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1.
Cancer Treat Rev ; 94: 102168, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33730627

RESUMO

OBJECTIVE: This systematic review and meta-analysis aimed to develop an evidence-based summary of current knowledge of bone metastases (BMs) in neuroendocrine neoplasms (NENs), inform diagnosis and treatment and standardise management between institutions. METHODS: PubMed, Medline, EMBASE and meeting proceedings were searched for eligible studies reporting data on patients with BMs and NENs of any grade of differentiation and site; poorly-differentiated large/small cell lung cancer were excluded. Data were extracted and analysed using STATA v.12. Meta-analysis of proportions for calculation of estimated pooled prevalence of BM and calculation of weighted pooled frequency and weighted pooled mean for other variables of interest was performed . RESULTS: A total of 149 studies met the eligibility criteria. Pooled prevalence of BMs was 18.4% (95% CI 15.4-21.5). BMs were mainly metachronous with initial diagnosis of NEN (61.2%) and predominantly osteoblastic; around 61% were multifocal, with a predisposition in axial skeleton. PET/CT seemed to provide (together with MRI) the highest sensitivity and specificity for BM detection. Almost half of patients (46.4%) reported BM-related symptoms: pain (66%) and skeletal-related events (SREs, fracture/spinal cord compression) (26.2%; weightedweighted mean time-to-SRE 9.9 months). Management of BMs was multimodal [bisphosphonates and bone-modifying agents (45.2%), external beam radiotherapy (34.9%), surgery (14.8%)] and supported by little evidence. Overall survival (OS) from the time of diagnosis of BMs was long [weighted mean 50.9 months (95% CI 40.0-61.9)]. Patients with BMs had shorter OS [48.8 months (95% CI 37.9-59.6)] compared to patients without BMs [87.4 months (95% CI 74.9-100.0); p = 0.001]. Poor performance status and BM-related symptoms were also associated with worse OS. CONCLUSIONS: BMs in patients with NENs remain underdiagnosed and undertreated. Recommendations for management of BMs derived from current knowledge are provided. Prospective studies to inform management are required.


Assuntos
Neoplasias Ósseas/secundário , Neoplasias Ósseas/terapia , Tumores Neuroendócrinos/patologia , Tumores Neuroendócrinos/terapia , Neoplasias Ósseas/diagnóstico , Humanos , Tumores Neuroendócrinos/diagnóstico , Tumores Neuroendócrinos/secundário
2.
Bull Cancer ; 108(4): 424-434, 2021 Apr.
Artigo em Francês | MEDLINE | ID: mdl-33722379

RESUMO

Two forms of bone lymphomas can be distinguished: the primary bone lymphoma (PBL) and the secondary bone lymphoma (SBL). PBL is a rare disease with a good prognosis. Clinical manifestations and imaging findings are usually non-specific. Patient can present with pain, swelling of affected bone or pathologic fracture. Positron emission tomography-CT scan is a sensitive imaging modality and very useful for staging, restaging, surveillance of recurrence, and monitoring of treatment response of lymphoma. The diagnosis of PBL is often difficult and made after biopsy examination. Most patients have diffuse large B-cell lymphoma. Patients have been treated with radiotherapy, chemotherapy or combination of both. Localized disease, low IPI (International Prognostic Index) and complete remission after initial treatment were associated with a better outcome. Management of late sequelae deserves particular attention. SBL is more common than PBL; this is a disseminated lymphoma with concomitant involvement of the skeleton. We review the clinical, imaging and pathologic features of bone lymphomas; and discuss therapeutic modalities as well as prognosis of these lymphomas in the era of immunochemotherapy.


Assuntos
Neoplasias Ósseas , Linfoma não Hodgkin , Adulto , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Neoplasias Ósseas/classificação , Neoplasias Ósseas/diagnóstico , Neoplasias Ósseas/secundário , Neoplasias Ósseas/terapia , Neoplasias do Sistema Nervoso Central/prevenção & controle , Neoplasias do Sistema Nervoso Central/secundário , Terapia Combinada , Diagnóstico por Imagem/métodos , Feminino , Fraturas Espontâneas/etiologia , Fraturas Espontâneas/cirurgia , Humanos , Linfoma não Hodgkin/diagnóstico , Linfoma não Hodgkin/patologia , Linfoma não Hodgkin/terapia , Masculino , Especificidade de Órgãos , Prognóstico , Radioterapia/métodos , Recidiva
3.
Biomed Eng Online ; 20(1): 24, 2021 Mar 02.
Artigo em Inglês | MEDLINE | ID: mdl-33653371

RESUMO

Osteosarcoma (OS) is the most common primary bone malignancy that affects children and young adults. OS is characterized by a high degree of malignancy, strong invasiveness, rapid disease progression, and extremely high mortality rate; it is considered as a serious threat to the human health globally. The incidence of OS is common in the metaphysis of long tubular bones, but rare in the spine, pelvis, and sacrum areas; moreover, majority of the OS patients present with only a single lesion. OS has a bimodal distribution pattern, that is, its incidence peaks in the second decade of life and in late adulthood. We examine historical and current literature to present a succinct review of OS. In this review, we have discussed the types, clinical diagnosis, and modern and future treatment methods of OS. The purpose of this article is to inspire new ideas to develop more effective therapeutic options.


Assuntos
Neoplasias Ósseas/diagnóstico por imagem , Neoplasias Ósseas/terapia , Estadiamento de Neoplasias/métodos , Osteossarcoma/diagnóstico por imagem , Osteossarcoma/terapia , Antineoplásicos/farmacologia , Progressão da Doença , Terapia Genética/métodos , Humanos , Imunoterapia/métodos , Imagem por Ressonância Magnética , Radioterapia/métodos , Tomografia Computadorizada por Raios X
4.
J Surg Oncol ; 123(5): 1299-1303, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33524202

RESUMO

BACKGROUND AND OBJECTIVES: Benign bone tumors are often treated with extended curettage utilizing an adjuvant therapy to eliminate any remaining tumor cells. The purpose of this study was to explore and compare the histologic depth of necrosis created by various adjuvant therapies used in the treatment of benign bone tumors. METHODS: A high-speed burr was utilized to create cortical defects within porcine humeri and femora. Phenol, polymethyl methacrylate (PMMA), argon beam coagulation (ABC), liquid nitrogen, and the Bipolar Hemostatic Sealer (BHS) were each applied to five defects, with an additional five defects left untreated as a control. The maximal depth of necrosis was determined under microscopic examination. RESULTS: The phenol, PMMA, ABC, liquid nitrogen, and BHS demonstrated an average histologic depth of necrosis of 0.30, 0.78, 2.54, 2.54, and 0.92 mm, respectively, each of which was significantly increased compared to the control group (p = .001, .003, .003, .01, and  <.001). Their respective variances, a measure of reproducibility, were 0.01, 0.09, 0.96, 1.93, and 0.03 mm2 . CONCLUSION: This study confirms, through histologic analysis, adjuvant therapies create a rim of cellular necrosis beyond that of burring during extended curettage, supporting their use in the treatment of benign bone tumors. Furthermore, it provides a head-to-head comparison.


Assuntos
Neoplasias Ósseas/patologia , Quimiorradioterapia Adjuvante/métodos , Neoplasias Ósseas/classificação , Neoplasias Ósseas/terapia , Humanos , Necrose , Prognóstico
5.
J Surg Oncol ; 123(5): 1274-1283, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33524203

RESUMO

BACKGROUNDS AND OBJECTIVES: This investigation sought to describe the outcomes of primary leiomyosarcoma of bone (PLB) compared to soft tissue leiomyosarcoma (SLMS). METHODS: This was a review of the Surveillance, Epidemiology, and End Results database from 1975 to 2016. Kaplan-Meier methods were used to estimate disease-specific survival (DSS), and a Cox regression model was used to identify prognostic factors. RESULTS: Of the 7502 identifiable cases, 1% (n = 74) were PLB and 99% (n = 7428) were SLMS. Survival was the same between PLB and SLMS (p = .209). On multivariable analysis for high-grade SLMS, radiation (neoadjuvant: hazard ratio [HR], 0.56; 95% confidence interval [CI], 0.4-0.8; p = .003; adjuvant: HR, 0.75; 95% CI, 0.6-0.9; p = .008) and surgery (procedure specific) improved DSS. For PLB, wide resection/limb salvage (HR, 0.40; 95% CI, 0.3-0.5; p = .018) and amputation (HR, 0.69; 95% CI, 0.5-0.9; p < .001) were positive prognostic factors. Neither radiation nor chemotherapy were prognostic factors for survival in PLB. CONCLUSIONS: For SLMS, radiation portends a survival advantage. For PLB, however, neither chemotherapy nor radiation were significant prognostic factors, which suggests the optimal treatment for PLB, similar to other primary soft tissue sarcomas originating in bone, remains an unmet medical need.


Assuntos
Neoplasias Ósseas/mortalidade , Leiomiossarcoma/mortalidade , Neoplasias de Tecidos Moles/mortalidade , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Neoplasias Ósseas/patologia , Neoplasias Ósseas/terapia , Criança , Pré-Escolar , Estudos de Coortes , Terapia Combinada , Feminino , Seguimentos , Humanos , Lactente , Recém-Nascido , Leiomiossarcoma/patologia , Leiomiossarcoma/terapia , Pessoa de Meia-Idade , Prognóstico , Neoplasias de Tecidos Moles/patologia , Neoplasias de Tecidos Moles/terapia , Taxa de Sobrevida , Adulto Jovem
6.
Int Orthop ; 45(3): 769-778, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33427899

RESUMO

BACKGROUND: Giant cell tumour (GCT) is an invasive benign bone tumour, and the incidence of pulmonary metastasis is rare. We are aiming to analyze risk factors of pulmonary metastasis and clinical prognosis for giant cell tumour patients with pulmonary metastasis. METHOD: We performed a retrospective study of 310 patients with GCT between December 2004 and December 2016. Risk factors of pulmonary metastasis were analyzed by univariate and multivariate logistic regression analysis. Then, the influence of risk factors of overall LR (local recurrence), recurrent tumor at presentation, LR after our therapy, and with soft tissue mass on the pulmonary metastasis-free survival rates was analyzed. RESULTS: The mean follow-up of the present cohort was 45.6 ± 35.3 months (median, 36.6 months; range, 6.1-193.4 months). Eighteen (5.8%) of 310 patients developed pulmonary metastasis. The average interval from surgery of primary tumour to detection of pulmonary metastasis was 15 months. Multivariate logistic regression analysis showed overall local recurrence was the independent risk factor of developing pulmonary metastasis. Among 18 patients with pulmonary metastasis, sixteen cases had history of local recurrence (88.9%, 16/18), including eleven (68.8%, 11/16) with local recurrence at presentation before receiving our therapy and seven (43.8%, 7/16) with local recurrence after receiving treatment in our hospital. Time to local recurrence had obvious difference between patients with and without pulmonary metastasis. Patients with pulmonary metastasis were prone to recur earlier. Furthermore, overall local recurrence, local recurrence after our therapy, recurrent tumor at presentation, and tumour with a soft tissue mass showed statistical differences in the pulmonary metastasis-free survival rates. CONCLUSIONS: Giant cell tumour patients with soft tissue mass and overall local recurrence are prone to develop pulmonary metastasis. Although giant cell tumour is a benign tumor, more attention should be paid to the problem of pulmonary metastatic lesions, and chest CT scan should be recommended during follow-up.


Assuntos
Neoplasias Ósseas , Tumor de Células Gigantes do Osso , Neoplasias Ósseas/epidemiologia , Neoplasias Ósseas/terapia , Tumor de Células Gigantes do Osso/epidemiologia , Humanos , Recidiva Local de Neoplasia/epidemiologia , Prognóstico , Estudos Retrospectivos
8.
Instr Course Lect ; 70: 475-492, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33438929

RESUMO

Metastatic bone disease to the pelvis can lead to lower quality of life and function secondary to pain. Historically, treatment was palliative with radiation therapy and chemotherapy used to reduce pain. The Harrington procedure and subsequent modifications improved pain and function. In the subset of patients with complications, this would delay potential life-prolonging interventions such as chemotherapy and radiation therapy. Percutaneous palliative pain procedures including ablation and cementoplasty have been developed by interventional radiology for pelvic lesions and have been shown to be safe and efficacious. Additionally, percutaneous methods of pelvic fracture fixation have been developed. Modern image guidance technologies have allowed an expanded multidisciplinary approach to pelvic metastatic disease in a minimally invasive fashion with combinations of ablation, internal fixation, and cementation to improve patient quality of life and outcomes with decreased morbidity and rapid return to radiation and systemic therapies.


Assuntos
Neoplasias Ósseas , Cementoplastia , Neoplasias Ósseas/terapia , Fixação Interna de Fraturas , Humanos , Qualidade de Vida , Resultado do Tratamento
9.
BMC Musculoskelet Disord ; 22(1): 18, 2021 Jan 05.
Artigo em Inglês | MEDLINE | ID: mdl-33402136

RESUMO

BACKGROUND: Like with all cancers, multidisciplinary team (MDT) meetings are the norm in bone and soft tissue tumour (BST) management too. Problem in attendance of specialists due to geographical location is the one of the key barriers to effective functioning of MDTs. To overcome this problem, virtual MDTs involving videoconferencing or telemedicine have been proposed, but however this has been seldom used and tested. The COVID-19 pandemic forced the implementation of virtual MDTs in the Oxford sarcoma service in order to maintain normal service provision. We conducted a survey among the participants to evaluate its efficacy. METHODS: An online questionnaire comprising of 24 questions organised into 4 sections was circulated among all participants of the MDT after completion of 8 virtual MDTs. Opinions were sought comparing virtual MDTs to the conventional face-to-face MDTs on various aspects. A total of 36 responses were received and were evaluated. RESULTS: 72.8% were satisfied with the depth of discussion in virtual MDTs and 83.3% felt that the decision-making in diagnosis had not changed following the switch from face-to-face MDTs. About 86% reported to have all essential patient data was available to make decisions and 88.9% were satisfied with the time for discussion of patient issues over virtual platform. Three-fourths of the participants were satisfied (36.1% - highly satisfied; 38.9% - moderately satisfied) with virtual MDTs and 55.6% of them were happy to attend MDTs only by the virtual platform in the future. Regarding future, 77.8% of the participants opined that virtual MDTs would be the future of cancer care and an overwhelming majority (91.7%) felt that the present exercise would serve as a precursor to global MDTs involving specialists from abroad in the future. CONCLUSION: Our study shows that the forced switch to virtual MDTs in sarcoma care following the unprecedented COVID-19 pandemic to be a viable and effective alternative to conventional face-to-face MDTs. With effective and efficient software in place, virtual MDTs would also facilitate in forming extended MDTs in seeking opinions on complex cases from specialists abroad and can expand cancer care globally.


Assuntos
Neoplasias Ósseas/terapia , Comunicação Interdisciplinar , Oncologia/organização & administração , Neoplasias Musculares/terapia , Equipe de Assistência ao Paciente/organização & administração , Sarcoma/terapia , Telemedicina/organização & administração , Comunicação por Videoconferência/organização & administração , Atitude do Pessoal de Saúde , Atitude Frente aos Computadores , Neoplasias Ósseas/diagnóstico , Tomada de Decisão Clínica , Prestação Integrada de Cuidados de Saúde/organização & administração , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Neoplasias Musculares/diagnóstico , Sarcoma/diagnóstico , Centros de Atenção Terciária
10.
West Afr J Med ; 38(1): 84-92, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-33463713

RESUMO

Giant cell tumours of bone are relatively uncommon, accounting for about 5% of all primary bone tumours. They are generally classified as benign bone tumours. However, some of them might be locally aggressive. The peak incidence is between second and fourth decades of life. They are commonly found at the epiphyseal and, occasionally, metaphyseal zones of long bones such as radius, femur and tibia. They most often present as painless swellings; however, pain may be experienced as a result of pressure on the surrounding soft tissues. The relevant diagnostic investigations that help in establishing the diagnosis include plain x-rays, Magnetic resonance imaging (MRI), CT and tissue biopsy for histological confirmation. Traditionally, surgery is the mainstay of treatment of the disease. Other modalities include radiation, tumour embolization and injectable drugs for surgically inaccessible or recurrent cases.


Assuntos
Neoplasias Ósseas , Tumor de Células Gigantes do Osso , Tíbia , Biópsia , Neoplasias Ósseas/diagnóstico por imagem , Neoplasias Ósseas/terapia , Tumor de Células Gigantes do Osso/diagnóstico por imagem , Tumor de Células Gigantes do Osso/terapia , Humanos , Imagem por Ressonância Magnética , Tíbia/diagnóstico por imagem , Tíbia/patologia , Tomografia Computadorizada por Raios X
11.
Bull Cancer ; 108(2): 163-176, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33455736

RESUMO

Sarcomas are a rare heterogeneous group of malignant neoplasms that can arise in almost any anatomic site and any age. Close collaboration among adult and pediatric cancer specialists in the management of these tumors is of foremost importance. In this review, we present the current multidisciplinary organization in care of patients with sarcoma in France and we review the main advances made in the last decades in systemic and radiotherapy treatment in the main sarcoma types diagnosed in children, adolescents and young adults (AYA), thanks to the international collaboration.


Assuntos
Neoplasias Ósseas/terapia , Institutos de Câncer , Equipe de Assistência ao Paciente/organização & administração , Sarcoma/terapia , Neoplasias de Tecidos Moles/terapia , Adolescente , Adulto , Fatores Etários , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Institutos de Câncer/organização & administração , Institutos de Câncer/provisão & distribução , Criança , Redes Comunitárias/organização & administração , Redes Comunitárias/provisão & distribução , Europa (Continente) , França , Humanos , Cooperação Internacional , Neoplasias Pulmonares/radioterapia , Neoplasias Pulmonares/secundário , Quimioterapia de Manutenção , Oncologia , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/radioterapia , Neoplasias Embrionárias de Células Germinativas/terapia , Osteossarcoma/terapia , Dosagem Radioterapêutica , Ensaios Clínicos Controlados Aleatórios como Assunto , Rabdomiossarcoma/terapia , Sarcoma Alveolar de Partes Moles/terapia , Sarcoma de Ewing/terapia , Sociedades Médicas , Adulto Jovem
12.
Tech Vasc Interv Radiol ; 23(4): 100705, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33308576

RESUMO

Neoplastic disease of the musculoskeletal system may result in serious morbidity and mortality secondary to cancer related bone pain, pathologic fracture, altered structural mechanics, and involvement of adjacent structures.1 Recent advances in cancer detection and treatment have allowed more patients to live longer. The prevalence of osseous metastatic disease has increased to 100,000 new patients developing bone metastases each year.2 These patients are seeing long-term exposure to chemotherapy and radiation leading to increased skeletal events, morbidity, and a negative impact on quality of life. Bone metastases in conjunction with poor bone quality often prevent surgical therapy. Utilization of thermal ablation in this patient population is supported by contemporary literature and offers a minimally invasive approach to pain palliation, local tumor control, and decreased morbidity with unique advantages compared to surgery or radiation.3 In addition to spine disease, interventional radiologists are able to meaningfully impact pelvic, shoulder girdle, and long bone metastases. Adding to ablation we have in our repertoire the ability to provide structural support utilizing cement and/or screw fixation as an adjunct for both pain palliation and mechanical stabilization.4-6 These novel therapies have allowed more patients with metastatic disease to be treated. The focus of this chapter is to highlight importance of patient selection, ablative modality selection, integration of cementoplasty (also described as osteoplasty) and osseous fixation, and procedural techniques/strategy in the pelvis and other common sites of bone metastases outside the spine.


Assuntos
Técnicas de Ablação , Neoplasias Ósseas/terapia , Manejo da Dor , Dor/prevenção & controle , Radiografia Intervencionista , Técnicas de Ablação/efeitos adversos , Neoplasias Ósseas/diagnóstico por imagem , Neoplasias Ósseas/secundário , Tomada de Decisão Clínica , Humanos , Dor/diagnóstico , Dor/etiologia , Manejo da Dor/efeitos adversos , Seleção de Pacientes , Radiografia Intervencionista/efeitos adversos , Fatores de Risco , Resultado do Tratamento
13.
Int J Nanomedicine ; 15: 10183-10197, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33363374

RESUMO

Purpose: Nanoparticle (NP)-based chemo-photothermal therapy (CPT) has been shown to be a promising non-invasive approach for antitumor treatment. However, NPs must overcome the limitations of opsonization, clearance of the reticuloendothelial system, and ineffective targeting of tumor tissue sites. To solve these problems, stem cell membrane (SCM)-camouflaged polydopamine nanoparticles (PDA@SCM NPs) carrying the hydrophobic anticancer drug 7-ethyl-10-hydroxycamptothecin (SN38) were constructed for CPT of malignant bone tumors. Methods: We developed umbilical-cord mesenchymal stem cell membrane-coated polydopamine nanoparticles encapsulating SN38 (PDA-SN38@SCM NPs) as an efficient tumor-targeting drug-delivery platform for CPT of malignant bone tumors. We characterized PDA@SCM NPs and evaluated the biocompatibility and anti-phagocytosis properties of PDA@SCM NPs. The antitumor activity of PDA-SN38@SCM NPs was evaluated in MG63 lines and an MG63 xenograft model in mice. Results: Synthesized PDA-SN38@SCM NPs retained an excellent photothermal effect after SN38 loading. The drug release of PDA-SN38@SCM NPs could be triggered by near-infrared irradiation and an acidic stimulus. PDA@SCM NPs exhibited lower nonspecific macrophage uptake, longer retention in blood, and more effective accumulation at tumor sites than that shown by PDA NPs. Confocal laser scanning microscopy (CLSM) and flow cytometry showed that MG63 cells took up more PDA-SN38@SCM NPs than PDA-SN38 NPs. In vitro and in vivo antitumor studies demonstrated the outstanding performance of PDA-SN38@SCM NPs in synergistic CPT for bone tumors. Conclusion: PDA-SN38@SCM NPs demonstrated an extraordinary synergistic CPT effect and could be a promising strategy for the treatment of malignant bone tumors.


Assuntos
Antineoplásicos/uso terapêutico , Neoplasias Ósseas/terapia , Membrana Celular/metabolismo , Indóis/química , Nanopartículas/química , Polímeros/química , Células-Tronco/metabolismo , Animais , Antineoplásicos/farmacologia , Materiais Biocompatíveis/química , Neoplasias Ósseas/tratamento farmacológico , Neoplasias Ósseas/patologia , Linhagem Celular Tumoral , Liberação Controlada de Fármacos , Feminino , Humanos , Evasão da Resposta Imune/efeitos dos fármacos , Irinotecano/farmacocinética , Irinotecano/farmacologia , Irinotecano/uso terapêutico , Camundongos , Camundongos Endogâmicos BALB C , Camundongos Nus , Nanopartículas/ultraestrutura , Células RAW 264.7 , Distribuição Tecidual/efeitos dos fármacos
14.
Curr Oncol ; 27(5): e512-e515, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-33173391

RESUMO

Sarcoma treatment during the covid-19 pandemic is a new challenge. This patient population is often immunocompromised and potentially more susceptible to viral complications. Government guidelines highlight the need to minimize patient exposure to unnecessary hospital visits. However, those guidelines lack practical recommendations on ways to manage triage and diagnosis expressly for new cancer patients. Furthermore, there are no reports on the efficiency of the guidelines. One of the main issues in treating musculoskeletal tumours is the complexity and variability of presentation. We offer a triage model, used in a quaternary-referral musculoskeletal oncology centre, that allows us to maintain an open pathway for referral of new patients while minimizing exposure risks. A multidisciplinary approach and analysis of existing investigations allow for a pre-clinic evaluation. The model identifies 3 groups of patients: ■ Patients with suspected high-grade malignancy, or benign cases with aggressive features, both in need of further evaluation in the clinic and prompt treatment■ Patients with low-grade malignancy, and benign cases whose treatment is not urgent, that are managed during the pandemic by telemedicine, with reassurance and information about their illness■ Patients who can be managed by their local medical professionals In comparison to a pre-pandemic period, that approach resulted in a higher ratio of malignant-to-benign conditions for new patients seen in the clinic (3:4 vs. 1:3 respectively), thus using available resources more efficiently and prioritizing patients with suspected high-grade malignancy. We believe that this triage system could be applied in other surgical oncology fields during a pandemic.


Assuntos
Betacoronavirus/isolamento & purificação , Neoplasias Ósseas/terapia , Infecções por Coronavirus/complicações , Pneumonia Viral/complicações , Guias de Prática Clínica como Assunto/normas , Neoplasias de Tecidos Moles/terapia , Telemedicina/métodos , Triagem/normas , Neoplasias Ósseas/virologia , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/virologia , Gerenciamento Clínico , Humanos , Pandemias , Pneumonia Viral/epidemiologia , Pneumonia Viral/virologia , Gestão de Riscos , Neoplasias de Tecidos Moles/virologia
15.
Bone Joint J ; 102-B(11): 1567-1573, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-33135449

RESUMO

AIMS: The aim of this study was to report the results of three forms of reconstruction for patients with a ditsl tibial bone tumour: an intercalary resection and reconstruction, an osteoarticular reconstruction, and arthrodesis of the ankle. METHODS: A total of 73 patients with a median age of 19 years (interquartile range (IQR) 14 to 36) were included in this retrospective, multicentre study. RESULTS: Reconstructions included intercalary resection in 17 patients, osteoarticular reconstruction in 11, and ankle arthrodesis in 45. The median follow-up was 77 months (IQR 35 to 130). Local recurrence occurred in eight patients after a median of 14 months (IQR 9 to 36), without a correlation with adequacy of margins or reconstructive technique. Major complications included fracture of the graft in ten patients, nonunion of the proximal osteotomy in seven, and infection in five. In the osteoarticular group, three of 11 patients developed radiological evidence of severe osteoarthritis, but only one was symptomatic and required conversion to ankle arthrodesis. Functional evaluation showed higher values of the Musculoskeletal Tumour Society (MSTS) and American Orthopaedic Foot and Ankle Society (AOFAS) scores in the intercalary group compared with the others. CONCLUSION: Preservation of the epiphysis in patients with a distal tibial bone tumour is a safe and effective form of limb-sparing treatment. It requires rigorous preoperative planning after accurate analysis of the imaging. When joint-sparing resection is not indicated, ankle arthrodesis, either isolated tibiotalar or combined tibiotalar and subtalar arthrodesis, should be preferred over osteoarticular reconstruction. Cite this article: Bone Joint J 2020;102-B(11):1567-1573.


Assuntos
Articulação do Tornozelo/cirurgia , Neoplasias Ósseas/cirurgia , Procedimentos Ortopédicos/métodos , Procedimentos Cirúrgicos Reconstrutivos/métodos , Tíbia/cirurgia , Adolescente , Adulto , Artrodese , Neoplasias Ósseas/terapia , Criança , Feminino , Humanos , Salvamento de Membro , Masculino , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
16.
Zhonghua Zhong Liu Za Zhi ; 42(8): 692-696, 2020 Aug 23.
Artigo em Chinês | MEDLINE | ID: mdl-32867464

RESUMO

Objective: To evaluate the efficacy and safety of polyethylene glycol liposome doxorubicin (PLD) in the treatment of osteosarcoma. Methods: This study was a single-center retrospective clinical study. Two hundreds and seventy-six classical osteosarcoma treated in Beijing Jishuitan Hospital from 2015 to 2016 were enrolled. There were 213 patients who received combined chemotherapy of high dose methotrexate, ifosfamide, cisplatin and doxorubicin (ADM) were classified in ADM group. Other 63 patients received the same types, doses and cycles of chemotherapy drugs except ADM replaced by PLD were identified as PLD group. Clinical and imaging evaluation and surgical treatment were performed after neoadjuvant chemotherapy. Tumor necrosis rate was examined according to Huvos method. The efficacy of neoadjuvant chemotherapy was evaluated based on 90% necrosis rate. The recurrence, metastasis and survival were followed up regularly after operation. The adverse reactions of hematology, hepatorenal toxicity, gastrointestinal reaction and cardiotoxicity were evaluated. Results: There were no significant differences between PLD group and ADM group in age, sex, location, stage and surgical margin (all P>0.05). There were no significant differences in clinical symptoms and imaging evaluation between PLD group and ADM group after preoperative chemotherapy (all P>0.05). The tumor necrosis rate was detected in 134 cases. Among 27 cases of PLD group, tumor necrosis rates more than 90% were 11 cases, while among 107 cases of ADM group, tumor necrosis rates more than 90% were 45 cases. No significant difference of tumor necrosis rate between this two group was observed (P=0.901). The recurrence rates of PLD group and ADM group were 7.8% (4/51) and 7.3% (12/164), the metastasis rates were 19.6% (10/51) and 16.5% (27/164), the median progression free survival (PFS) were 42 and 37 months, respectively, without significant differences (all P>0.05). The incidence of granulocytopenia and decrease degree of granulocytes in PLD group were significantly lower than those in ADM group (P<0.001). There were no significant differences in the incidences of thrombocytopenia, anemia, gastrointestinal reaction, liver function damage and stomatitis between two groups (all P>0.05). Conclusions: PLD and ADM have similar chemotherapeutic effects in osteosarcoma. The incidences of adverse reactions of PLD are lower, especially the hematological toxicity represented by granulocytopenia is significantly reduced. PLD has a better application prospect.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Neoplasias Ósseas/tratamento farmacológico , Neoplasias Ósseas/terapia , Lipossomos/uso terapêutico , Osteossarcoma/tratamento farmacológico , Neoplasias Ósseas/patologia , Cisplatino/administração & dosagem , Doxorrubicina/administração & dosagem , Extremidades , Humanos , Ifosfamida/administração & dosagem , Metotrexato/administração & dosagem , Metotrexato/uso terapêutico , Recidiva Local de Neoplasia , Osteoblastos/efeitos dos fármacos , Osteoblastos/patologia , Osteossarcoma/patologia , Polietilenoglicóis , Prognóstico , Estudos Retrospectivos
17.
Br J Radiol ; 93(1115): 20200465, 2020 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-32783618

RESUMO

Management of musculoskeletal (MSK) tumours has traditionally been delivered by surgeons and medical oncologists. However, in recent years, image-guided interventional oncology (IO) has significantly impacted the clinical management of MSK tumours. With the rapid evolution of relevant technologies and the expanding range of clinical indications, it is likely that the impact of IO will significantly grow and further evolve in the near future.In this narrative review, we describe well-established and new interventional technologies that are currently integrating into the IO armamentarium available to radiologists to treat MSK tumours and illustrate new emerging IO indications for treatment.


Assuntos
Neoplasias Ósseas/terapia , Oncologia/tendências , Neoplasias Musculares/terapia , Antineoplásicos/administração & dosagem , Dor do Câncer/terapia , Terapia Combinada/métodos , Criocirurgia/métodos , Eletroporação/métodos , Potenciais Evocados , Feminino , Fluoroscopia/métodos , Previsões , Fraturas Ósseas/terapia , Ablação por Ultrassom Focalizado de Alta Intensidade , Humanos , Doença Iatrogênica/prevenção & controle , Lipossomos/administração & dosagem , Imagem por Ressonância Magnética Intervencionista/métodos , Masculino , Micro-Ondas/uso terapêutico , Traumatismos dos Nervos Periféricos/etiologia , Traumatismos dos Nervos Periféricos/prevenção & controle , Ablação por Radiofrequência/métodos , Terapia por Radiofrequência/métodos , Radiologia Intervencionista/métodos , Radiologia Intervencionista/tendências , Neoplasias da Coluna Vertebral/terapia , Coluna Vertebral/cirurgia , Tomografia Computadorizada por Raios X/métodos , Ultrassonografia de Intervenção/métodos
18.
Int J Hematol ; 112(5): 666-673, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32783165

RESUMO

We retrospectively analyzed 51 patients with solitary plasmacytoma diagnosed from October 2002 to September 2018 from a cohort of 3575 patients with plasma cell dyscrasias registered in the Kansai Myeloma Forum. Twenty-seven patients had solitary bone plasmacytoma (SBP) and 24 had extramedullary plasmacytoma (EMP), with prevalence of 0.8% and 0.7%, respectively. The most frequent M protein was IgG (40%) in SBP, whereas non-secretory proteins were most frequent (50%) in EMP. Five-year overall survival was 78.2% in SBP and 80.8% in EMP (P = 0.894). Among patients with SBP, 44% progressed to MM with a median time of 10.5 months (2.4-93.3 months), whereas 8% of EMP patients progressed to MM with a median time of 18.6 months (13.0-24.2 months). The most frequent treatment was radiotherapy (41%) or observation (41%) in SBP, and chemotherapy (54%) in EMP. No statistically significant difference was observed upon univariate analysis of prognostic factors including age, sex, performance status, and IgG M protein. Our results suggest that there are biological differences between SBP and EMP in real-world settings.


Assuntos
Neoplasias Ósseas , Plasmocitoma , Sistema de Registros , Adulto , Idoso , Idoso de 80 Anos ou mais , Neoplasias Ósseas/epidemiologia , Neoplasias Ósseas/mortalidade , Neoplasias Ósseas/patologia , Neoplasias Ósseas/terapia , Progressão da Doença , Feminino , Humanos , Imunoglobulina G , Japão/epidemiologia , Masculino , Pessoa de Meia-Idade , Mieloma Múltiplo/etiologia , Proteínas do Mieloma , Plasmocitoma/epidemiologia , Plasmocitoma/mortalidade , Plasmocitoma/patologia , Plasmocitoma/terapia , Prognóstico , Estudos Retrospectivos , Taxa de Sobrevida
19.
F1000Res ; 92020.
Artigo em Inglês | MEDLINE | ID: mdl-32724558

RESUMO

Chordomas are rare and difficult-to-treat tumors arising from the embryonic notochord. While surgery is the mainstay of treatment, and despite new techniques aimed at maximizing total tumoral resection, recurrence remains high and the probability of disease-free survival low. New breakthroughs in genetics, targeted molecular therapy, and heavy-particle beam therapy offer some promise as adjuvant treatments in addition to surgical resection. A multidisciplinary approach encompassing genetics, immunotherapy, radiation therapy, and surgery, at a facility experienced in the management of this complex disease, offers the best chance of survival and quality of life to patients while limiting the intrinsic morbidity of these treatments.


Assuntos
Neoplasias Ósseas/terapia , Cordoma/terapia , Humanos , Recidiva Local de Neoplasia , Qualidade de Vida , Radiocirurgia
20.
BMJ Case Rep ; 13(7)2020 Jul 08.
Artigo em Inglês | MEDLINE | ID: mdl-32641312

RESUMO

A 17-year-old man with osteosarcoma of the proximal humerus was planned for possible limb salvage surgery after standard neoadjuvant chemotherapy. However, during the surgical phase of treatment, the COVID-19 or SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) outbreak occurred changing the healthcare landscape due to uncertainty regarding the virus, risk of COVID-19 infection and complications, and implementation of an enhanced community quarantine restricting movement of people within cities. Instead of limb salvage surgery, the patient underwent a forequarter amputation. Exposure to the virus in a high-risk hospital setting was minimised with patient discharge after a short hospital stay and home convalescence monitored by video conferencing. Multidisciplinary sarcoma team meetings with family members and a sarcoma navigator nurse were crucial in managing expectations and deciding on appropriate treatment in the setting of a novel infectious disease causing a pandemic.


Assuntos
Amputação/métodos , Neoplasias Ósseas , Cisplatino/administração & dosagem , Infecções por Coronavirus , Doxorrubicina/administração & dosagem , Úmero , Salvamento de Membro/métodos , Osteossarcoma , Pandemias , Pneumonia Viral , Adolescente , Antineoplásicos , Betacoronavirus , Neoplasias Ósseas/patologia , Neoplasias Ósseas/terapia , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Humanos , Úmero/diagnóstico por imagem , Úmero/cirurgia , Imagem por Ressonância Magnética/métodos , Masculino , Estadiamento de Neoplasias , Osteossarcoma/patologia , Osteossarcoma/terapia , Pandemias/prevenção & controle , Seleção de Pacientes , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle
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