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Choice of Local Therapy in Children With Ewing Sarcoma. Indian Pediatr 2020. [DOI: 10.1007/s13312-020-1843-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Is Microscopic Vascular Invasion in Tumor Specimens Associated with Worse Prognosis in Patients with High-grade Localized Osteosarcoma? Clin Orthop Relat Res 2020; 478:1190-1198. [PMID: 31904683 PMCID: PMC7319361 DOI: 10.1097/corr.0000000000001079] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Other than metastases at diagnosis and histological response to preoperative chemotherapy, there are few reliable predictors of survival in patients with osteosarcoma. Microscopic vascular invasion (MVI) has been identified in the resection specimens of patients with osteosarcoma. However, it is unknown whether the MVI in resected specimens is associated with worse overall survival and higher cumulative incidence of local recurrence or metastasis in a large cohort of patients younger than 40 years with high-grade localized osteosarcoma. QUESTIONS/PURPOSES (1) Is MVI associated with worse overall survival and higher cumulative incidence of events (local recurrence or metastasis) in patients younger than 40 years with high-grade localized osteosarcoma? (2) What clinical characteristics are associated with MVI in patients with high-grade localized osteosarcoma? METHODS A total of 625 patients younger than 40 years with primary high-grade osteosarcoma between 1997 and 2016 were identified in our oncology database. We included patients younger than 40 years with primary high-grade osteosarcoma who underwent definitive surgery and preoperative and postoperative chemotherapy. The minimum follow-up period was 2 years after treatment. Patients with the following were excluded: metastasis at initial presentation (21%, n = 133), progression with preoperative chemotherapy precluding definitive surgery (6%, n = 38), surgery at another unit (2%, n = 13), lost to follow-up before 2 years but not known to have died (3%, n = 18), and death related to complications of preoperative chemotherapy (1%, n = 4). A retrospective pathologic and record review was conducted in the remaining 419 patients. The median follow-up period was 5 years (interquartile range [IQR] 3 to 9 years). The overall survival of the entire group (n = 419) was 67% [95% CI 63 to 72] at 5 years. Of the 419 patients, 10% (41) had MVI in their resection specimens. The Kaplan-Meier method was used to estimate overall survival. The cumulative incidence of events captured the first event of either metastasis or local recurrence. This analysis was completed with a competing risk framework: deaths without evidence of local recurrence or metastasis were regarded as a competing event. Clinical and histological variables (sex, age, tumor site, tumor largest dimension, surgical margin, chemotherapy-induced necrosis, type of surgery, histologic type of tumor, type of chemotherapy regimen, pathologic fracture, and MVI) were evaluated using the log-rank test or Gray test in the univariate analyses and Cox proportional hazard model or Fine and Gray model in the multivariate analyses. RESULTS After adjusting for other factors, multivariate analyses showed that the presence of MVI in resection specimens was associated with worse overall survival and higher cumulative incidence of event (hazard ratio 1.88 [95% CI 1.22 to 2.89]; p = 0.004 and HR 2.33 [95% CI 1.56 to 3.49]; p < 0.001, respectively). A subgroup analysis demonstrated that the relationship between MVI and survival applied only to patients with a poor response to chemotherapy (less than 90% necrosis; overall survival at 5 years, MVI [+] = 24% [95% CI 11 to 39] versus MVI [-] = 60% [95% CI 52 to 66]; p < 0.001 and cumulative incidence of events at 5 years, MVI [+] = 86% [95% CI 68 to 94] versus MVI [-] = 54% [95% CI 46 to 61]; p < 0.001). The MVI (+) group had a higher proportion of patients with a poor response to chemotherapy (85% [35 of 41] versus 53% [201 of 378]; p < 0.001), involved margins (15% [6 of 41] versus 5% [18 of 378]; p = 0.021), and limb-ablative surgery (37% [15 of 41] versus 21% [79 of 378]; p = 0.022) than the MVI (-) group did. CONCLUSIONS MVI is associated with lower overall survival and higher cumulative incidence of local recurrence or metastasis, especially in patients with a poor histologic response to preoperative chemotherapy. Future studies in patients treated for osteosarcoma should consider this observation when planning new trials. LEVEL OF EVIDENCE Level III, therapeutic study.
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The sensitivity, specificity, and diagnostic accuracy of whole-bone MRI for identifying skip metastases in appendicular osteosarcoma and Ewing sarcoma. Skeletal Radiol 2020; 49:913-919. [PMID: 31900513 DOI: 10.1007/s00256-019-03364-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 12/06/2019] [Accepted: 12/09/2019] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Pre-operative whole-bone MRI is required to assess intra-osseous tumour extent and to identify skip metastases in cases of bone sarcoma. The current study aims to determine the sensitivity, specificity, and diagnostic accuracy of whole-bone MRI for the identification of skip metastases. MATERIALS AND METHOD Review of 162 patients with long bone osteosarcoma or Ewing sarcoma who had undergone whole-bone MRI to assess intra-osseous tumour length and identify skip metastases. Comparison was made with post-chemotherapy MRI to look for a change in the appearance of suspected skip metastases, and resection specimens were assessed for the presence of skip metastases. The presence of local osseous recurrence was determined at final follow-up. RESULTS There were 112 males and 50 females (mean age 18.8 years), with 119 osteosarcomas and 43 Ewing sarcomas. Skip metastases were diagnosed on whole-bone MRI in 23 cases (14.2%). In 2 cases, pre-operative needle biopsy diagnosed enchondromata, resulting in false positive diagnoses. Skip metastases were diagnosed in the resection specimens in 3 cases, and based on comparison with post-chemotherapy MRI in 12. There was no evidence of local osseous recurrence in 160 patients, while late recurrence occurred in 2 patients. Sensitivity was calculated as 88.2%, specificity as 97.6%, and diagnostic accuracy as 96.7%. CONCLUSION Whole-bone MRI has a high sensitivity, specificity, and diagnostic accuracy for the identification of skip metastases in osteosarcoma and Ewing sarcoma. The possibility of false positive skip lesions and late local osseous recurrence is also highlighted.
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Liu H, Nazmun N, Hassan S, Liu X, Yang J. BRAF mutation and its inhibitors in sarcoma treatment. Cancer Med 2020; 9:4881-4896. [PMID: 32476297 PMCID: PMC7367634 DOI: 10.1002/cam4.3103] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 03/26/2020] [Accepted: 04/16/2020] [Indexed: 12/11/2022] Open
Abstract
The mitogen‐activated protein kinase (MAPK) signaling pathway plays a significant role in mediating cellular physiological activities, such as proliferation, differentiation, apoptosis, and senescence. This signaling pathway is composed of several major proto‐oncogenes of RAS/RAF/MEK/ERK, among which the BRAF proto‐oncogene, as one of the three members of the RAF family, has a higher mutation rate than ARAF and CRAF and has attracted extensive attention. Regarding the BRAF mutation, approximately 95% of BRAF mutations belong to the BRAF V600E mutation, which can enhance the expression of the MAPK signaling pathway and is thus related to the occurrence and development of various malignant tumors and has been successfully identified as a therapeutic target. Moreover, drug resistance to BRAF inhibitor treatment also appears to be an important issue. Considering the successful use of BRAF inhibitors in melanoma, we provide a brief overview of the BRAF mutations, including their basic structures and activation mechanisms, and the new classification method for BRAF mutations. Most importantly, we summarize the results of BRAF inhibitor treatment in different sarcomas. To overcome drug resistance to BRAF inhibitor treatment, we also outline the different mechanisms of drug resistance to BRAF inhibitor treatment and introduce the combination strategy of BRAF inhibitors with other targeted therapies.
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Affiliation(s)
- Haotian Liu
- Department of Bone and Soft Tissue Tumor, Tianjin Medical University Cancer Institute & Hospital, Tianjin, P.R. China
| | - Nahar Nazmun
- Department of Bone and Soft Tissue Tumor, Tianjin Medical University Cancer Institute & Hospital, Tianjin, P.R. China.,National Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute & Hospital, Tianjin, P.R. China.,International Medical School, Tianjin Medical University, Tianjin, P.R. China
| | - Shafat Hassan
- Department of Bone and Soft Tissue Tumor, Tianjin Medical University Cancer Institute & Hospital, Tianjin, P.R. China.,National Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute & Hospital, Tianjin, P.R. China.,International Medical School, Tianjin Medical University, Tianjin, P.R. China
| | - Xinyue Liu
- Department of Bone and Soft Tissue Tumor, Tianjin Medical University Cancer Institute & Hospital, Tianjin, P.R. China.,National Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute & Hospital, Tianjin, P.R. China
| | - Jilong Yang
- Department of Bone and Soft Tissue Tumor, Tianjin Medical University Cancer Institute & Hospital, Tianjin, P.R. China.,National Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute & Hospital, Tianjin, P.R. China
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105
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Kurisunkal V, Botchu R, Davies AM, James SL, Jeys L. Computer assisted tumour surgery - An insight. J Orthop 2020; 22:268-273. [PMID: 32467658 DOI: 10.1016/j.jor.2020.04.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 04/06/2020] [Accepted: 04/26/2020] [Indexed: 11/30/2022] Open
Abstract
Success in the management of bone sarcomas entails being able to achieve wide margins, which helps decrease the risk of local recurrence and provide an improvement in overall survival. The role of computer-assisted surgery has been investigated across various areas of orthopaedics, including joint replacement, cruciate ligament reconstruction, and pedicle screw placements which has led to increased interested in computer assisted tumour surgery (CATS). CATS can be used in a wide array of tumour surgeries, however its role in pelvic and sacral tumours is unparalled. Its importance lies in being able to provide radiological information to guide the surgeon at the time of surgery i.e. the distance from the tumour to the resection margin can be determined precisely based on preoperative planning and intra-operative image guidance. This minimises unnecessary bone resection, aiming to achieve good oncological and functional results which can be challenging in pelvic surgery. Most published articles on CATS have concentrated on the surgical aspects of navigation surgery. Although advanced imaging techniques such as magnetic resonance imaging (MRI) and computed tomography (CT) scans can provide anatomic detail about the primary tumour, the successful transfer of that information from a viewing screen to the intraoperative field can be difficult. The role of the radiologist lies in being able to provide appropriate imaging (CT, MRI) to facilitate surgical planning. This article aims at providing the radiologist a surgical insight on CATS and to facilitate optimal imaging in a patient tentatively being planned for CATS.
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Affiliation(s)
- V Kurisunkal
- Department of Orthopaedic Oncology Royal Orthopaedic Hospital, Birmingham, UK
| | - R Botchu
- Department of Musculoskeletal Radiology, Royal Orthopaedic Hospital, Birmingham, UK
| | - A M Davies
- Department of Musculoskeletal Radiology, Royal Orthopaedic Hospital, Birmingham, UK
| | - S L James
- Department of Musculoskeletal Radiology, Royal Orthopaedic Hospital, Birmingham, UK
| | - L Jeys
- Department of Orthopaedic Oncology Royal Orthopaedic Hospital, Birmingham, UK
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Image-guided core needle biopsy for Ewing sarcoma of bone: a 10-year single-institution review. Eur Radiol 2020; 30:5308-5314. [PMID: 32468104 DOI: 10.1007/s00330-020-06926-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 03/26/2020] [Accepted: 04/28/2020] [Indexed: 01/18/2023]
Abstract
OBJECTIVE To evaluate the performance of image-guided core needle biopsy (IGCNB) for the diagnosis of Ewing sarcoma of bone. METHODS All patients with a confirmed diagnosis of Ewing sarcoma who underwent IGCNB between January 2007 and December 2016 were included in this retrospective study. Analysis included mean age, skeletal distribution, imaging modality used for biopsy guidance, type of anaesthesia, needle type, number of passes, type of tissue sampled, and complications. RESULTS The study included 139 patients (94 males and 45 females; mean age 18.7 years) who underwent 141 image-guided core needle biopsies as the primary diagnostic test. Of these, 101 were CT-guided, 38 ultrasound-guided, and 2 utilised both CT and ultrasound guidance. A total of 97.9% were diagnostic at first procedure. Of the 3 non-diagnostic cases, 2 underwent a further IGCNB and were positive, while 1 patient required an open surgical procedure. Only 1 patient (0.7%) suffered an immediate complication, and there were no recorded delayed complications. CONCLUSION IGCNB is a safe procedure providing a positive diagnosis of Ewing sarcoma of bone in a very high percentage of cases. It should be the first-line method for establishing a diagnosis in suspected Ewing sarcoma of bone. KEY POINTS • Image-guided core needle biopsy is a safe procedure providing a positive diagnosis of Ewing sarcoma of bone in a very high percentage of cases. • Image-guided core needle biopsy should be the first-line method for establishing a definitive diagnosis in Ewing sarcoma and should be performed at a specialist sarcoma referral centre. • When technically feasible, extra-osseous soft tissue alone can be sampled with confidence as there is no difference in diagnostic performance whether bone or an extra-osseous soft tissue component of the tumour is sampled.
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107
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Jettoo P, Tan G, Gerrand CH, Rankin KS. Role of routine blood tests for predicting clinical outcomes in osteosarcoma patients. J Orthop Surg (Hong Kong) 2020; 27:2309499019838293. [PMID: 30909848 DOI: 10.1177/2309499019838293] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND This retrospective cohort study aimed to investigate whether simple routine blood tests at presentation (C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), alkaline phosphatase and albumin) predict survival in patients with osteosarcoma. METHODS Between January 1998 and February 2015, 134 patients with a histological diagnosis of osteosarcoma were treated in our unit. Of these, 79 patients with high-grade osteosarcomas were included in the study. Demographic and clinical data, and laboratory parameters obtained prior to biopsy (CRP, ESR, alkaline phosphatase and albumin levels), were obtained from patients' records. RESULTS There were 44 males and 35 females. Univariate analysis showed that high pre-biopsy CRP ( p = 0.004), raised pre-biopsy ESR ( p = 0.010), older age ( p < 0.001), poor tumour necrosis rates (≤90%, p = 0.023) and metastasis at presentation ( p < 0.001) were poor prognostic factors. Multivariate analysis showed pre-biopsy CRP and ESR levels to be independent predictors of overall survival ( p = 0.020 and p = 0.025, respectively). Kaplan-Meier survival was significantly lower in patients with elevated CRP ( p = 0.002) and ESR ( p = 0.003). Hypoalbuminaemia and elevated alkaline phosphatase levels did not correlate with overall survival. CONCLUSION Preoperative CRP and ESR levels may have value in building a prognostic model for patients presenting with osteosarcoma.
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Affiliation(s)
- P Jettoo
- 1 Northern Deanery Training Programme, Newcastle upon Tyne, UK
| | - Gjs Tan
- 2 East Suffolk & North Essex NHS Foundation Trust, The Ipswich Hospital, Ipswich, UK
| | - C H Gerrand
- 3 Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, UK
| | - K S Rankin
- 4 North of England Bone and Soft Tissue Tumour Service, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK.,5 Northern Institute for Cancer Research, Newcastle University, Newcastle upon Tyne, UK
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108
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Advances in image enhancement for sarcoma surgery. Cancer Lett 2020; 483:1-11. [PMID: 32247870 DOI: 10.1016/j.canlet.2020.03.029] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 03/19/2020] [Accepted: 03/29/2020] [Indexed: 12/12/2022]
Abstract
The recurrence rate of soft tissue and bone sarcomas strongly correlates to the status of the surgical margin after excision, yet excessive removal of tissue may lead to distinct, otherwise avoidable morbidity. Therefore, adequate margination of sarcomas both pre- and intra-operatively is a clinical necessity that has not yet fully been met. Current guidance for soft-tissue sarcomas recommends an ultrasound scan followed by magnetic resonance imaging (MRI). For bone sarcomas, two plane radiographs are required, followed similarly by an MRI scan. The introduction of more precise imaging modalities may reduce the morbidity associated with sarcoma surgery; the PET-CT and PET-MRI approaches in particular demonstrating high clinical efficacy. Despite advancements in the accuracy in pre-operative imaging, translation of an image to surgical margins is difficult, regularly resulting in wider resection margins than required. For soft tissue sarcomas there is currently no standard technique for image guided resections, while for bone sarcomas fluoroscopy may be used, however margins are not easily discernible during the surgical procedure. Near infra-red (NIR) fluorescence guided surgery offers an intra-operative modality through which complete tumour resection with adequate tumour-free margins may be achieved, while simultaneously minimising surgical morbidity. NIR imaging presents a potentially valuable adjunct to sarcoma surgery. Early reports indicate that it may be able to provide the surgeon with helpful information on anatomy, perfusion, lymphatic drainage, tumour margins and metastases. The use of NIR fluorochromes have also been demonstrated to be well tolerated by patients. However, prior to widespread implementation, studies related to cost-effectiveness and the development of protocols are essential. Nevertheless, NIR imaging may become ubiquitous in the future, carrying the potential to transform the surgical management of sarcoma.
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109
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Assessment of Familiarity With Work-up Guidelines for Bone and Soft Tissue Sarcoma Among Primary Care Practitioners in Minnesota. MAYO CLINIC PROCEEDINGS: INNOVATIONS, QUALITY & OUTCOMES 2020; 4:143-149. [PMID: 32280924 PMCID: PMC7140016 DOI: 10.1016/j.mayocpiqo.2019.12.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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CORR Insights®: Is There an Association Between Insurance Status and Survival and Treatment of Primary Bone and Extremity Soft-tissue Sarcomas? A SEER Database Study. Clin Orthop Relat Res 2020; 478:537-539. [PMID: 31498260 PMCID: PMC7145082 DOI: 10.1097/corr.0000000000000932] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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111
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Abstract
Chondrosarcomas in children and adolescents are uncommon and constitute < 5% of all chondrosarcomas. There are very few studies discussing extremity chondrosarcomas in young patients. The pelvis is the most common site, followed by the proximal femur. As cartilaginous tumours can be quite challenging to diagnose, it is best for these lesions to be discussed in a multidisciplinary meeting which includes a radiologist and a pathologist specializing in bone tumours. Treatment principles are similar to those in adults, with adequate surgical excision respecting oncologic principles being the mainstay of treatment. Select extremity Grade I chondrosarcomas may be managed with extended intralesional curettage without increasing the risk for local recurrence or metastatic disease, but case selection is critical and should be based on clinical, imaging and histological characteristics. Chondrosarcomas are resistant to chemotherapy and relatively radioresistant. For mesenchymal chondrosarcomas, there may be a role for chemotherapy, though data on this is limited. Prognosis and rate of recurrence correlate directly to the adequacy of the surgical resection. Chondrosarcomas in younger patients behave in a similar fashion to those in adults, and outcomes in the young are no different from those in adults.
Cite this article: EFORT Open Rev 2020;5:90-95. DOI: 10.1302/2058-5241.5.190052
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Affiliation(s)
- Ajay Puri
- Department of Surgery, Tata Memorial Hospital, HBNI, Mumbai
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112
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Abstract
After initial treatment of sarcoma, disease progression may occur in the form of local recurrence, pulmonary metastases, or extrapulmonary metastases. As such, surveillance is an important aspect of management, but no universally accepted practice standards are found. In the absence of strong evidence, and to allow for individualized care, existing guidelines contain flexibility in terms of both the frequency and modality of surveillance. In general, they agree that follow-up should be more intense in the early years after treatment, especially for high-grade sarcomas, and continue for at least 10 years. For local recurrence, data suggest that physical examination is usually sufficient for monitoring; in addition, some guidelines endorse imaging routinely, whereas others only as clinically indicated. For pulmonary metastasis, either radiograph or CT is recommended, with the latter having theoretical advantages but no proven survival benefit to date. Extrapulmonary metastases are rare in most sarcoma types, so the literature only supports extrapulmonary surveillance for certain diagnoses. This topic is complicated by the diversity of sarcomas, the limited evidence, and the indefinite, often conflicting recommendations; therefore, it is critical for providers to understand the existing research and guidelines to determine optimal surveillance strategies for their patients.
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113
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Which Factors Are Associated with Local Control and Survival of Patients with Localized Pelvic Ewing's Sarcoma? A Retrospective Analysis of Data from the Euro-EWING99 Trial. Clin Orthop Relat Res 2020; 478:290-302. [PMID: 31580267 PMCID: PMC7438129 DOI: 10.1097/corr.0000000000000962] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Local treatment of pelvic Ewing's sarcoma may be challenging, and intergroup studies have focused on improving systemic treatments rather than prospectively evaluating aspects of local tumor control. The Euro-EWING99 trial provided a substantial number of patients with localized pelvic tumors treated with the same chemotherapy protocol. Because local control included surgical resection, radiation therapy, or a combination of both, we wanted to investigate local control and survival with respect to the local modality in this study cohort. QUESTIONS/PURPOSES (1) Do patients with localized sacral tumors have a lower risk of local recurrence and higher survival compared with patients with localized tumors of the innominate bones? (2) Is the local treatment modality associated with local control and survival in patients with sacral and nonsacral tumors? (3) Which local tumor- and treatment-related factors, such as response to neoadjuvant chemotherapy, institution where the biopsy was performed, and surgical complications, are associated with local recurrence and patient survival in nonsacral tumors? (4) Which factors, such as persistent extraosseous tumor growth after chemotherapy or extent of bony resection, are independently associated with overall survival in patients with bone tumors undergoing surgical treatment? METHODS Between 1998 and 2009, 1411 patients with previously untreated, histologically confirmed Ewing's sarcoma were registered in the German Society for Pediatric Oncology and Hematology Ewing's sarcoma database and treated in the Euro-EWING99 trial. In all, 24% (339 of 1411) of these patients presented with a pelvic primary sarcoma, 47% (159 of 339) of which had macroscopic metastases at diagnosis and were excluded from this analysis. The data from the remaining 180 patients were reviewed retrospectively, based on follow-up data as of July 2016. The median (range) follow-up was 54 months (5 to 191) for all patients and 84 months (11 to 191) for surviving patients. The study endpoints were overall survival, local recurrence and event-free survival probability, which were calculated with the Kaplan-Meier method and compared using the log-rank test. Hazard ratios (HRs) with their respective 95% CIs were estimated in a multivariate Cox regression model. RESULTS Sacral tumors were associated with a reduced probability of local recurrence (12% [95% CI 1 to 22] versus 28% [95% CI 20 to 36] at 5 years, p = 0.032), a higher event-free survival probability (66% [95% CI 51 to 81] versus 50% [95% CI 41 to 58] at 5 years, p = 0.026) and a higher overall survival probability (72% [95% CI 57 to 87] versus 56% [95% CI 47 to 64] at 5 years, p = 0.025) compared with nonsacral tumors. With the numbers available, we found no differences between patients with sacral tumors who underwent definitive radiotherapy and those who underwent combined surgery and radiotherapy in terms of local recurrence (17% [95% CI 0 to 34] versus 0% [95% CI 0 to 20] at 5 years, p = 0.125) and overall survival probability (73% [95% CI 52 to 94] versus 78% [95% CI 56 to 99] at 5 years, p = 0.764). In nonsacral tumors, combined local treatment was associated with a lower local recurrence probability (14% [95% CI 5 to 23] versus 33% [95% CI 19 to 47] at 5 years, p = 0.015) and a higher overall survival probability (72% [95% CI 61 to 83] versus 47% [95% CI 33 to 62] at 5 years, p = 0.024) compared with surgery alone. Even in a subgroup of patients with wide surgical margins and a good histologic response to induction treatment, the combined local treatment was associated with a higher overall survival probability (87% [95% CI 74 to 100] versus 51% [95% CI 33 to 69] at 5 years, p = 0.009), compared with surgery alone.A poor histologic response to induction chemotherapy in nonsacral tumors (39% [95% CI 19 to 59] versus 64% [95% CI 52 to 76] at 5 years, p = 0.014) and the development of surgical complications after tumor resection (35% [95% CI 11 to 59] versus 68% [95% CI 58 to 78] at 5 years, p = 0.004) were associated with a lower overall survival probability in nonsacral tumors, while a tumor biopsy performed at the same institution where the tumor resection was performed was associated with lower local recurrence probability (14% [95% CI 4 to 24] versus 32% [95% CI 16 to 48] at 5 years, p = 0.035), respectively.In patients with bone tumors who underwent surgical treatment, we found that after controlling for tumor localization in the pelvis, tumor volume, and surgical margin status, patients who did not undergo complete (defined as a Type I/II resection for iliac bone tumors, a Type II/III resection for pubic bone and ischium tumors and a Type I/II/III resection for tumors involving the acetabulum, according to the Enneking classification) removal of the affected bone (HR 5.04 [95% CI 2.07 to 12.24]; p < 0.001), patients with a poor histologic response to induction chemotherapy (HR 3.72 [95% CI 1.51 to 9.21]; p = 0.004), and patients who did not receive additional radiotherapy (HR 4.34 [95% CI 1.71 to 11.05]; p = 0.002) had a higher risk of death. The analysis suggested that the same might be the case in patients with a persistent extraosseous tumor extension after induction chemotherapy (HR 4.61 [95% CI 1.03 to 20.67]; p = 0.046), although the wide CIs pointing at a possible sparse-data bias precluded any definitive conclusions. CONCLUSION Patients with sacral Ewing's sarcoma appear to have a lower probability for local recurrence and a higher overall survival probability compared with patients with tumors of the innominate bones. Our results seem to support a recent recommendation of the Scandinavian Sarcoma Group to locally treat most sacral Ewing's sarcomas with definitive radiotherapy. Combined surgical resection and radiotherapy appear to be associated with a higher overall survival probability in nonsacral tumors compared with surgery alone, even in patients with a wide resection and a good histologic response to neoadjuvant chemotherapy. Complete removal of the involved bone, as defined above, in patients with nonsacral tumors may be associated with a decreased likelihood of local recurrence and improved overall survival. Persistent extraosseous tumor growth after induction treatment in patients with nonsacral bone tumors undergoing surgical treatment might be an important indicator of poorer overall survival probability, but the possibility of sparse-data bias in our cohort means that this factor should first be validated in future studies. LEVEL OF EVIDENCE Level III, therapeutic study.
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114
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Thierfelder KM, Niendorf S, Gerhardt JS, Weber MAD. [Bone tumors and metastases: tips for initial diagnosis and follow-up : Update 2019]. Radiologe 2020; 60:169-178. [PMID: 31974747 DOI: 10.1007/s00117-019-00635-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Benign bone tumors are frequently discovered as incidental findings, whereas malignant tumors and metastases often become clinically noticeable due to pain or swelling. The initial radiological diagnostics by conventional X‑ray imaging, magnetic resonance imaging (MRI) and computed tomography (CT) play an important role in the assessment of dignity and further treatment planning. The aftercare of bone tumors is necessary for the recognition of recurrences and distant metastases as well as the detection of complications, e.g. after implantation of a prosthesis. Implanted metal and posttherapeutic alterations can impede the aftercare due to artifacts and treatment-associated tissue alterations. In addition to the recommendations of the Association of the Scientific Medical Societies in Germany (AWMF), the European Organisation for Research and Treatment of Cancer (EORTC) and the European Society of Musculoskeletal Radiology (ESSR), study protocols can be used as orientation for the aftercare of individual primary malignant bone tumors.
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Affiliation(s)
- Kolja M Thierfelder
- Institut für Diagnostische und Interventionelle Radiologie, Kinder- und Neuroradiologie, Ernst-Heydemann-Str. 6, 18057, Rostock, Deutschland.
| | - Sophie Niendorf
- Institut für Diagnostische und Interventionelle Radiologie, Kinder- und Neuroradiologie, Ernst-Heydemann-Str. 6, 18057, Rostock, Deutschland
| | - Judith S Gerhardt
- Institut für Diagnostische und Interventionelle Radiologie, Kinder- und Neuroradiologie, Ernst-Heydemann-Str. 6, 18057, Rostock, Deutschland
| | - Marc-An Dré Weber
- Institut für Diagnostische und Interventionelle Radiologie, Kinder- und Neuroradiologie, Ernst-Heydemann-Str. 6, 18057, Rostock, Deutschland
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Shemesh SS, Pretell-Mazzini J, Quartin PAJ, Rutenberg TF, Conway SA. Surgical treatment of low-grade chondrosarcoma involving the appendicular skeleton: long-term functional and oncological outcomes. Arch Orthop Trauma Surg 2019; 139:1659-1666. [PMID: 31020410 DOI: 10.1007/s00402-019-03184-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND The traditional treatment for chondrosarcoma is wide local excision (WLE), as these tumors are resistant to chemotherapy and radiation treatment. While achieving negative margins has traditionally been the goal of chondrosarcoma resection, multiple studies have demonstrated good short-term results after intralesional procedures for low-grade chondrosarcomas (LGCS) with curettage and adjuvant treatments (phenol application, cauterization or cryotherapy) followed by either cementation or bone grafting. Due to the rarity of this diagnosis and the recent application of this surgical treatment modality to chondrosarcoma, most of the information regarding treatment outcomes is retrospective, with short or intermediate-term follow-up. The aim of this study was to assess the long-term results of patients with LGCS of bone treated with intralesional curettage (IC) treatment versus WLE. This retrospective analysis aims to characterize the oncologic outcomes (local recurrence, metastases) and functional outcomes in these two treatment groups at a single institution. METHODS Using an institutional musculoskeletal oncologic database, we retrospectively reviewed medical records of all patients with LGCS of the appendicular skeleton that underwent surgical treatment between 1985 and 2007. Thirty-two patients (33 tumors) were identified with LGCS; 17 treated with IC and 15 with WLE. RESULTS Seventeen patients (18 tumors) with a minimum clinical and radiologic follow-up of 10 years were included. Nine patients were treated with IC (four with no adjuvant, three with additional phenol, one with liquid nitrogen and one with H2O2) with either bone graft or cement augmentation, and nine others were treated with WLE and reconstruction with intercalary/osteoarticular allograft or megaprosthesis. The mean age at surgery was 41 years (range 14-66 years) with no difference (p = 0.51) between treatment cohorts. There was a mean follow-up of 13.5 years in the intralesional cohort (range 10-19 years) and 15.9 years in the WLE cohort (range 10-28 years, p = 0.36). Tumor size varied significantly between groups and was larger in patients treated with WLE (8.2 ± 3.1 cm versus 5.4 ± 1.2 cm, at the greatest dimension, p = 0.021). There were two local recurrences (LR), one in the intralesional group and one in the wide local excision group, occurring at 3.5 months and 2.9 years, respectively, and both required revision. No further LR could be detected with long-term follow-up. The MSTS score at final follow-up was significantly higher for patients managed with intralesional procedures (28.7 ± 1.7 versus 25.7 ± 3.4, p = 0.033). There were less complications requiring reoperation in the intralesional group compared with the wide local excision group, although this difference was not found to be statistically significant (one versus four patients, respectively; p = 0.3). CONCLUSION This series of low-grade chondrosarcoma, surgically treated with an intralesional procedures, with 10-year follow-up, demonstrates excellent local control (88.9%). Complications were infrequent and minor and MSTS functional scores were excellent. Wide resection of LGCS was associated with lower MSTS score and more complications. In our series, the LR in both groups were detected within the first 3.5 years following the index procedure, and none were detected in the late surveillance period.
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Affiliation(s)
- Shai S Shemesh
- Department of Orthopedic Surgery, Rabin Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Juan Pretell-Mazzini
- Department of Orthopaedic Surgery, Musculoskeletal Oncology Division, University of Miami-Miller School of Medicine, 1400 NW 12th Avenue, East Building, 4th Floor, Suite 4036, Miami, FL, USA.
| | | | - Tal Frenkel Rutenberg
- Department of Orthopedic Surgery, Rabin Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Sheila A Conway
- Department of Orthopaedic Surgery, Musculoskeletal Oncology Division, University of Miami-Miller School of Medicine, 1400 NW 12th Avenue, East Building, 4th Floor, Suite 4036, Miami, FL, USA
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Tween H, Peake D, Spooner D, Sherriff J. Radiotherapy for the Palliation of Advanced Sarcomas-The Effectiveness of Radiotherapy in Providing Symptomatic Improvement for Advanced Sarcomas in a Single Centre Cohort. Healthcare (Basel) 2019; 7:healthcare7040120. [PMID: 31635409 PMCID: PMC6955748 DOI: 10.3390/healthcare7040120] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Accepted: 10/15/2019] [Indexed: 01/26/2023] Open
Abstract
Background: Sarcomas are rare and heterogeneous tumours with a large proportion of patients requiring palliative intervention. They are regarded as relatively radioresistant and therefore achieving good palliation with radiation may require larger doses than for more common solid tumour types. Limited data is available regarding appropriate palliative radiotherapy dose fractionation. This case series aims to assess the effectiveness of radiotherapy in providing symptomatic improvement for advanced sarcomas. Method: Data was retrospectively collected for patients treated with palliative radiotherapy between July 2010 and April 2019 at one institution. The primary outcome was documented symptomatic improvement following radiotherapy. Secondary outcome was overall survival. Results: One hundred and five patients had a total of 137 sites treated using 25 different dose fractionation schedules. The median patient age was 54 (range 8–90) years. Treated sites included 114 soft tissue and 23 bone sarcomas. Data on symptomatic improvement was available in 56% and 67% of cases respectively. A total of 70% of soft tissue and 55% of bone sarcoma patients reported symptomatic improvement. Symptomatic response rates appeared to increase to a biological effective dose (BED) of 50Grey4 (Gy4) (alpha beta ratio (α/β) = 4 for tumour) but did not continue to improve with further rises in dose beyond this. Conclusion: Palliative radiotherapy offers symptomatic improvement for sarcoma patients with two-thirds of patients reporting reduction in symptoms. These results are limited by the heterogeneous study population including different sarcoma subtypes each with a probable different radio-sensitivity, treated with different radiotherapy schedules. Further prospective data collection is needed considering sarcoma subtype radio-sensitivity, to determine appropriate palliative dose fractionation schedules.
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Affiliation(s)
- Hannah Tween
- Hall-Edwards Radiotherapy Research Group, Queen Elizabeth Hospital, Birmingham, B15 2WB, UK.
| | - David Peake
- Hall-Edwards Radiotherapy Research Group, Queen Elizabeth Hospital, Birmingham, B15 2WB, UK.
| | - David Spooner
- Hall-Edwards Radiotherapy Research Group, Queen Elizabeth Hospital, Birmingham, B15 2WB, UK.
| | - Jenny Sherriff
- Hall-Edwards Radiotherapy Research Group, Queen Elizabeth Hospital, Birmingham, B15 2WB, UK.
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Martins A, Whelan JS, Bennister L, Fern LA, Gerrand C, Onasanya M, Storey L, Wells M, Windsor R, Woodford J, Taylor RM. Qualitative study exploring patients experiences of being diagnosed and living with primary bone cancer in the UK. BMJ Open 2019; 9:e028693. [PMID: 31551374 PMCID: PMC6773292 DOI: 10.1136/bmjopen-2018-028693] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVE The aim of this study is to explore the experiences of patients with primary bone cancer. DESIGN Qualitative study design using semistructured interviews and focus groups. SETTING Hospitals across the UK and recruitment through UK sarcoma charities and support groups. METHODS Semistructured telephone/face-to-face interviews and focus groups with a purposive sample of 26 participants. Data were analysed using Framework Analysis. PARTICIPANTS Patients (n=26) with primary bone cancer aged 13-77 years. The majority were male (69%), white (85%); diagnosed within 4 years (54%); and had lower limb sarcoma (65%). Ten participants had undergone an upper/lower limb amputation (39%). RESULTS The health-related quality-of-life domains of physical, emotional and social well-being and healthcare professionals' role were the overarching themes of analysis. The physical domain anchored patient experiences. The intensity and length of treatment, the severity of side-effects, the level of disability after surgery and the uncertainty of their prognosis had an impact on patient's self-image, confidence, mood and identity, and caused disruption to various aspects of the patients' social life, including their relationships (emotional and sexual) and participation in work/school and leisure activities. Adaptation was influenced by the way patients dealt with stress and adversity, with some finding a new outlook in life, and others struggling with finding their 'new normal'. Family and friends were the main source of support. Healthcare professional's expertise and support was critical. Rehabilitation services had a considerable role in patient's physical and emotional well-being, but inequitable access to these services was apparent. CONCLUSIONS This study described the impact of primary bone cancer on patients' well-being and adjustment over time with the identification of influencing factors of better/worse experiences. It showed that impact was felt after end of treatment and affected patients at different life stages. Holistic models of survivorship care are needed.
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Affiliation(s)
- Ana Martins
- Cancer Division, University College London Hospitals NHS Foundation Trust, London, UK
| | - Jeremy S Whelan
- Cancer Division, University College London Hospitals NHS Foundation Trust, London, UK
| | | | - Lorna A Fern
- Cancer Division, University College London Hospitals NHS Foundation Trust, London, UK
| | - Craig Gerrand
- Sarcoma Service, Royal National Orthopaedic Hospital Stanmore, Stanmore, UK
| | - Maria Onasanya
- Cancer Division, University College London Hospitals NHS Foundation Trust, London, UK
| | - Lesley Storey
- Department of Psychology, Birmingham City University, Birmingham, UK
| | - Mary Wells
- Imperial College Healthcare NHS Trust, London, UK
| | - Rachael Windsor
- Cancer Division, University College London Hospitals NHS Foundation Trust, London, UK
| | - Julie Woodford
- Sarcoma Service, Royal National Orthopaedic Hospital Stanmore, Stanmore, UK
| | - Rachel M Taylor
- Cancer Division, University College London Hospitals NHS Foundation Trust, London, UK
- CNMAR, University College London Hospitals NHS Foundation Trust, London, UK
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Bouaoud J, Beinse G, Epaillard N, Amor-Sehlil M, Bidault F, Brocheriou I, Hervé G, Spano JP, Janot F, Boudou-Rouquette P, Benassarou M, Schouman T, Goudot P, Malouf G, Goldwasser F, Bertolus C. Lack of efficacy of neoadjuvant chemotherapy in adult patients with maxillo-facial high-grade osteosarcomas: A French experience in two reference centers. Oral Oncol 2019; 95:79-86. [DOI: 10.1016/j.oraloncology.2019.06.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Revised: 05/08/2019] [Accepted: 06/07/2019] [Indexed: 02/07/2023]
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Palmerini E, Torricelli E, Cascinu S, Pierini M, De Paolis M, Donati D, Cesari M, Longhi A, Abate M, Paioli A, Setola E, Ferrari S. Is there a role for chemotherapy after local relapse in high-grade osteosarcoma? Pediatr Blood Cancer 2019; 66:e27792. [PMID: 31058424 DOI: 10.1002/pbc.27792] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2018] [Revised: 03/26/2019] [Accepted: 04/17/2019] [Indexed: 01/24/2023]
Abstract
BACKGROUND High-grade bone osteosarcoma has a high relapse rate. The best treatment of local recurrence (LR) is under discussion. The aim of this study is to analyze LR patterns and factors prognostic for survival. METHODS LR diagnostic modality (clinical or imaging), pattern of recurrence, and post-LR survival (PLRS) were assessed. RESULTS Sixty-two patients were identified, with median age 21 years (range, 9-75 years), including 11 (18%) ≤15 years, 30 (48%) from 16 to 29 years; 21 (34%) were older. Patterns of relapse were LR only 58%, LR + distant metastases (DM) 42%. Seventy-nine percent of patients relapsed within 24 months, and diagnosis was clinical in 88%. LR treatment was surgery 85%, chemotherapy 55%, chemotherapy + surgery 45%. Surgical complete remission after LR (CR2) was achieved in 60% (LR 86%; LR + DM 23%). With a median follow-up of 43 months (range, 5-235 months), the five-year PLRS was 37%, significantly better for patients with longer LR-free interval (LRFI; ≤24 months 31% vs > 24 months 61.5%, P = 0.03), absence of DM (no DM 56% vs DM 11.5%, P = 0.0001), and achievement of CR2 (no CR2 0% vs CR2 58.5%, P = 0.0001). No difference was found according to age and chemotherapy (LR only: five-year PLRS: 53% without chemotherapy vs 58% with chemotherapy, P = 0.9; LR + DM: five-year PLRS: 25% without chemotherapy vs 9% with chemotherapy, P = 0.7). CONCLUSIONS Early relapse is detected by symptoms in 90% of cases and associated with worse outcome. The achievement of CR2, not age, is crucial for survival. For patients with LR only, better survival was demonstrated, as compared with DM, and no improvement with chemotherapy after surgery was found.
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Affiliation(s)
| | - Elisa Torricelli
- Department of Oncology, University Hospital of Modena and Reggio Emilia, Modena, Italy
| | - Stefano Cascinu
- Department of Oncology, University Hospital of Modena and Reggio Emilia, Modena, Italy
| | - Michela Pierini
- Chemotherapy Unit, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | | | - Davide Donati
- Department of Orthopaedic Oncology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Marilena Cesari
- Chemotherapy Unit, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Alessandra Longhi
- Chemotherapy Unit, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Massimo Abate
- Chemotherapy Unit, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Anna Paioli
- Chemotherapy Unit, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Elisabetta Setola
- Chemotherapy Unit, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Stefano Ferrari
- Chemotherapy Unit, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
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Lex JR, Gregory J, Allen C, Reid JP, Stevenson JD. Distinguishing bone and soft tissue infections mimicking sarcomas requires multimodal multidisciplinary team assessment. Ann R Coll Surg Engl 2019; 101:405-410. [PMID: 31155889 PMCID: PMC6554572 DOI: 10.1308/rcsann.2019.0040] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/23/2019] [Indexed: 12/11/2022] Open
Abstract
INTRODUCTION The aims of this study were to report the presenting characteristics and identify how best to distinguish bone and soft-tissue infections that mimic sarcomas. MATERIALS AND METHODS A total of 238 (211 osteomyelitis and 27 soft-tissue infections) patients referred to a tertiary sarcoma multidisciplinary team with suspected sarcoma who were ultimately diagnosed with a bone or soft tissue infection were included. Data from a prospectively collated database was analysed retrospectively. RESULTS Of all possible bone and soft-tissue sarcoma referrals, a diagnosis of infection was made in 2.1% and 0.7%, respectively. Median age was 18 years in the osteomyelitis group and 46 years in the soft-tissue infection group. In the osteomyelitis group, the most common presenting features were pain (85.8%) and swelling (32.7%). In the soft-tissue infection group, the most common clinical features were swelling (96.3%) and pain (70.4%). Those in the soft-tissue group were more likely to have raised inflammatory markers. Radiological investigations were unable to discern between tumour or infection in 59.7% of osteomyelitis and 81.5% of soft-tissue infection cases. No organism was identified in 64.9% of those who had a percutaneous biopsy culture. CONCLUSIONS This study has highlighted that infection is frequently clinically indistinguishable from sarcoma and remains a principle non-neoplastic differential diagnosis. When patients are investigated for suspected sarcoma, infections can be missed due to falsely negative radiological investigations and percutaneous biopsy. As no single clinical, biochemical or radiological feature or investigation can be relied upon for diagnosis, clinicians should have a low threshold for tissue biopsy and discussion in a sarcoma multidisciplinary team meeting.
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Affiliation(s)
- JR Lex
- Royal Orthopaedic Hospital Oncology Service, Birmingham, UK
| | - J Gregory
- Royal Orthopaedic Hospital Oncology Service, Birmingham, UK
| | - C Allen
- Royal Orthopaedic Hospital Oncology Service, Birmingham, UK
| | - JP Reid
- Royal Orthopaedic Hospital Oncology Service, Birmingham, UK
| | - JD Stevenson
- Royal Orthopaedic Hospital Oncology Service, Birmingham, UK
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121
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Gomez-Brouchet A, Mascard E, Siegfried A, de Pinieux G, Gaspar N, Bouvier C, Aubert S, Marec-Bérard P, Piperno-Neumann S, Marie B, Larousserie F, Galant C, Fiorenza F, Anract P, Sales de Gauzy J, Gouin F. Assessment of resection margins in bone sarcoma treated by neoadjuvant chemotherapy: Literature review and guidelines of the bone group (GROUPOS) of the French sarcoma group and bone tumor study group (GSF-GETO/RESOS). Orthop Traumatol Surg Res 2019; 105:773-780. [PMID: 30962172 DOI: 10.1016/j.otsr.2018.12.015] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Revised: 12/04/2018] [Accepted: 12/07/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND Standardized reports are essential to meeting the bone sarcoma reference center certification requirements of the French National Cancer Institute (INCa). The usual classifications of the Musculoskeletal Tumor Society (MSTS), the American Joint Committee on Cancer (AJCC/IUCC) TNM R classification and the American College of Pathologists, are inexact inasmuch as they fail to include chemotherapy impact on tumor cells in assessing surgical margins. This leads to inconsistent interpretation by teams managing bone sarcoma. The present literature analysis sought to assess the limitations of existing classifications for purposes of standardized reporting of the management of surgical specimens from patients with osteosarcoma or Ewing sarcoma receiving neoadjuvant chemotherapy, by addressing the following questions: 1) What is the prognostic value of margins and chemotherapy response in the classifications? 2) What are the histologic changes induced by chemotherapy, with what impact on interpretation of margins? METHOD A PubMed literature analysis was performed, targeting the prognostic value of resection margin assessment, in September 2018. French bone pathology group (Groupe français des pathologistes osseux) and international guidelines on bone specimen management were referred to so as select items for a standardized report. Eight of the 523 articles retrieved met the study eligibility criteria. RESULTS Minimal distance between tumor and surgical margin, with a>2mm threshold, seemed to be the optimal parameter for predicting local recurrence. Good chemotherapy response and appendicular skeletal location were associated with lower risk of local recurrence. None of the available classifications take into account the microscopic changes induced by chemotherapy in interpreting resection margins. DISCUSSION To standardize practice, GROUPOS developed a standardized report for bone sarcoma specimens, considering the histopathologic changes in the tumor after neoadjuvant chemotherapy. The TNM R system was adapted and a threshold of>2mm was chosen as an acceptable limit to qualify surgical resection as safe (R0). R1 status (≤2mm) was subdivided into subgroups a, b and c, to include margin measurement in relation to the post-chemotherapy scar: R1a, resection within the scar; R1b, resection in healthy tissue,≤2mm from the scar and/or residual viable cells; and R1c, resection within the lesion in contact with viable cells or within coagulation necrosis areas. The GROUPOS members drew up this standardized report so as to ensure a common language, improving bone sarcoma management in specialized centers. Reliable data can thus be established for national and international multicenter studies. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Anne Gomez-Brouchet
- Département de pathologie, IUCT-oncopole, CHU de Toulouse and université de Toulouse, 1, avenue Irène Joliot Curie, 31059 Toulouse cedex 9, France.
| | - Eric Mascard
- Département de chirurgie orthopédique pédiatrique, hôpital-Necker, 149, rue de Sèvres, 75015 Paris, France
| | - Aurore Siegfried
- Département de pathologie, IUCT-oncopole, CHU de Toulouse and université de Toulouse, 1, avenue Irène Joliot Curie, 31059 Toulouse cedex 9, France
| | - Gonzague de Pinieux
- Service d'anatomie et cytologie pathologiques et université de Tours, CHRU de Tours, Avenue de la République, 37170 Chambray-lès-Tours, France
| | - Nathalie Gaspar
- Département de cancérologie de l'enfant et l'adolescent, Gustave-Roussy cancer campus, 114, rue Edouard Vaillant, 94800 Villejuif, France
| | - Corinne Bouvier
- Département de pathologie, CHU la Timone, 278, rue Saint-Pierre, 13005 Marseille, France
| | - Sébastien Aubert
- Université de lille - institut de pathologie, centre de biologie pathologie, 1, rue Philippe Marache, 59000 Lille, France
| | - Perrine Marec-Bérard
- Département d' oncologie pédiatrique, IHOPe/Centre Léon Bérard, 28, promenade Léa et Napoléon Bullukian, 69008 Lyon, France
| | | | - Béatrice Marie
- Département de Pathologie, CHU Nancy, 25, rue Lionnois, 54000 Nancy, France
| | - Frédérique Larousserie
- Service de pathologie et université Paris Descartes, AP-HP, hôpital Cochin, 27, rue du Faubourg Saint-Jacques, 75014 Paris, France
| | - Christine Galant
- Service d'anatomie pathologique des cliniques universitaires Saint-Luc, 10, avenue Hippocrate, 1200 Brussels, Belgium
| | - Fabrice Fiorenza
- Département de chirurgie orthopédique, CHU de Limoges, 2, avenue Martin Luther King, 87000 Limoges, France
| | - Philippe Anract
- Département de chirurgie orthopédique, CHU de Cochin, AP-HP, 27, rue du Faubourg Saint-Jacques, 75014 Paris, France
| | - Jérôme Sales de Gauzy
- Département de chirurgie orthopédique pédiatrique, hôpital-Mère-Enfant, CHU Toulouse, 330, avenue de Grande Bretagne, 31300 Toulouse, France
| | - François Gouin
- Centre Léon-Bérard, CHU Nantes, Nantes/Inserm, UMR 1238, Phy-Os, université de Nantes, 28, rue Laennec, 69008 Lyon France
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Stamatopoulos A, Stamatopoulos T, Gamie Z, Kenanidis E, Ribeiro RDC, Rankin KS, Gerrand C, Dalgarno K, Tsiridis E. Mesenchymal stromal cells for bone sarcoma treatment: Roadmap to clinical practice. J Bone Oncol 2019; 16:100231. [PMID: 30956944 PMCID: PMC6434099 DOI: 10.1016/j.jbo.2019.100231] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2019] [Revised: 03/14/2019] [Accepted: 03/18/2019] [Indexed: 12/12/2022] Open
Abstract
Over the past few decades, there has been growing interest in understanding the molecular mechanisms of cancer pathogenesis and progression, as it is still associated with high morbidity and mortality. Current management of large bone sarcomas typically includes the complex therapeutic approach of limb salvage or sacrifice combined with pre- and postoperative multidrug chemotherapy and/or radiotherapy, and is still associated with high recurrence rates. The development of cellular strategies against specific characteristics of tumour cells appears to be promising, as they can target cancer cells selectively. Recently, Mesenchymal Stromal Cells (MSCs) have been the subject of significant research in orthopaedic clinical practice through their use in regenerative medicine. Further research has been directed at the use of MSCs for more personalized bone sarcoma treatments, taking advantage of their wide range of potential biological functions, which can be augmented by using tissue engineering approaches to promote healing of large defects. In this review, we explore the use of MSCs in bone sarcoma treatment, by analyzing MSCs and tumour cell interactions, transduction of MSCs to target sarcoma, and their clinical applications on humans concerning bone regeneration after bone sarcoma extraction.
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Key Words
- 5-FC, 5-fluorocytosine
- AAT, a1-antitrypsin
- APCs, antigen presenting cells
- ASC, adipose-derived stromal/stem cells
- Abs, antibodies
- Ang1, angiopoietin-1
- BD, bone defect
- BMMSCs, bone marrow-derived mesenchymal stromal cells
- Biology
- Bone
- CAM, cell adhesion molecules
- CCL5, chemokine ligand 5
- CCR2, chemokine receptor 2
- CD, classification determinants
- CD, cytosine deaminase
- CLUAP1, clusterin associated protein 1
- CSPG4, Chondroitin sulfate proteoglycan 4
- CX3CL1, chemokine (C-X3-C motif) ligand 1
- CXCL12/CXCR4, C-X-C chemokine ligand 12/ C-X-C chemokine receptor 4
- CXCL12/CXCR7, C-X-C chemokine ligand 12/ C-X-C chemokine receptor 7
- CXCR4, chemokine receptor type 4
- Cell
- DBM, Demineralized Bone Marrow
- DKK1, dickkopf-related protein 1
- ECM, extracellular matrix
- EMT, epithelial-mesenchymal transition
- FGF-2, fibroblast growth factors-2
- FGF-7, fibroblast growth factors-7
- GD2, disialoganglioside 2
- HER2, human epidermal growth factor receptor 2
- HGF, hepatocyte growth factor
- HMGB1/RACE, high mobility group box-1 protein/ receptor for advanced glycation end-products
- IDO, indoleamine 2,3-dioxygenase
- IFN-α, interferon alpha
- IFN-β, interferon beta
- IFN-γ, interferon gamma
- IGF-1R, insulin-like growth factor 1 receptor
- IL-10, interleukin-10
- IL-12, interleukin-12
- IL-18, interleukin-18
- IL-1b, interleukin-1b
- IL-21, interleukin-21
- IL-2a, interleukin-2a
- IL-6, interleukin-6
- IL-8, interleukin-8
- IL11RA, Interleukin 11 Receptor Subunit Alpha
- MAGE, melanoma antigen gene
- MCP-1, monocyte chemoattractant protein-1
- MMP-2, matrix metalloproteinase-2
- MMP2/9, matrix metalloproteinase-2/9
- MRP, multidrug resistance protein
- MSCs, mesenchymal stem/stromal cells
- Mesenchymal
- NF-κB, nuclear factor kappa-light-chain-enhancer of activated B cells
- OPG, osteoprotegerin
- Orthopaedic
- PBS, phosphate-buffered saline
- PDGF, platelet-derived growth factor
- PDX, patient derived xenograft
- PEDF, pigment epithelium-derived factor
- PGE2, prostaglandin E2
- PI3K/Akt, phosphoinositide 3-kinase/protein kinase B
- PTX, paclitaxel
- RANK, receptor activator of nuclear factor kappa-B
- RANKL, receptor activator of nuclear factor kappa-B ligand
- RBCs, red blood cells
- RES, reticuloendothelial system
- RNA, ribonucleic acid
- Regeneration
- SC, stem cells
- SCF, stem cells factor
- SDF-1, stromal cell-derived factor 1
- STAT-3, signal transducer and activator of transcription 3
- Sarcoma
- Stromal
- TAAs, tumour-associated antigens
- TCR, T cell receptor
- TGF-b, transforming growth factor beta
- TGF-b1, transforming growth factor beta 1
- TNF, tumour necrosis factor
- TNF-a, tumour necrosis factor alpha
- TRAIL, tumour necrosis factor related apoptosis-inducing ligand
- Tissue
- VEGF, vascular endothelial growth factor
- VEGFR, vascular endothelial growth factor receptor
- WBCs, white blood cell
- hMSCs, human mesenchymal stromal cells
- rh-TRAIL, recombinant human tumour necrosis factor related apoptosis-inducing ligand
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Affiliation(s)
- Alexandros Stamatopoulos
- Academic Orthopaedic Unit, Papageorgiou General Hospital, Aristotle University Medical School, West Ring Road of Thessaloniki, Pavlos Melas Area, N. Efkarpia, 56403 Thessaloniki, Greece
- Center of Orthopaedics and Regenerative Medicine (C.O.RE.), Center for Interdisciplinary Research and Innovation (C.I.R.I.), Aristotle University Thessaloniki, Greece
| | - Theodosios Stamatopoulos
- Academic Orthopaedic Unit, Papageorgiou General Hospital, Aristotle University Medical School, West Ring Road of Thessaloniki, Pavlos Melas Area, N. Efkarpia, 56403 Thessaloniki, Greece
- Center of Orthopaedics and Regenerative Medicine (C.O.RE.), Center for Interdisciplinary Research and Innovation (C.I.R.I.), Aristotle University Thessaloniki, Greece
| | - Zakareya Gamie
- Northern Institute for Cancer Research, Paul O'Gorman Building, Medical School, Newcastle University, Framlington Place, Newcastle upon Tyne NE2 4HH, UK
| | - Eustathios Kenanidis
- Academic Orthopaedic Unit, Papageorgiou General Hospital, Aristotle University Medical School, West Ring Road of Thessaloniki, Pavlos Melas Area, N. Efkarpia, 56403 Thessaloniki, Greece
- Center of Orthopaedics and Regenerative Medicine (C.O.RE.), Center for Interdisciplinary Research and Innovation (C.I.R.I.), Aristotle University Thessaloniki, Greece
| | - Ricardo Da Conceicao Ribeiro
- School of Mechanical and Systems Engineering, Stephenson Building, Claremont Road, Newcastle upon Tyne NE1 7RU, UK
| | - Kenneth Samora Rankin
- Northern Institute for Cancer Research, Paul O'Gorman Building, Medical School, Newcastle University, Framlington Place, Newcastle upon Tyne NE2 4HH, UK
| | - Craig Gerrand
- Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, HA7 4LP, UK
| | - Kenneth Dalgarno
- School of Mechanical and Systems Engineering, Stephenson Building, Claremont Road, Newcastle upon Tyne NE1 7RU, UK
| | - Eleftherios Tsiridis
- Academic Orthopaedic Unit, Papageorgiou General Hospital, Aristotle University Medical School, West Ring Road of Thessaloniki, Pavlos Melas Area, N. Efkarpia, 56403 Thessaloniki, Greece
- Center of Orthopaedics and Regenerative Medicine (C.O.RE.), Center for Interdisciplinary Research and Innovation (C.I.R.I.), Aristotle University Thessaloniki, Greece
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123
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Gatfield ER, Noble DJ, Barnett GC, Early NY, Hoole ACF, Kirkby NF, Jefferies SJ, Burnet NG. Tumour Volume and Dose Influence Outcome after Surgery and High-dose Photon Radiotherapy for Chordoma and Chondrosarcoma of the Skull Base and Spine. Clin Oncol (R Coll Radiol) 2019; 30:243-253. [PMID: 29402600 DOI: 10.1016/j.clon.2018.01.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Revised: 11/15/2017] [Accepted: 11/20/2017] [Indexed: 11/27/2022]
Abstract
AIMS To evaluate the long-term outcomes of patients with chordoma and low-grade chondrosarcoma after surgery and high-dose radiotherapy. MATERIALS AND METHODS High-dose photon radiotherapy was delivered to 28 patients at the Neuro-oncology Unit at Addenbrooke's Hospital (Cambridge, UK) between 1996 and 2016. Twenty-four patients were treated with curative intent, 17 with chordoma, seven with low-grade chondrosarcoma, with a median dose of 65 Gy (range 65-70 Gy). Local control and survival rates were calculated using the Kaplan-Meier method. RESULTS The median follow-up was 83 months (range 7-205 months). The 5 year disease-specific survival for chordoma patients treated with radical intent was 85%; the local control rate was 74%. The 5 year disease-specific survival for chondrosarcoma patients treated with radical intent was 100%; the local control rate was 83%. The mean planning target volume (PTV) was 274.6 ml (median 124.7 ml). A PTV of 110 ml or less was a good predictor of local control, with 100% sensitivity and 63% specificity. For patients treated with radical intent, this threshold of 110 ml or less for the PTV revealed a statistically significant difference when comparing local control with disease recurrence (P = 0.019, Fisher's exact test). Our data also suggest that the probability of disease control may be partly related to both target volume and radiotherapy dose. CONCLUSION Our results show that refined high-dose photon radiotherapy, following tumour resection by a specialist surgical team, is effective in the long-term control of chordoma and low-grade chondrosarcoma, even in the presence of metal reconstruction. The results presented here will provide a useful source for comparison between high-dose photon therapy and proton beam therapy in a UK setting, in order to establish best practice for the management of chordoma and low-grade chondrosarcoma.
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Affiliation(s)
- E R Gatfield
- Oncology Centre, Addenbrooke's Hospital, Cambridge, UK.
| | - D J Noble
- University of Cambridge Department of Oncology, Cambridge Biomedical Campus, Addenbrooke's Hospital, Cambridge, UK
| | - G C Barnett
- Oncology Centre, Addenbrooke's Hospital, Cambridge, UK
| | - N Y Early
- Department of Medical Physics and Clinical Engineering, Addenbrooke's Hospital, Cambridge, UK
| | - A C F Hoole
- Department of Medical Physics and Clinical Engineering, Addenbrooke's Hospital, Cambridge, UK
| | - N F Kirkby
- Division of Molecular and Clinical Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, UK; Christie Medical Physics and Engineering, The Christie NHS Foundation Trust, Manchester, UK
| | - S J Jefferies
- Oncology Centre, Addenbrooke's Hospital, Cambridge, UK
| | - N G Burnet
- University of Cambridge Department of Oncology, Cambridge Biomedical Campus, Addenbrooke's Hospital, Cambridge, UK
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124
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Saifuddin A, Sharif B, Gerrand C, Whelan J. The current status of MRI in the pre-operative assessment of intramedullary conventional appendicular osteosarcoma. Skeletal Radiol 2019; 48:503-516. [PMID: 30288560 DOI: 10.1007/s00256-018-3079-1] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Revised: 09/08/2018] [Accepted: 09/16/2018] [Indexed: 02/08/2023]
Abstract
Osteosarcoma is the commonest primary malignant bone tumour in children and adolescents, the majority of cases being conventional intra-medullary high-grade tumours affecting the appendicular skeleton. Treatment is typically with a combination of neo-adjuvant chemotherapy, tumour resection with limb reconstruction and post-operative chemotherapy. The current article reviews the role of magnetic resonance imaging (MRI) in the pre-operative assessment of high-grade central conventional osteosarcoma.
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Affiliation(s)
- Asif Saifuddin
- Department of Imaging, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, HA7 4LP, UK
| | - Ban Sharif
- Department of Imaging, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, HA7 4LP, UK.
| | - Craig Gerrand
- Department of Orthopaedic Oncology, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, HA7 4LP, UK
| | - Jeremy Whelan
- Medical Oncology, University College London Hospital, 235 Euston Rd, London, NW1 2BU, UK
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125
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Whole-body MRI vs bone scintigraphy in the staging of Ewing sarcoma of bone: a 12-year single-institution review. Eur Radiol 2019; 29:5700-5708. [DOI: 10.1007/s00330-019-06132-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Revised: 02/14/2019] [Accepted: 03/06/2019] [Indexed: 12/15/2022]
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126
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Iaquinta MR, Mazzoni E, Manfrini M, D'Agostino A, Trevisiol L, Nocini R, Trombelli L, Barbanti-Brodano G, Martini F, Tognon M. Innovative Biomaterials for Bone Regrowth. Int J Mol Sci 2019; 20:E618. [PMID: 30709008 PMCID: PMC6387157 DOI: 10.3390/ijms20030618] [Citation(s) in RCA: 80] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Revised: 01/25/2019] [Accepted: 01/29/2019] [Indexed: 12/16/2022] Open
Abstract
The regenerative medicine, a new discipline that merges biological sciences and the fundamental of engineering to develop biological substitutes, has greatly benefited from recent advances in the material engineering and the role of stem cells in tissue regeneration. Regenerative medicine strategies, involving the combination of biomaterials/scaffolds, cells, and bioactive agents, have been of great interest especially for the repair of damaged bone and bone regrowth. In the last few years, the life expectancy of our population has progressively increased. Aging has highlighted the need for intervention on human bone with biocompatible materials that show high performance for the regeneration of the bone, efficiently and in a short time. In this review, the different aspects of tissue engineering applied to bone engineering were taken into consideration. The first part of this review introduces the bone cellular biology/molecular genetics. Data on biomaterials, stem cells, and specific growth factors for the bone regrowth are reported in this review.
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Affiliation(s)
- Maria Rosa Iaquinta
- Department of Morphology, Surgery, and Experimental Medicine, University of Ferrara, 44121 Ferrara, Italy.
| | - Elisa Mazzoni
- Department of Morphology, Surgery, and Experimental Medicine, University of Ferrara, 44121 Ferrara, Italy.
| | - Marco Manfrini
- Department of Morphology, Surgery, and Experimental Medicine, University of Ferrara, 44121 Ferrara, Italy.
| | | | | | - Riccardo Nocini
- Department of Surgery, University of Verona, 37129 Verona, Italy.
| | - Leonardo Trombelli
- Research Centre for the Study of Periodontal and Peri-Implant Diseases, University of Ferrara, 44121 Ferrara, Italy.
| | | | - Fernanda Martini
- Department of Morphology, Surgery, and Experimental Medicine, University of Ferrara, 44121 Ferrara, Italy.
| | - Mauro Tognon
- Department of Morphology, Surgery, and Experimental Medicine, University of Ferrara, 44121 Ferrara, Italy.
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127
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Ali NM, Niada S, Brini AT, Morris MR, Kurusamy S, Alholle A, Huen D, Antonescu CR, Tirode F, Sumathi V, Latif F. Genomic and transcriptomic characterisation of undifferentiated pleomorphic sarcoma of bone. J Pathol 2018; 247:166-176. [PMID: 30281149 DOI: 10.1002/path.5176] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Revised: 08/24/2018] [Accepted: 09/25/2018] [Indexed: 12/13/2022]
Abstract
Undifferentiated pleomorphic sarcoma of bone (UPSb) is a rare primary bone sarcoma that lacks a specific line of differentiation. There is very little information about the genetic alterations leading to tumourigenesis or malignant transformation. Distinguishing between UPSb and other malignant bone sarcomas, including dedifferentiated chondrosarcoma and osteosarcoma, can be challenging due to overlapping features. To explore the genomic and transcriptomic landscape of UPSb tumours, whole-exome sequencing (WES) and RNA sequencing (RNA-Seq) were performed on UPSb tumours. All tumours lacked hotspot mutations in IDH1/2 132 or 172 codons, thereby excluding the diagnosis of dedifferentiated chondrosarcoma. Recurrent somatic mutations in TP53 were identified in four of 14 samples (29%). Moreover, recurrent mutations in histone chromatin remodelling genes, including H3F3A, ATRX and DOT1L, were identified in five of 14 samples (36%), highlighting the potential role of deregulated chromatin remodelling pathways in UPSb tumourigenesis. The majority of recurrent mutations in chromatin remodelling genes identified here are reported in COSMIC, including the H3F3A G34 and K36 hotspot residues. Copy number alteration analysis identified gains and losses in genes that have been previously altered in UPSb or UPS of soft tissue. Eight somatic gene fusions were identified by RNA-Seq, two of which, CLTC-VMP1 and FARP1-STK24, were reported previously in multiple cancers. Five gene fusions were genomically characterised. Hierarchical clustering analysis, using RNA-Seq data, distinctly clustered UPSb tumours from osteosarcoma and other sarcomas, thus molecularly distinguishing UPSb from other sarcomas. RNA-Seq expression profiling analysis and quantitative reverse transcription-polymerase chain reaction showed an elevated expression in FGF23, which can be a potential molecular biomarker for UPSb. To our knowledge, this study represents the first comprehensive WES and RNA-Seq analysis of UPSb tumours revealing novel protein-coding recurrent gene mutations, gene fusions and identifying a potential UPSb molecular biomarker, thereby broadening the understanding of the pathogenic mechanisms and highlighting the possibility of developing novel targeted therapeutics. Copyright © 2018 Pathological Society of Great Britain and Ireland. Published by John Wiley & Sons, Ltd.
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Affiliation(s)
- Naser M Ali
- Institute of Cancer and Genomic Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Stefania Niada
- Laboratory of Biotechnological Applications, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | - Anna T Brini
- Laboratory of Biotechnological Applications, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy.,Department of Biomedical, Surgical and Dental Sciences, Università degli Studi di Milano, Milan, Italy
| | - Mark R Morris
- Research Institute in Healthcare Science, Faculty of Science and Engineering, University of Wolverhampton, Wolverhampton, UK
| | - Sathishkumar Kurusamy
- Research Institute in Healthcare Science, Faculty of Science and Engineering, University of Wolverhampton, Wolverhampton, UK
| | - Abdullah Alholle
- Institute of Cancer and Genomic Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - David Huen
- Research Institute in Healthcare Science, Faculty of Science and Engineering, University of Wolverhampton, Wolverhampton, UK
| | - Cristina R Antonescu
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Franck Tirode
- Department of Translational Research and Innovation, Centre Léon Bérard, Université Claude Bernard Lyon 1, CNRS 5286, INSERM U1052, Cancer Research Center of Lyon, Lyon, France
| | - Vaiyapuri Sumathi
- Department of Musculoskeletal Pathology, The Royal Orthopaedic Hospital, Robert Aitken Institute of Clinical Research, University of Birmingham, Birmingham, UK
| | - Farida Latif
- Institute of Cancer and Genomic Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
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128
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Younger E, Husson O, Bennister L, Whelan J, Wilson R, Roast A, Jones RL, van der Graaf WT. Age-related sarcoma patient experience: results from a national survey in England. BMC Cancer 2018; 18:991. [PMID: 30333006 PMCID: PMC6192120 DOI: 10.1186/s12885-018-4866-8] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Accepted: 09/26/2018] [Indexed: 01/04/2023] Open
Abstract
Background Sarcomas are rare, heterogeneous tumours affecting patients of any age. Previous surveys describe that sarcoma patients report a significantly worse experience than those with common cancers. Consequently, Sarcoma UK conducted a national survey and these data were examined for age- and tumour-related differences in patients’ experiences. Methods Patients were randomly selected from respondents to National Cancer Patient Experience Surveys (n = 900). Differences between patient groups according to age (Adolescents and Young Adults [AYA] 18–39 years, middle-aged 40–64 years, elderly 65 + years) and tumour type (soft-tissue [STS] vs. bone]) were analysed with t-tests or chi-square tests. Results Survey response rate was 62% (n = 558; STS 75%, bone sarcoma 25%). Delay in diagnosis was reported; 27% patients (n = 150) waited > 3 months and initial symptoms were incorrectly interpreted; AYA STS patients were significantly more likely to be treated for another condition, or advised that their symptoms were not serious, than older STS patients. Clinical trial participation was low (6%, n = 35). Symptom burden was high, most commonly daytime fatigue (48%, n = 277) and pain (44%, n = 248). AYAs were significantly more likely to report most side-effects and post-treatment concerns than older patients. Elderly patients were more satisfied with the information and emotional support provided than younger patients, however were significantly less likely to be referred to rehabilitation services. Conclusions This study identifies significant age-related differences in the sarcoma patient journey, which are not only related to variation in tumour-types. These results provide rationale for adopting an age-specific approach to the management of sarcoma patients in order to improve overall patient experience. Electronic supplementary material The online version of this article (10.1186/s12885-018-4866-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | - Olga Husson
- Sarcoma Unit, Royal Marsden Hospital, London, SW3 6JJ, UK.,Division of Clinical Studies, Institute of Cancer Research, London, SW7 3RP, UK
| | | | - Jeremy Whelan
- University College London Hospital (UCLH), London, NW1 2BU, UK
| | - Roger Wilson
- Sarcoma UK Registered Cancer Charity, London, N1 6AH, UK
| | - Andy Roast
- Sarcoma UK Registered Cancer Charity, London, N1 6AH, UK
| | - Robin L Jones
- Sarcoma Unit, Royal Marsden Hospital, London, SW3 6JJ, UK.,Division of Clinical Studies, Institute of Cancer Research, London, SW7 3RP, UK
| | - Winette Ta van der Graaf
- Sarcoma Unit, Royal Marsden Hospital, London, SW3 6JJ, UK. .,Division of Clinical Studies, Institute of Cancer Research, London, SW7 3RP, UK.
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129
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Casali PG, Bielack S, Abecassis N, Aro HT, Bauer S, Biagini R, Bonvalot S, Boukovinas I, Bovee JVMG, Brennan B, Brodowicz T, Broto JM, Brugières L, Buonadonna A, De Álava E, Dei Tos AP, Del Muro XG, Dileo P, Dhooge C, Eriksson M, Fagioli F, Fedenko A, Ferraresi V, Ferrari A, Ferrari S, Frezza AM, Gaspar N, Gasperoni S, Gelderblom H, Gil T, Grignani G, Gronchi A, Haas RL, Hassan B, Hecker-Nolting S, Hohenberger P, Issels R, Joensuu H, Jones RL, Judson I, Jutte P, Kaal S, Kager L, Kasper B, Kopeckova K, Krákorová DA, Ladenstein R, Le Cesne A, Lugowska I, Merimsky O, Montemurro M, Morland B, Pantaleo MA, Piana R, Picci P, Piperno-Neumann S, Pousa AL, Reichardt P, Robinson MH, Rutkowski P, Safwat AA, Schöffski P, Sleijfer S, Stacchiotti S, Strauss SJ, Sundby Hall K, Unk M, Van Coevorden F, van der Graaf WTA, Whelan J, Wardelmann E, Zaikova O, Blay JY. Bone sarcomas: ESMO-PaedCan-EURACAN Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 2018; 29:iv79-iv95. [PMID: 30285218 DOI: 10.1093/annonc/mdy310] [Citation(s) in RCA: 333] [Impact Index Per Article: 55.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/08/2023] Open
Affiliation(s)
- P G Casali
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milan and University of Milan, Milan, Italy
| | - S Bielack
- Klinikum Stuttgart-Olgahospital, Stuttgart, Germany
| | - N Abecassis
- Instituto Portugues de Oncologia de Lisboa Francisco Gentil EPE, Lisbon, Portugal
| | - H T Aro
- Turku University Hospital (Turun Yliopistollinen Keskussairaala), Turlu, Finland
| | - S Bauer
- University Hospital Essen, Essen, Germany
| | - R Biagini
- Department of Oncological Orthopedics, Musculoskeletal Tissue Bank, IFO, Regina Elena National Cancer Institute, Rome, Italy
| | | | | | - J V M G Bovee
- Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands
| | - B Brennan
- Royal Manchester Children's Hospital, Manchester, UK
| | - T Brodowicz
- Vienna General Hospital (AKH), Medizinische Universität Wien, Vienna, Austria
| | - J M Broto
- Hospital Universitario Virgen del Rocio-CIBERONC, Seville, Spain
| | - L Brugières
- Gustave Roussy Cancer Campus, Villejuif, France
| | - A Buonadonna
- Centro di Riferimento Oncologico di Aviano, Aviano
| | - E De Álava
- Institute of Biomedicine of Sevilla (IBiS), Virgen del Rocio University Hospital /CSIC/University of Sevilla/CIBERONC, Seville, Spain
| | - A P Dei Tos
- Ospedale Regionale di Treviso "S.Maria di Cà Foncello", Treviso, Italy
| | - X G Del Muro
- Integrated Unit ICO Hospitalet, HUB, Barcelona, Spain
| | - P Dileo
- Sarcoma Unit, University College London Hospitals NHS Trust, London, UK
| | - C Dhooge
- Ghent University Hospital (Pediatric Hematology-Oncology & Stem Cell Transplantation), Ghent, Belgium
| | - M Eriksson
- Skane University Hospital-Lund, Lund, Sweden
| | - F Fagioli
- Pediatric Onco-Hematology, Stem Cell Transplantation and Cellular Therapy Division, Regina Margherita Children's Hospital, University of Turin, Turin, Italy
| | - A Fedenko
- N. N. Blokhin Russian Cancer Research Center, Moscow, Russian Federation
| | - V Ferraresi
- Department of Oncological Orthopedics, Musculoskeletal Tissue Bank, IFO, Regina Elena National Cancer Institute, Rome, Italy
| | - A Ferrari
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan
| | - S Ferrari
- Istituto Ortopedico Rizzoli, Bologna
| | - A M Frezza
- Fondazione Istituto di Ricovero e Cura a Carattere Scientifico, Istituto Nazionale dei Tumori, Milan, Italy
| | - N Gaspar
- Gustave Roussy Cancer Campus, Villejuif, France
| | - S Gasperoni
- Azienda Ospedaliera Universitaria Careggi Firenze, Florence, Italy
| | - H Gelderblom
- Department of Medical Oncology, Leiden University Medical Centre, Leiden, The Netherlands
| | - T Gil
- Institut Jules Bordet, Brussels, Belgium
| | - G Grignani
- Candiolo Cancer Institute, FPO IRCCS, Candiolo, Italy
| | - A Gronchi
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milan and University of Milan, Milan, Italy
| | - R L Haas
- Department of Radiotherapy, The Netherlands Cancer Institute, Amsterdam and Department of Radiotherapy, Leiden University Medical Centre, Leiden, The Netherlands
| | - B Hassan
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | | | | | - R Issels
- Department of Medicine III, University Hospital Ludwig-Maximilians-University Munich, Munich, Germany
| | - H Joensuu
- Helsinki University Central Hospital (HUCH), Helsinki, Finland
| | | | - I Judson
- The Institute of Cancer Research, London, UK
| | - P Jutte
- University Medical Center Groningen, Groningen
| | - S Kaal
- Radboud University Medical Center, Nijmegen, The Netherlands
| | - L Kager
- St. Anna Children's Hospital & Children's Cancer Research Institute, Medical University Vienna, Vienna, Austria
| | - B Kasper
- Mannheim University Medical Center, Mannheim
| | | | - D A Krákorová
- Masaryk Memorial Cancer Institute, Brno, Czech Republic
| | - R Ladenstein
- St. Anna Children's Hospital & Children's Cancer Research Institute, Medical University Vienna, Vienna, Austria
| | - A Le Cesne
- Gustave Roussy Cancer Campus, Villejuif, France
| | - I Lugowska
- Maria Sklodowska Curie Institute-Oncology Centre, Warsaw, Poland
| | - O Merimsky
- Tel Aviv Sourasky Medical Center (Ichilov), Tel Aviv, Israel
| | - M Montemurro
- Medical Oncology University Hospital of Lausanne, Lausanne, Switzerland
| | - B Morland
- Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - M A Pantaleo
- Azienda Ospedaliera, Universitaria, Policlinico S Orsola-Malpighi Università di Bologna, Bologna, Italy
| | - R Piana
- Pediatric Onco-Hematology, Stem Cell Transplantation and Cellular Therapy Division, Regina Margherita Children's Hospital, University of Turin, Turin, Italy
| | - P Picci
- Istituto Ortopedico Rizzoli, Bologna
| | | | - A L Pousa
- Fundacio de Gestio Sanitaria de L'Hospital de la Santa Creu I Sant Pau, Barcelona, Spain
| | - P Reichardt
- Helios Klinikum Berlin Buch, Berlin, Germany
| | - M H Robinson
- YCRC Department of Clinical Oncology, Weston Park Hospital NHS Trust, Sheffield, UK
| | - P Rutkowski
- Maria Sklodowska Curie Institute-Oncology Centre, Warsaw, Poland
| | - A A Safwat
- Aarhus University Hospital, Aarhus, Finland
| | - P Schöffski
- Department of General Medical Oncology, Leuven Cancer Institute, University Hospitals Leuven, Leuven, Belgium
| | - S Sleijfer
- Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - S Stacchiotti
- Fondazione Istituto di Ricovero e Cura a Carattere Scientifico, Istituto Nazionale dei Tumori, Milan, Italy
| | - S J Strauss
- Sarcoma Unit, University College London Hospitals NHS Trust, London, UK
| | - K Sundby Hall
- Department of Oncology, Oslo University Hospital, The Norwegian Radium Hospital, Oslo, Norway
| | - M Unk
- Institute of Oncology of Ljubljana, Ljubljana, Slovenia
| | - F Van Coevorden
- Netherlands Cancer Institute Antoni van Leeuwenhoek, Amsterdam, The Netherlands
| | - W T A van der Graaf
- Royal Marsden Hospital, London
- Radboud University Medical Center, Nijmegen, The Netherlands
- Netherlands Cancer Institute Antoni van Leeuwenhoek, Amsterdam, The Netherlands
| | - J Whelan
- Sarcoma Unit, University College London Hospitals NHS Trust, London, UK
| | - E Wardelmann
- Gerhard-Domagk-Institut für Pathologie, Universitätsklinikum Münster, Münster, Germany
| | - O Zaikova
- Norwegian Radium Hospital, Oslo University Hospital, Oslo, Norway
| | - J Y Blay
- Centre Leon Bernard and UCBL1, Lyon, France
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130
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Morri M, Raffa D, Barbieri M, Ferrari S, Mariani E, Vigna D. Compliance and satisfaction with intensive physiotherapy treatment during chemotherapy in patients with bone tumours and evaluation of related prognostic factors: An observational study. Eur J Cancer Care (Engl) 2018; 27:e12916. [PMID: 30260524 DOI: 10.1111/ecc.12916] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2017] [Revised: 07/25/2018] [Accepted: 08/19/2018] [Indexed: 11/29/2022]
Abstract
The purpose of this study was to evaluate compliance and satisfaction of adult patients to intensive rehabilitation treatment during chemotherapy cycles after surgery for bone-musculoskeletal tumours, as well as to identify possible predictive factors. An observational, prognostic, prospective study was conducted. The study enrolled 27 patients who previously had undergone modular knee prosthesis surgery in the period between October 2014 and October 2015. The outcome was compliance to intensive rehabilitation treatment during hospitalisations in the chemotherapy unit and patient satisfaction 6 months' post-surgery. The variables taken into account were linked to the patient's characteristics, to the oncological pathology and to the chemotherapy treatment administered. Patients' compliance was 100% (range, 61-100). The presence of surgery complications (29.6%) produced 5% loss in compliance to treatment; likewise, chemotherapy treatment with prevalent use of ifosfamide reduced compliance to rehabilitation by 6%. The mean patient satisfaction score was 7.9 in the Likert scale from 0 to 10. Intensive physiotherapy starting during chemotherapy administration is a feasible treatment for bone tumour patients that have shown to be able to positively adhere to it. Rehabilitation treatments, within chemotherapy wards, should therefore be promoted according to satisfaction level as reported by patient.
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Affiliation(s)
- Mattia Morri
- Servizio di Assistenza infermieristica, tecnica e della riabilitazione, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Debora Raffa
- Servizio di Assistenza infermieristica, tecnica e della riabilitazione, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Maria Barbieri
- Servizio di Assistenza infermieristica, tecnica e della riabilitazione, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Stefano Ferrari
- Reparto di Chemioterapia, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Elisabetta Mariani
- Servizio di Medicina Fisica e Riabilitativa, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Daniela Vigna
- Servizio di Assistenza infermieristica, tecnica e della riabilitazione, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
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131
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Morris RW, Kumar V, Saad AG. Anaplastic plasmacytoma: a rare tumor presenting as a pathological fracture in a younger adult. Skeletal Radiol 2018; 47:995-1001. [PMID: 29388036 DOI: 10.1007/s00256-018-2884-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Revised: 01/05/2018] [Accepted: 01/09/2018] [Indexed: 02/02/2023]
Abstract
Solitary plasmacytoma is the rarest type of plasma cell neoplasm, and the anaplastic form is even more uncommon. Plasmacytoma most commonly originates in bone and predominantly affects older patients. We describe the case of a 35-year-old woman with solitary osseous anaplastic plasmacytoma that presented initially with a pathological fracture following minor trauma. The patient was immunocompetent and had no predisposing conditions for a plasma cell tumor. Left lower extremity radiographs revealed an oblique fracture of the distal femur, and CT imaging indicated a primary osseous lesion at the fracture site. MRI confirmed the diagnosis of pathological fracture. Initial surgical pathology of the lesion was concerning because it could have been an osteosarcoma. Further immunostaining demonstrated CD138 positivity and kappa light chain restriction, confirming the diagnosis of plasmacytoma. In addition, the presence of marked anaplastic cellular changes confirmed the anaplastic variant. Further workup showed no evidence of multiple myeloma. This case is unusual given the age and gender of the patient. Awareness of the anaplastic variant of plasmacytoma is important to avoid erroneous diagnoses.
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Affiliation(s)
- Robert W Morris
- Department of Radiology, University of Mississippi Medical Center, 2500 North State Street, Jackson, MS, 39216, USA.
| | - Varsha Kumar
- Department of Radiology, University of Mississippi Medical Center, 2500 North State Street, Jackson, MS, 39216, USA
| | - Ali G Saad
- Department of Pathology and Laboratory Medicine, University of Mississippi Medical Center, 2500 North State Street, Jackson, MS, 39216, USA
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Freeman JL, Kaufmann AB, Everson RG, DeMonte F, Raza SM. Evidence-Based Optimization of Post-Treatment Surveillance for Skull Base Chordomas Based on Local and Distant Disease Progression. Oper Neurosurg (Hagerstown) 2018; 16:27-36. [DOI: 10.1093/ons/opy073] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2017] [Accepted: 02/28/2018] [Indexed: 11/13/2022] Open
Abstract
Abstract
BACKGROUND
There are no guidelines regarding post-treatment surveillance specific to skull base chordomas.
OBJECTIVE
To determine an optimal imaging surveillance schedule to detect both local and distant metastatic skull base chordoma recurrences.
METHODS
A retrospective review of 91 patients who underwent treatment for skull base chordoma between 1993 and 2017 was conducted. Time to and location of local and distant recurrence(s) were cataloged. Existing chordoma surveillance recommendations (National Comprehensive Cancer Network [NCCN], London and South East Sarcoma Network [LSESN], European Society for Medical Oncology [ESMO], Chordoma Global Consensus Group [CGCG]) were applied to our cohort to compare the number of recurrent patients and months of undiagnosed tumor growth between surveillances. These findings were used to inform the creation of a revised imaging surveillance protocol (MD Anderson Cancer Center Chordoma Imaging Protocol [MDACC-CIP]), presented here.
RESULTS
Thirty-four patients with 79 local/systemic recurrences met inclusion criteria. Mean age at diagnosis and follow-up time were 45 yr and 79 mo, respectively. The MDACC-CIP imaging protocol significantly reduced the time to diagnosis of recurrence compared with the LSESN and CGCG/ESMO imaging protocols for surveillance of local disease with a cumulative/average of 576/16.9 (LSESN), 336/9.8 (CGCG), and 170/5.0 (MDACC-CIP) months of undetected growth, respectively. The NCCN and MDACC-CIP guidelines for distant metastatic surveillance identified a cumulative/average of 65/6.5 and 51/5.1 mo of undetected growth, respectively, and were not significantly different.
CONCLUSION
The MDACC-CIP for skull base chordoma accounts for recurrence trends unique to this disease, including a higher rate of leptomeningeal spread than sacrococcygeal primaries, resulting in improved sensitivity and prompt diagnosis.
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Affiliation(s)
- Jacob L Freeman
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Ascher B Kaufmann
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Richard G Everson
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Franco DeMonte
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Shaan M Raza
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
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Claro G, Meyer N, Meresse T, Gangloff D, Grolleau JL, Chaput B. Does needle biopsy cause an increased risk of extracapsular extension in the diagnosis of metastatic lymph node in melanoma? Int J Dermatol 2018; 57:410-416. [PMID: 29430630 DOI: 10.1111/ijd.13936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Revised: 11/16/2017] [Accepted: 01/09/2018] [Indexed: 12/01/2022]
Abstract
BACKGROUND Needle biopsy is a rapid, reliable, and reproducible procedure for histological confirmation of metastatic melanoma localization. Nonetheless, this procedure presents a theoretical risk of a mechanical weakening of the lymph node capsule with perinodal tumor seeding. The objective of the study was to evaluate the incidence of extracapsular extension after needle biopsy in comparison with surgical adenectomy in patients suspected of metastatic lymph node of melanoma. METHODS We conducted a retrospective study of 1056 patients who underwent lymphadenectomy for melanoma between 2000 and 2016 in our unit. Sixty-nine patients were clinically and/or radiologically suspected of metastatic lymph node of melanoma. Patients were divided according to external lymph node biopsy or surgical adenectomy before lymphadenectomy. The primary endpoint was the histopathological identification of extracapsular extension in analyzed lymph nodes. RESULTS The two populations were comparable except for the mitotic index, which was more frequently > 1/mm2 in the group with surgical adenectomy (P = 0.005). The proportion of extracapsular extension was significantly greater in the needle biopsy group (28/37) than in patients who underwent surgical adenectomy (14/32) (P = 0.0067; OR = 4 [95% CI: 1.4-11]). CONCLUSION Our results suggest an increased risk of extracapsular extension after external lymph node biopsy in cases of suspicion of metastatic lymph node of melanoma. Thus, this encourages us to prefer surgical adenectomy in patients with suspected adenopathy accessible surgically. In other cases, needle biopsy should be carried out under radiological guidance using devices limiting tumor seeding.
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Affiliation(s)
- Gilles Claro
- Department of Plastic, Reconstructive and Aesthetic Surgery, Rangueil Hospital, Toulouse, France.,Department of Surgical Oncology, Cancer University Institute of Toulouse Oncopole, Toulouse Cedex 09, France
| | - Nicolas Meyer
- Department of Dermatology, Cancer University Institute of Toulouse Oncopole, Toulouse Cedex 09, France
| | - Thomas Meresse
- Department of Surgical Oncology, Cancer University Institute of Toulouse Oncopole, Toulouse Cedex 09, France
| | - Dimitri Gangloff
- Department of Surgical Oncology, Cancer University Institute of Toulouse Oncopole, Toulouse Cedex 09, France
| | - Jean-Louis Grolleau
- Department of Plastic, Reconstructive and Aesthetic Surgery, Rangueil Hospital, Toulouse, France
| | - Benoit Chaput
- Department of Plastic, Reconstructive and Aesthetic Surgery, Rangueil Hospital, Toulouse, France.,Department of Surgical Oncology, Cancer University Institute of Toulouse Oncopole, Toulouse Cedex 09, France
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134
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Puri A, Ranganathan P, Gulia A, Crasto S, Hawaldar R, Badwe RA. Does a less intensive surveillance protocol affect the survival of patients after treatment of a sarcoma of the limb? Bone Joint J 2018; 100-B:262-268. [DOI: 10.1302/0301-620x.100b2.bjj-2017-0789.r1] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Aims A single-centre prospective randomized trial was conducted to investigate whether a less intensive follow-up protocol would not be inferior to a conventional follow-up protocol, in terms of overall survival, in patients who have undergone surgery for sarcoma of the limb. Initial short-term results were published in 2014. Patients and Methods The primary objective was to show non-inferiority of a chest radiograph (CXR) group compared with a CT scan group, and of a less frequent (six-monthly) group than a more frequent (three-monthly) group, in two-by-two comparison. The primary outcome was overall survival and the secondary outcome was a recurrence-free survival. Five-year survival was compared between the CXR and CT scan groups and between the three-monthly and six-monthly groups. Of 500 patients who were enrolled, 476 were available for follow-up. Survival analyses were performed on a per-protocol basis (n = 412). Results The updated results recorded 12 (2.4%) local recurrences, 182 (36.8%) metastases, and 56 (11.3%) combined (local + metastases) recurrence at a median follow-up of 81 months (60 to 118). Of 68 local recurrences, 60 (88%) were identified by the patients themselves. The six-monthly regime (overall survival (OS) 54%, recurrence-free survival (RFS) 46%) did not lead to a worse survival and was not inferior to the three-monthly regime (OS 55%, RFS 47%) in terms of detecting recurrence. Although CT scans (OS 53%, RFS 54%) detected pulmonary metastasis earlier, it did not lead to a better survival compared with CXR (OS 56%, RFS 59%). Conclusion The overall survival of patients who are treated for a sarcoma of the limb is not inferior to those followed up with a less intensive regimen than a more intensive protocol, in terms of frequency of visits and mode of imaging. CXR at six-monthly intervals and patient education about examination of the site of the surgery will detect most recurrences without deleterious effects on the eventual outcome. Cite this article: Bone Joint J 2018;100-B:262–8.
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Affiliation(s)
- A. Puri
- Tata Memorial Centre, HBNI, Dr
E. Borges Road, Parel, Mumbai
400 012, India
| | - P. Ranganathan
- Tata Memorial Centre, HBNI, Dr
E. Borges Road, Parel, Mumbai
400 012, India
| | - A. Gulia
- Tata Memorial Centre, HBNI, Dr
E. Borges Road, Parel, Mumbai
400 012, India
| | - S. Crasto
- Tata Memorial Centre, HBNI, Dr
E. Borges Road, Parel, Mumbai
400 012, India
| | - R. Hawaldar
- Tata Memorial Centre, HBNI, Dr
E. Borges Road, Parel, Mumbai
400 012, India
| | - R. A. Badwe
- Tata Memorial Centre, HBNI, Dr
E. Borges Road, Parel, Mumbai
400 012, India
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135
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Crompton JG, Ogura K, Bernthal NM, Kawai A, Eilber FC. Local Control of Soft Tissue and Bone Sarcomas. J Clin Oncol 2018; 36:111-117. [DOI: 10.1200/jco.2017.75.2717] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Sarcomas of soft tissue and bone are mesenchymal malignancies that can arise in any anatomic location, most commonly the extremity, retroperitoneum, and trunk. Even for lower grade histologic subtypes, local recurrence can cause significant morbidity and even disease-related death. Although surgery remains the cornerstone of local control, perioperative radiation and systemic therapy are often important adjuvants. This review will summarize the current therapeutic approaches for local control of soft tissue and bone sarcomas.
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Affiliation(s)
- Joseph G. Crompton
- Joseph G. Crompton, Nicholas M. Bernthal, and Fritz C. Eilber, University of California Los Angeles, Los Angeles, CA; and Koichi Ogura and Akira Kawai, National Cancer Center Hospital, Tokyo, Japan
| | - Koichi Ogura
- Joseph G. Crompton, Nicholas M. Bernthal, and Fritz C. Eilber, University of California Los Angeles, Los Angeles, CA; and Koichi Ogura and Akira Kawai, National Cancer Center Hospital, Tokyo, Japan
| | - Nicholas M. Bernthal
- Joseph G. Crompton, Nicholas M. Bernthal, and Fritz C. Eilber, University of California Los Angeles, Los Angeles, CA; and Koichi Ogura and Akira Kawai, National Cancer Center Hospital, Tokyo, Japan
| | - Akira Kawai
- Joseph G. Crompton, Nicholas M. Bernthal, and Fritz C. Eilber, University of California Los Angeles, Los Angeles, CA; and Koichi Ogura and Akira Kawai, National Cancer Center Hospital, Tokyo, Japan
| | - Fritz C. Eilber
- Joseph G. Crompton, Nicholas M. Bernthal, and Fritz C. Eilber, University of California Los Angeles, Los Angeles, CA; and Koichi Ogura and Akira Kawai, National Cancer Center Hospital, Tokyo, Japan
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136
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Thévenin-Lemoine C, Destombes L, Vial J, Wargny M, Bonnevialle P, Lefevre Y, Gomez Brouchet A, Sales de Gauzy J. Planning for Bone Excision in Ewing Sarcoma: Post-Chemotherapy MRI More Accurate Than Pre-Chemotherapy MRI Assessment. J Bone Joint Surg Am 2018; 100:13-20. [PMID: 29298256 DOI: 10.2106/jbjs.16.01461] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND In determining the level of bone resection in Ewing sarcoma, the most suitable time at which to perform magnetic resonance imaging (MRI) remains controversial. Current guidelines recommend that surgical planning be based on MRI performed prior to neoadjuvant chemotherapy. The goal of this study was to determine whether pre-chemotherapy or post-chemotherapy MRI provides greater accuracy of tumor limits for planning bone excision in the management of Ewing sarcoma. METHODS This was a single-center, retrospective study. MRI was performed using 3 sequences: T1-weighted, T1-weighted with contrast enhancement by gadolinium injection, and a fluid-sensitive sequence (STIR [short tau inversion recovery] or proton-density-weighted with fat saturation). The tumor extent as assessed on pre-chemotherapy and post-chemotherapy MRI was compared with histological measurement of the resected specimen. RESULTS Twenty patients with Ewing sarcoma of a long bone were included. In 6 cases, the tumor was located on the femur, in 5, the tibia; in 5, the fibula; and in 4, the humerus. The median patient age at diagnosis was 9.7 years. We found greater accuracy of measurements from MRI scans acquired after chemotherapy than from those acquired before chemotherapy. For both pre-chemotherapy and post-chemotherapy MRI, the greatest accuracy was achieved with the nonenhanced T1 sequence. There was no benefit to gadolinium enhancement. The median difference between T1 MRI and histological measurements was 19.0 mm (interquartile range [IQR], 4.3 to 32.8 mm) before chemotherapy and 5.0 mm (IQR, 2.0 to 13.0 mm) after chemotherapy. Adding a minimum margin of 20 mm to the limit of the tumor on post-chemotherapy T1 MRI always led to safe histological margin. CONCLUSIONS Post-chemotherapy MRI provided a more accurate assessment of the limits of Ewing sarcoma. Surgical planning can therefore be based on post-chemotherapy MRI. Surgical cuts can be, at minimum, 20 mm from the limits as seen on MRI.
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Affiliation(s)
- Camille Thévenin-Lemoine
- Departments of Pediatric Orthopaedics (C.T.-L. and J.S.d.G.) and Radiology (L.D. and J.V.), Hôpital des Enfants, Toulouse-Purpan University Hospital, Toulouse, France
| | - Louise Destombes
- Departments of Pediatric Orthopaedics (C.T.-L. and J.S.d.G.) and Radiology (L.D. and J.V.), Hôpital des Enfants, Toulouse-Purpan University Hospital, Toulouse, France
| | - Julie Vial
- Departments of Pediatric Orthopaedics (C.T.-L. and J.S.d.G.) and Radiology (L.D. and J.V.), Hôpital des Enfants, Toulouse-Purpan University Hospital, Toulouse, France
| | - Matthieu Wargny
- Departments of Epidemiology and Public Health (M.W.) and Orthopaedics and Trauma (P.B.), Toulouse-Purpan University Hospital, Toulouse, France
| | - Paul Bonnevialle
- Departments of Epidemiology and Public Health (M.W.) and Orthopaedics and Trauma (P.B.), Toulouse-Purpan University Hospital, Toulouse, France
| | - Yan Lefevre
- Department of Pediatric Orthopaedics, Hôpital des Enfants, Bordeaux University Hospital, Bordeaux, France
| | - Anne Gomez Brouchet
- Department of Pathology, IUCT-Oncopole, University of Toulouse, Toulouse, France
| | - Jérome Sales de Gauzy
- Departments of Pediatric Orthopaedics (C.T.-L. and J.S.d.G.) and Radiology (L.D. and J.V.), Hôpital des Enfants, Toulouse-Purpan University Hospital, Toulouse, France
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137
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Abstract
This article discusses the epidemiology, diagnosis, and management of primary soft-tissue sarcomas (STS). These musculoskeletal tumors are a rare and heterogeneous group of malignancies, which are best managed by multidisciplinary teams in specialist sarcoma referral centers. Historically, the standard for local control of these tumors has been amputation. Evolutions in multimodality treatment have seen a shift toward preservation of the limb. Advances in limb-sparing surgery have seen the quality of life in sarcoma patients to improve drastically; however, unplanned surgical excision of STS remains a major treatment dilemma in the control of local disease.
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Affiliation(s)
- Domagoj Ante Vodanovich
- Department of Orthopaedics, St. Vincent's Hospital Melbourne, Victoria, Australia,Department of Surgery, St. Vincent's Hospital Melbourne, University of Melbourne, Victoria, Australia
| | - Peter F M Choong
- Department of Orthopaedics, St. Vincent's Hospital Melbourne, Victoria, Australia,Department of Surgery, St. Vincent's Hospital Melbourne, University of Melbourne, Victoria, Australia,Bone and Soft Tissue Sarcoma Service, Peter MacCallum Cancer Centre, Victoria, Australia,Address for correspondence: Prof. Peter F M Choong, Level 2, Clinical Sciences Building, 29 Regent Street, Fitzroy 3065, Victoria, Australia. E-mail:
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138
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Paterakis KN, Brotis A, Dardiotis E, Giannis T, Tzerefos C, Fountas KN. Multimodality treatment of intradural extramedullary Ewing's sarcomas. A systematic review. Clin Neurol Neurosurg 2017; 164:169-181. [PMID: 29247908 DOI: 10.1016/j.clineuro.2017.11.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2017] [Revised: 11/12/2017] [Accepted: 11/28/2017] [Indexed: 01/01/2023]
Abstract
Ewing's sarcoma (ES) is an aggressive bone and soft tissue sarcoma that usually affects adolescents and young adults. ES occasionally presents as an intradural-extramedullary lesion of the spine. Our aim was to study the role of the multimodality treatment on the survival (overall survival, recurrence-free survival, and metastasis-free survival) of patients with intradural-extramedullary Ewing's sarcoma. Pubmed, EMBASE, Scopus, Web of Science, Cochrane Reviews were searched up to January 2017, using as mesh terms "intradural extramedullary", "Ewing's sarcoma", AND "treatment". The multidisciplinary treatment was recorded in binary variables under the headings of "surgery", "chemotherapy" and "radiotherapy". We also recorded three time-to-event variables, including death, recurrence, and metastasis. We performed survival analysis for all potential combinations. Twenty articles with twenty-three patients were eligible for the current review. The survival curves of GTR did not differ from the equivalent of STR regarding survival (p=0.098), recurrence-free survival (p=0.318), and metastasis-free survival (p=0.089). Patients who received chemotherapy enjoyed longer survival regarding overall survival (p<0.05), recurrence-free survival (p<0.05), and metastasis-free survival (p<0.05), when compared to those who did not receive chemotherapy. Their overall survival of patients who had radiotherapy was marginally superior to those who did not receive (p=0.0653). However, their recurrence-free survival (p<0.05), and metastasis-free survival (p<0.05) were significantly improved in comparison to the latter. In conclusion, the multimodality treatment is mandatory for the management of patients with intradural extramedullary Ewing's sarcomas, with surgery assisting in the diagnosis and decompression the neural elements. However, it is chemotherapy that improves survival, recurrence-free survival, and metastasis-free survival. Radiotherapy is reserved as an adjuvant therapy in the local control, especially in cases with subtotal tumour resection.
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Affiliation(s)
| | | | | | | | | | - Kostas N Fountas
- Department of Neurosurgery, University Hospital of Larissa, Greece
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Cai N, Zhou W, Ye LL, Chen J, Liang QN, Chang G, Chen JJ. The STAT3 inhibitor pimozide impedes cell proliferation and induces ROS generation in human osteosarcoma by suppressing catalase expression. Am J Transl Res 2017; 9:3853-3866. [PMID: 28861175 PMCID: PMC5575198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Accepted: 08/04/2017] [Indexed: 06/07/2023]
Abstract
Currently, there is a considerable need to develop new treatments for osteosarcoma (OS), a very aggressive bone cancer. The activation of STAT3 signaling is positively associated with poor prognosis and aggressive progression in OS patients. Our previous study reported that the FDA-approved antipsychotic drug pimozide had anti-tumor activity against hepatocellular carcinoma and prostate cancer cells by suppressing STAT3 activity. Therefore, the aim of this study was to investigate the specific effect of pimozide on OS cells and the underlying molecular mechanism. Pimozide inhibited cell proliferation, colony formation, and sphere formation capacities of the OS cells in a dose-dependent manner, inducing G0/G1 phase cell cycle arrest. Pimozide reduced the percentage of side population cells representing cancer stem-like cells and enhanced the sensitivity of OS cells to 5-FU induced proliferative inhibition. In addition, pimozide induced apoptosis of U2OS cells, which showed increased expression of cleaved-PARP, a marker of programmed cell death. Moreover, pimozide suppressed Erk signaling in OS cells. Importantly, pimozide induced ROS generation by downregulating the expression of the antioxidant enzyme catalase (CAT). NAC treatment partially reversed the ROS generation and cytotoxic effects induced by pimozide. CAT treatment attenuated the pimozide-induced proliferation inhibition. The decrease of CAT expression induced by pimozide was potentially mediated through the suppression of cellular STAT3 activity in OS cells. Thus, pimozide may be a novel STAT3 inhibitor that suppresses cellular STAT3 activity to inhibit OS cells or stem-like cells and is a novel potential anti-cancer agent in OS treatment.
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Affiliation(s)
- Nan Cai
- School of Medicine, Shenzhen UniversityShenzhen 518060, People’s Republic of China
- College of Life Sciences and Oceanography, Shenzhen Key Laboratory of Marine Bioresources and Ecology, Shenzhen UniversityShenzhen 518060, People’s Republic of China
| | - Wei Zhou
- Department of Spine Surgery and Joint Surgery, The Third Affiliated Hospital of Guangzhou Medical UniversityGuangzhou 510150, People’s Republic of China
| | - Lan-Lan Ye
- School of Medicine, Shenzhen UniversityShenzhen 518060, People’s Republic of China
| | - Jun Chen
- College of Life Sciences and Oceanography, Shenzhen Key Laboratory of Marine Bioresources and Ecology, Shenzhen UniversityShenzhen 518060, People’s Republic of China
| | - Qiu-Ni Liang
- School of Medicine, Shenzhen UniversityShenzhen 518060, People’s Republic of China
| | - Gang Chang
- School of Medicine, Shenzhen UniversityShenzhen 518060, People’s Republic of China
| | - Jia-Jie Chen
- School of Medicine, Shenzhen UniversityShenzhen 518060, People’s Republic of China
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van der Heijden L, Dijkstra PDS, Blay JY, Gelderblom H. Giant cell tumour of bone in the denosumab era. Eur J Cancer 2017; 77:75-83. [PMID: 28365529 DOI: 10.1016/j.ejca.2017.02.021] [Citation(s) in RCA: 97] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2016] [Revised: 02/12/2017] [Accepted: 02/20/2017] [Indexed: 11/26/2022]
Abstract
Giant cell tumour of bone (GCTB) is an intermediate locally aggressive primary bone tumour, occurring mostly at the meta-epiphysis of long bones. Overexpression of receptor activator of nuclear factor kappa-B ligand (RANKL) by mononuclear neoplastic stromal cells promotes recruitment of numerous reactive multinucleated osteoclast-like giant cells, causing lacunar bone resorption. Preferential treatment is curettage with local adjuvants such as phenol, alcohol or liquid nitrogen. The remaining cavity may be filled with bone graft or polymethylmethacrylate (PMMA) bone cement; benefits of the latter are a lower risk of recurrence, possibility of direct weight bearing and early radiographic detection of recurrences. Reported recurrence rates are comparable for the different local adjuvants (27-31%). Factors increasing the local recurrence risk include soft tissue extension and anatomically difficult localisations such as the sacrum. When joint salvage is impossible, en-bloc resection and endoprosthetic joint replacement may be performed. Local tumour control on the one hand and maintenance of a functional native joint and quality of life on the other hand are the main pillars of surgical treatment for this disease. Current knowledge and development in the fields of imaging, functional biology and systemic therapy are forcing us into a paradigm shift from a purely surgical approach towards a multidisciplinary approach. Systemic therapy with denosumab (RANKL inhibitor) or zoledronic acid (bisphosphonates) blocks, respectively inhibits, bone resorption by osteoclast-like giant cells. After use of zoledronic acid, stabilisation of local and metastatic disease has been reported, although the level of evidence is low. Denosumab is more extensively studied in two prospective trials, and appears effective for the optimisation of surgical treatment. Denosumab should be considered in the standard multidisciplinary treatment of advanced GCTB (e.g. cortical destruction, soft tissue extension, joint involvement or sacral localisation) to facilitate surgery at a later stage, and thereby aiming at immediate local control. Even though several questions concerning optimal treatment dose, duration and interval and drug safety remain unanswered, denosumab is among the most effective drug therapies in oncology.
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Affiliation(s)
- Lizz van der Heijden
- Department of Orthopedic Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - P D Sander Dijkstra
- Department of Orthopedic Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Jean-Yves Blay
- Department of Medical Oncology, Centre Leon Berard, Lyon, France
| | - Hans Gelderblom
- Department of Medical Oncology, Leiden University Medical Center, Leiden, The Netherlands.
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Dangoor A, Seddon B, Gerrand C, Grimer R, Whelan J, Judson I. UK guidelines for the management of soft tissue sarcomas. Clin Sarcoma Res 2016; 6:20. [PMID: 27891213 PMCID: PMC5109663 DOI: 10.1186/s13569-016-0060-4] [Citation(s) in RCA: 287] [Impact Index Per Article: 35.9] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Accepted: 11/01/2016] [Indexed: 01/18/2023] Open
Abstract
Soft tissue sarcomas (STS) are rare tumours arising in mesenchymal tissues, and can occur almost anywhere in the body. Their rarity, and the heterogeneity of subtype and location means that developing evidence-based guidelines is complicated by the limitations of the data available. However, this makes it more important that STS are managed by teams, expert in such cases, to ensure consistent and optimal treatment, as well as recruitment to clinical trials, and the ongoing accumulation of further data and knowledge. The development of appropriate guidance, by an experienced panel referring to the evidence available, is therefore a useful foundation on which to build progress in the field. These guidelines are an update of the previous version published in 2010 (Grimer et al. in Sarcoma 2010:506182, 2010). The original guidelines were drawn up following a consensus meeting of UK sarcoma specialists convened under the auspices of the British Sarcoma Group (BSG) and were intended to provide a framework for the multidisciplinary care of patients with soft tissue sarcomas. This current version has been updated and amended with reference to other European and US guidance. There are specific recommendations for the management of selected subtypes of disease including retroperitoneal and uterine sarcomas, as well as aggressive fibromatosis (desmoid tumours) and other borderline tumours commonly managed by sarcoma services. An important aim in sarcoma management is early diagnosis and prompt referral. In the UK, any patient with a suspected soft tissue sarcoma should be referred to one of the specialist regional soft tissues sarcoma services, to be managed by a specialist sarcoma multidisciplinary team. Once the diagnosis has been confirmed using appropriate imaging, plus a biopsy, the main modality of management is usually surgical excision performed by a specialist surgeon. In tumours at higher risk of recurrence or metastasis pre- or post-operative radiotherapy should be considered. Systemic anti-cancer therapy (SACT) may be utilized in some cases where the histological subtype is considered more sensitive to systemic treatment. Regular follow-up is recommended to assess local control, development of metastatic disease, and any late-effects of treatment. For local recurrence, and more rarely in selected cases of metastatic disease, surgical resection would be considered. Treatment for metastases may include radiotherapy, or systemic therapy guided by the sarcoma subtype. In some cases, symptom control and palliative care support alone will be appropriate.
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Affiliation(s)
- Adam Dangoor
- Bristol Cancer Institute, Bristol Haematology & Oncology Centre, University Hospitals Bristol NHS Trust, Bristol, BS2 8ED UK
| | - Beatrice Seddon
- Department of Oncology, University College London Hospital NHS Trust, London, NW1 2PG UK
| | - Craig Gerrand
- The Newcastle upon Tyne Hospitals NHS Foundation Trust, Freeman Hospital, Newcastle-upon-Tyne, NE7 7DN UK
| | - Robert Grimer
- Royal Orthopaedic Hospital NHS Trust, Birmingham, B31 2AP UK
| | - Jeremy Whelan
- Department of Oncology, University College London Hospital NHS Trust, London, NW1 2PG UK
| | - Ian Judson
- Royal Marsden NHS Foundation Trust, London, SW3 6JJ UK
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