíneas. Essa evolucao técnica tem permitido resultados da cirurgia artroscópica comparáveis aos da cirurgia aberta. Um dos possíveis problemas do uso de âncoras nas cirurgias artroscópicas do ombro é sua soltura da superfície óssea. O presente estudo tem o objetivo de comparar a resistência à tracao das âncoras metálicas rosqueadas inseridas no osso cortical e no osso esponjoso.