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Deng GH, Wang H, Tan Z, Chen R. Risk factors for distant metastasis of chondrosarcoma: A population-based study. Medicine (Baltimore) 2023; 102:e35259. [PMID: 37713884 PMCID: PMC10508579 DOI: 10.1097/md.0000000000035259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 08/25/2023] [Indexed: 09/17/2023] Open
Abstract
Chondrosarcoma is the second largest bone malignancy after osteosarcoma and mainly affects middle-aged adults, where patients with distant metastasis (DM) often have a poor prognosis. Although nomograms have been widely used to predict distant tumor metastases, there is a lack of large-scale data studies for the diagnostic evaluation of DM in chondrosarcoma. Data on patients diagnosed with chondrosarcoma from 2004 to 2015 were obtained from the Surveillance, Epidemiology, and End Results database. Independent risk factors for having DM from chondrosarcoma were screened using univariate and multivariate logistics regression analysis. A nomogram was created to predict the probability of DM from the screened independent risk factors. The nomogram was then validated using receiver operating characteristic curves and calibration curves. A total of 1870 chondrosarcoma patients were included in the study after data screening, of which 157 patients (8.40%) had DM at the time of diagnosis. Univariate and multivariate logistic regression analysis screened four independent risk factors, including grade, tumor number, T stage, and N stage. receiver operating characteristic curves and calibration curves showed good accuracy of the nomogram in both training and validation sets. The current study screened for independent risk factors for DM from chondrosarcoma, which will help clinicians evaluate patients.
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Affiliation(s)
- Guang-Hua Deng
- Ya’an Hospital of Traditional Chinese Medicine, Yaan, Sichuan, China
| | - Hong Wang
- Ya’an Hospital of Traditional Chinese Medicine, Yaan, Sichuan, China
| | - Zhe Tan
- Ya’an Hospital of Traditional Chinese Medicine, Yaan, Sichuan, China
| | - Rong Chen
- Ya’an Hospital of Traditional Chinese Medicine, Yaan, Sichuan, China
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2
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Wang D, Liu F, Li B, Xu J, Gong H, Yang M, Wan W, Jiao J, Liu Y, Xiao J. Development and Validation of a Prognostic Model for Overall Survival in Patients with Primary Pelvis and Spine Osteosarcoma: A Population-Based Study and External Validation. J Clin Med 2023; 12:jcm12072521. [PMID: 37048606 PMCID: PMC10095419 DOI: 10.3390/jcm12072521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 02/24/2023] [Accepted: 03/01/2023] [Indexed: 03/29/2023] Open
Abstract
Background: Primary pelvis and spine osteosarcoma (PSOS) is a specific type of osteosarcoma that is difficult to treat and has a poor prognosis. In recent years, the research on osteosarcoma has been increasing, but there have been few studies on PSOS; in particular, there have been a lack of analyses with a large sample size. This study aimed to construct and validate a model to predict the overall survival (OS) of PSOS patients, as currently there are no tools available for assessing their prognosis. Methods: Data including demographic information, clinical characteristics, and follow-up information on patients with PSOS were collected from the Surveillance, Epidemiology, and End Results (SEER) database, as well as from the Spine Tumor Center of Changzheng Hospital. Variable selection was achieved through a backward procedure based on the Akaike Information Criterion (AIC). Prognostic factors were identified by univariate and multivariate Cox analysis. A nomogram was further constructed for the estimation of 1-, 3-, and 5-year OS. Calibration plots, the concordance index (C-index), and the receiver operating characteristic (ROC) were used to evaluate the prediction model. Results: In total, 83 PSOS patients and 90 PSOS patients were separately collected from the SEER database and Changzheng Hospital. In the SEER cohort, liver metastasis, lung metastasis, and chemotherapy were recognized as independent prognostic factors for OS (p < 0.05) and were incorporated to construct the initial nomogram. However, the initial nomogram showed poor predictive accuracy in internal and external validation. Then, we shifted our focus to the Changzheng data. Lung metastasis involving segments, Eastern Cooperative Oncology Group (ECOG) performance score, alkaline phosphatase (ALP) level, and en bloc resection were ultimately identified as independent prognostic factors for OS (p < 0.05) and were further incorporated to construct the current nomogram, of which the bias-corrected C-index was 0.834 (0.824–0.856). The areas under the ROC curves (AUCs) of the current nomogram regarding 1-, 3-, and 5-year OS probabilities were 0.93, 0.96, and 0.92, respectively. Conclusion: We have developed a predictive model with satisfactory performance and clinical practicability, enabling effective prediction of the OS of PSOS patients and aiding clinicians in decision-making.
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Affiliation(s)
- Da Wang
- Department of Orthopedic Oncology, Shanghai Changzheng Hospital, Navy Military Medical University, Shanghai 200003, China
| | - Fanrong Liu
- Department of Orthopedics, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325015, China
| | - Binbin Li
- Department of Pathology, Shanghai Changzheng Hospital, Navy Military Medical University, Shanghai 200003, China
| | - Jinhui Xu
- Department of Orthopedic Oncology, Shanghai Changzheng Hospital, Navy Military Medical University, Shanghai 200003, China
| | - Haiyi Gong
- Department of Orthopedic Oncology, Shanghai Changzheng Hospital, Navy Military Medical University, Shanghai 200003, China
| | - Minglei Yang
- Department of Orthopedic Oncology, Shanghai Changzheng Hospital, Navy Military Medical University, Shanghai 200003, China
| | - Wei Wan
- Department of Orthopedic Oncology, Shanghai Changzheng Hospital, Navy Military Medical University, Shanghai 200003, China
| | - Jian Jiao
- Department of Orthopedic Oncology, Shanghai Changzheng Hospital, Navy Military Medical University, Shanghai 200003, China
- Correspondence: (J.J.); (Y.L.); (J.X.)
| | - Yujie Liu
- Department of Orthopedic Oncology, Shanghai Changzheng Hospital, Navy Military Medical University, Shanghai 200003, China
- Correspondence: (J.J.); (Y.L.); (J.X.)
| | - Jianru Xiao
- Department of Orthopedic Oncology, Shanghai Changzheng Hospital, Navy Military Medical University, Shanghai 200003, China
- Department of Orthopedics, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325015, China
- Correspondence: (J.J.); (Y.L.); (J.X.)
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3
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Sambri A, Fiore M, Rottoli M, Bianchi G, Pignatti M, Bortoli M, Ercolino A, Ancetti S, Perrone AM, De Iaco P, Cipriani R, Brunocilla E, Donati DM, Gargiulo M, Poggioli G, De Paolis M. A Planned Multidisciplinary Surgical Approach to Treat Primary Pelvic Malignancies. Curr Oncol 2023; 30:1106-1115. [PMID: 36661733 PMCID: PMC9857743 DOI: 10.3390/curroncol30010084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 01/10/2023] [Accepted: 01/11/2023] [Indexed: 01/15/2023] Open
Abstract
The pelvic anatomy poses great challenges to orthopedic surgeons. Sarcomas are often large in size and typically enclosed in the narrow confines of the pelvis with the close proximity of vital structures. The aim of this study is to report a systematic planned multidisciplinary surgical approach to treat pelvic sarcomas. Seventeen patients affected by bone and soft tissue sarcomas of the pelvis, treated using a planned multidisciplinary surgical approach, combining the expertise of orthopedic oncology and other surgeons (colleagues from urology, vascular surgery, abdominal surgery, gynecology and plastic surgery), were included. Seven patients were treated with hindquarter amputation; 10 patients underwent excision of the tumor. Reconstruction of bone defects was conducted in six patients with a custom-made 3D-printed pelvic prosthesis. Thirteen patients experienced at least one complication. Well-organized multidisciplinary collaborations between each subspecialty are the cornerstone for the management of patients affected by pelvic sarcomas, which should be conducted in specialized centers. A multidisciplinary surgical approach is of paramount importance in order to obtain the best successful surgical results and adequate margins for achieving acceptable outcomes.
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Affiliation(s)
- Andrea Sambri
- Orthopedic and Traumatology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Michele Fiore
- Orthopedic and Traumatology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Matteo Rottoli
- General Surgery Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | | | - Marco Pignatti
- Plastic Surgery Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Marta Bortoli
- Orthopedic and Traumatology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Amelio Ercolino
- Division of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Stefano Ancetti
- Vascular Surgery Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Anna Myriam Perrone
- Gynecologic Oncoloy Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Pierandrea De Iaco
- Gynecologic Oncoloy Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Riccardo Cipriani
- Plastic Surgery Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Eugenio Brunocilla
- Division of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | | | - Mauro Gargiulo
- Vascular Surgery Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Gilberto Poggioli
- General Surgery Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Massimiliano De Paolis
- Orthopedic and Traumatology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
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4
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Management of Unresectable Localized Pelvic Bone Sarcomas: Current Practice and Future Perspectives. Cancers (Basel) 2022; 14:cancers14102546. [PMID: 35626150 PMCID: PMC9139258 DOI: 10.3390/cancers14102546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 05/18/2022] [Accepted: 05/20/2022] [Indexed: 02/04/2023] Open
Abstract
Simple Summary Some locally advanced pelvic bone tumors are deemed unresectable and, as such, not suitable for curative surgery. In this setting, treatment options are generally limited and not unanimous, with decisions being made on an individual basis after multidisciplinary discussion. Ultimately, and notwithstanding the bright prospects raised by novel therapeutic approaches, treatment should be patient-tailored, weighing a panoply of patient- and tumor-related factors. Abstract Bone sarcomas (BS) are rare mesenchymal tumors usually located in the extremities and pelvis. While surgical resection is the cornerstone of curative treatment, some locally advanced tumors are deemed unresectable and hence not suitable for curative intent. This is often true for pelvic sarcoma due to anatomic complexity and proximity to vital structures, making treatment options for these tumors generally limited and not unanimous, with decisions being made on an individual basis after multidisciplinary discussion. Several studies have been published in recent years focusing on innovative treatment options for patients with locally advanced sarcoma not amenable to local surgery. The present article reviews the evidence regarding the treatment of patients with locally advanced and unresectable pelvic BS, with the goal of providing an overview of treatment options for the main BS histologic subtypes involving this anatomic area and exploring future therapeutic perspectives. The management of unresectable localized pelvic BS represents a major challenge and is hampered by the lack of comprehensive and standardized guidelines. As such, the optimal treatment needs to be individually tailored, weighing a panoply of patient- and tumor-related factors. Despite the bright prospects raised by novel therapeutic approaches, the role of each treatment option in the therapeutic armamentarium of these patients requires solid clinical evidence before becoming fully established.
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5
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Jawad MU, Pollock BH, Zeitlinger LN, O'Donnell EF, Traven SA, Carr-Ascher JR, Alvarez E, Malogolowkin MH, Thorpe SW, Randall RL. Impact of local treatment modality on overall- and disease-specific survival for nonmetastatic pelvic and sacral Ewing sarcoma. J Surg Oncol 2022; 126:577-587. [PMID: 35585834 DOI: 10.1002/jso.26922] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 04/23/2022] [Accepted: 05/02/2022] [Indexed: 12/12/2022]
Abstract
PURPOSE The ideal local treatment modality for pelvic and sacral Ewing sarcoma (EWS) is controversial. METHODS We present the data from the American College of Surgeon's National Cancer Database (NCDB) and the National Cancer Institute's Surveillance, Epidemiology and End Result (SEER) database to investigate the impact of local treatment modalities on survival for nonmetastatic pelvic and sacral Ewing sarcoma. Local treatment includes "surgery," "radiation," and a combination of "surgery and radiation." RESULTS A total of 235 cases from SEER and 285 cases from NCDB were analyzed. Patients with "localized" stage (intraosseous) in the SEER database did not show any statistically significant difference in the disease-specific survival (DSS) for any of the local treatment modalities. Similar findings were observed for overall survival among patients with American Joint Committee on Cancer (AJCC) stage II and III in the NCDB database. However, patients with nonmetastatic disease, particularly regional disease (extraosseous), showed improved DSS with surgery only, in the SEER. CONCLUSION We found similar levels of efficacy for different treatment modalities for patients with intraosseous and AJCC II and III pelvic and sacral EWS. "Radiotherapy" is the most common local treatment modality employed in the United States. A prospective, randomized controlled trial with a direct head-to-head comparison is needed for a definitive conclusion.
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Affiliation(s)
- Muhammad Umar Jawad
- Department of Orthopaedic Surgery, University of California-Davis, Sacramento, California, USA
| | - Brad H Pollock
- Department of Public Health, University of California-Davis, Sacramento, California, USA
| | - Lauren N Zeitlinger
- Department of Orthopaedic Surgery, University of California-Davis, Sacramento, California, USA
| | - Edmond F O'Donnell
- Department of Orthopaedic Surgery, University of California-Davis, Sacramento, California, USA
| | - Sophia A Traven
- Department of Orthopaedic Surgery, University of California-Davis, Sacramento, California, USA
| | - Janai R Carr-Ascher
- Department of Orthopaedic Surgery, University of California-Davis, Sacramento, California, USA.,Department of Medicine, University of California-Davis, Sacramento, California, USA
| | - Elysia Alvarez
- Department of Pediatrics, University of California-Davis, Sacramento, California, USA
| | - Marcio H Malogolowkin
- Department of Pediatrics, University of California-Davis, Sacramento, California, USA
| | - Steven W Thorpe
- Department of Orthopaedic Surgery, University of California-Davis, Sacramento, California, USA
| | - R Lor Randall
- Department of Orthopaedic Surgery, University of California-Davis, Sacramento, California, USA
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6
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Meazza C, Luksch R, Luzzati A. Managing axial bone sarcomas in childhood. Expert Rev Anticancer Ther 2021; 21:747-764. [PMID: 33593222 DOI: 10.1080/14737140.2021.1891886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Introduction: Axial osteosarcoma and Ewing sarcoma are rare, aggressive neoplasms with a worse prognosis than with tumors involving the extremities because they are more likely to be associated with larger tumor volumes, older age, primary metastases, and a poor histological response to chemotherapy. The 5-year OS rates are reportedly in the range of 18-41% for axial osteosarcoma, and 46-64% for Ewing sarcoma.Area covered: The treatment of axial bone tumors is the same as for extremity bone tumors, and includes chemotherapy, surgery and/or radiotherapy.Expert opinion: Local treatment of axial tumors is particularly difficult due to their proximity to neurological and vascular structures, which often makes extensive and en bloc resections impossible without causing significant morbidity. The incidence of local relapse is consequently high, and this is the main issue in the treatment of these tumors. Radiotherapy is an option in the case of surgical resections with close or positive margins, as well as for inoperable tumors. Delivering high doses of RT to the spinal cord can be dangerous. Given the complexity and rarity of these tumors, it is essential for this subset of patients to be treated at selected reference institutions with specific expertise and multidisciplinary skills.
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Affiliation(s)
- Cristina Meazza
- Pediatric Oncology Unit, Medical Oncology and Emathology Department, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milano, Italy
| | - Roberto Luksch
- Pediatric Oncology Unit, Medical Oncology and Emathology Department, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milano, Italy
| | - Alessandro Luzzati
- Orthopedic Oncology and Spinal Reconstruction Surgery, Orthopedic Oncology Department, IRCCS Istituto Ortopedico Galeazzi, Milano, Italy
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7
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Guder WK, Hardes J, Nottrott M, Steffen AJ, Dirksen U, Streitbürger A. Pelvic Ewing sarcoma: a retrospective outcome analysis of 104 patients who underwent pelvic tumor resection at a single supra-regional center. J Orthop Surg Res 2020; 15:534. [PMID: 33198775 PMCID: PMC7667797 DOI: 10.1186/s13018-020-02028-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 10/20/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Local treatment in pelvic Ewing sarcoma (ES) consists of operation, radiation therapy, or a combination of both. Reported outcomes vary depending on the treatment modality performed. It is the objective of this study to analyze surgical outcome and complications as well as oncological outcome and complications of chemo- and radiation therapy in this patient cohort and evaluate prognostic factors. METHODS Retrospective review of 104 patients who underwent tumor resection for pelvic ES from 1988 to 2014. RESULTS All patients underwent pelvic resection and radiation therapy was administered in 77.9%. Margins were clear in 94.2%. The response to chemotherapy was good in 78.8%. Local recurrence occurred in 7.7%. The presence of distant metastases at the time of operation was the most important negative predictor for overall survival (p = 0.003). The cumulative 5- and 10-year survival rates were 82.7% and 80.1% for non-metastasized and 61.4% and 41.6% for metastasized pelvic ES at operation. In the presence of a single-distant metastatic site at operation compared to multiple metastatic sites, the cumulative survival rates were 64.3% versus 50% at five and 50.7% versus 16.7% at 10 years. CONCLUSIONS A combined treatment approach of tumor resection and radiation therapy leads to a local control and overall survival rates comparable with those of extremity locations in this study's patient cohort with localized pelvic ES. Therefore, surgical tumor resection (combined with (neo-)adjuvant radiation therapy) in non-metastatic pelvic ES seems feasible. In metastatic patients, however, the significance of tumor resection as a part of local treatment remains less certain and improved outcomes of combined local treatment approaches need to be weighed against these patients' prognosis and quality of life.
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Affiliation(s)
- Wiebke K Guder
- Department of Orthopedics and Tumor Orthopedics, University Hospital Muenster, Albert-Schweitzer-Campus 1, Building A1, 48149, Muenster, Germany. .,Department of Orthopedic Oncology, University Hospital Essen, Hufelandstrasse 55, 45147, Essen, Germany.
| | - Jendrik Hardes
- Department of Orthopedics and Tumor Orthopedics, University Hospital Muenster, Albert-Schweitzer-Campus 1, Building A1, 48149, Muenster, Germany.,Department of Orthopedic Oncology, University Hospital Essen, Hufelandstrasse 55, 45147, Essen, Germany
| | - Markus Nottrott
- Department of Orthopedics and Tumor Orthopedics, University Hospital Muenster, Albert-Schweitzer-Campus 1, Building A1, 48149, Muenster, Germany.,Department of Orthopedic Oncology, University Hospital Essen, Hufelandstrasse 55, 45147, Essen, Germany
| | - Anne Juliane Steffen
- Department of Orthopedics and Tumor Orthopedics, University Hospital Muenster, Albert-Schweitzer-Campus 1, Building A1, 48149, Muenster, Germany
| | - Uta Dirksen
- Department of Pediatric Hematology and Oncology (III), University Hospital Essen, Hufelandstrasse 55, 45147, Essen, Germany
| | - Arne Streitbürger
- Department of Orthopedics and Tumor Orthopedics, University Hospital Muenster, Albert-Schweitzer-Campus 1, Building A1, 48149, Muenster, Germany.,Department of Orthopedic Oncology, University Hospital Essen, Hufelandstrasse 55, 45147, Essen, Germany
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8
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Takenaka S, Araki N, Outani H, Hamada KI, Yoshikawa H, Kamada T, Imai R. Complication rate, functional outcomes, and risk factors associated with carbon ion radiotherapy for patients with unresectable pelvic bone sarcoma. Cancer 2020; 126:4188-4196. [PMID: 32658315 DOI: 10.1002/cncr.33082] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 06/11/2020] [Accepted: 06/12/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND To the authors' knowledge, carbon ion radiotherapy (CIRT) is one of the few curative treatments for unresectable pelvic bone sarcoma. The current study investigated the complications, functional outcomes, and risk factors of CIRT. METHODS Of 112 patients who were treated with CIRT for unresectable pelvic bone sarcoma, the authors enrolled 29 patients who were without local disease recurrence or distant metastasis. The mean follow-up was 93 months. Complications, functional outcomes, and quality of life scores were assessed. Risk factors were analyzed, including the dose-volume histogram of the femoral head. RESULTS Femoral head necrosis occurred in approximately 37% of patients, pelvic fractures were reported in 48% of patients, and neurological deficits were noted in 52% of patients. Femoral head necrosis was found to be significantly more prevalent among patients with periacetabular tumors (P = .018). The dose-volume histogram of the femoral head indicated tolerable volume percentages of the femoral head to be <33% for 40 grays (relative biological effectiveness) and 16% for 60 grays ( relative biological effectiveness). The mean Musculoskeletal Tumor Society score and Toronto Extremity Salvage Score were 53% and 64%, respectively, and the mean EuroQol 5 dimensions questionnaire index was 0.587. Patients aged >50 years and those with periacetabular tumors were found to have significantly lower Toronto Extremity Salvage Scores. CONCLUSIONS Femoral head necrosis, pelvic fracture, and nerve damage are common complications with the use of CIRT for pelvic bone sarcoma. To prevent femoral head necrosis, the radiation dose to the femoral head should be kept below the estimated tolerance curve presented in the current study. The functional outcome is nearly equivalent to that of surgery. CIRT may be a promising alternative to surgery for patients with unresectable pelvic bone sarcoma.
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Affiliation(s)
- Satoshi Takenaka
- Department of Orthopaedics, Osaka University Graduate School of Medicine, Suita, Japan.,Department of Orthopaedics, Osaka International Cancer Institute, Osaka, Japan.,Research Center for Charged Particle Therapy, National Institute of Radiological Sciences, Chiba, Japan
| | - Nobuhito Araki
- Department of Orthopaedic Surgery, Ashiya Municipal Hospital, Ashiya, Japan
| | - Hidetatsu Outani
- Department of Orthopaedics, Osaka University Graduate School of Medicine, Suita, Japan
| | - Ken-Ichiro Hamada
- Department of Orthopaedics, Osaka University Graduate School of Medicine, Suita, Japan
| | - Hideki Yoshikawa
- Department of Orthopaedics, Osaka University Graduate School of Medicine, Suita, Japan.,Department of Orthopaedic Surgery, Toyonaka Municipal Hospital, Toyonaka, Japan
| | - Tadashi Kamada
- Research Center for Charged Particle Therapy, National Institute of Radiological Sciences, Chiba, Japan
| | - Reiko Imai
- Research Center for Charged Particle Therapy, National Institute of Radiological Sciences, Chiba, Japan
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9
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Fujiwara T, Sree DV, Stevenson J, Kaneuchi Y, Parry M, Tsuda Y, Le Nail L, Medellin RM, Grimer R, Jeys L. Acetabular reconstruction with an ice‐cream cone prosthesis following resection of pelvic tumors: Does computer navigation improve surgical outcome? J Surg Oncol 2020; 121:1104-1114. [DOI: 10.1002/jso.25882] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Accepted: 02/17/2020] [Indexed: 12/11/2022]
Affiliation(s)
- Tomohiro Fujiwara
- Department of OncologyThe Royal Orthopaedic Hospital NHS Foundation Trust Birmingham UK
- Department of Orthopaedic SurgeryOkayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences Okayama Japan
| | - Deepak V. Sree
- Department of OncologyThe Royal Orthopaedic Hospital NHS Foundation Trust Birmingham UK
| | - Jonathan Stevenson
- Department of OncologyThe Royal Orthopaedic Hospital NHS Foundation Trust Birmingham UK
| | - Yoichi Kaneuchi
- Department of OncologyThe Royal Orthopaedic Hospital NHS Foundation Trust Birmingham UK
| | - Michael Parry
- Department of OncologyThe Royal Orthopaedic Hospital NHS Foundation Trust Birmingham UK
| | - Yusuke Tsuda
- Department of OncologyThe Royal Orthopaedic Hospital NHS Foundation Trust Birmingham UK
| | - Louis‐Romée Le Nail
- Department of OncologyThe Royal Orthopaedic Hospital NHS Foundation Trust Birmingham UK
| | - Ricardo M. Medellin
- Department of OncologyThe Royal Orthopaedic Hospital NHS Foundation Trust Birmingham UK
| | - Robert Grimer
- Department of OncologyThe Royal Orthopaedic Hospital NHS Foundation Trust Birmingham UK
| | - Lee Jeys
- Department of OncologyThe Royal Orthopaedic Hospital NHS Foundation Trust Birmingham UK
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10
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Gallaway KE, Ahn J, Callan AK. Thirty-Day Outcomes following Pediatric Bone and Soft Tissue Sarcoma Surgery: A NSQIP Pediatrics Analysis. Sarcoma 2020; 2020:1283080. [PMID: 32148435 PMCID: PMC7042554 DOI: 10.1155/2020/1283080] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2019] [Revised: 12/23/2019] [Accepted: 01/23/2020] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Pediatric bone and soft tissue sarcomas are rare; therefore, national registries are essential tools for orthopedic oncology research. Past studies provide excellent data on long-term prognosis and survival trends but fail to examine treatment-specific morbidity. The aim of this study is to use a national registry to describe patient demographics, comorbidities, and adverse events in the first thirty days following surgical management of pediatric bone and soft tissue sarcomas. METHODS A retrospective review of patients in the American College of Surgeons National Surgical Quality Improvement Program-Pediatrics database (NSQIP-P) was performed. The cohort was partitioned by tumor origin (bone versus soft tissue) and tumor location (axial versus appendicular). RESULTS One-hundred ninety-two patients were identified. Bone sarcomas were more common (71.9%) and predominately appendicular (62.3%), while soft tissue sarcomas were predominately axial (77.8%). The overall complication rate was 8.9%. The most frequent etiologies were wound dehiscence (3.6%) and infectious complications such as surgical site infections (2.6%), pneumonia (1.6%), urinary tract infections (1.6%), and C. diff colitis (1.0%). Twenty-four percent of patients experienced bleeding requiring transfusion. The unplanned readmission rate was 12.5% (3.6% related to principle procedure), and the unplanned reoperation rate was 4.7% (4.2% related to principle procedure). The mortality rate was 1.0%. Neoadjuvant chemotherapy was associated with higher rates of wound dehiscence and infectious complications. There were no differences in adverse events with respect to tumor origin or location. CONCLUSION Approximately 1 in 11 pediatric patients will experience a complication in the first thirty days following surgery. However, perioperative mortality remains low. This study represents the first comprehensive review of pediatric bone and soft tissue sarcoma surgery in the NSQIP-P database. As the case volume of NSQIP-P continues to grow, NSQIP-P has the potential to become a powerful tool for pediatric orthopedic oncology research.
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Affiliation(s)
- Kathryn E Gallaway
- Department of Orthopaedic Surgery, UT Southwestern Medical Center, Dallas, TX, USA
| | - Junho Ahn
- Department of Orthopaedic Surgery, UT Southwestern Medical Center, Dallas, TX, USA
| | - Alexandra K Callan
- Department of Orthopaedic Surgery, UT Southwestern Medical Center, Dallas, TX, USA
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11
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Thirty-Day Outcomes after Surgery for Primary Sarcomas of the Extremities: An Analysis of the NSQIP Database. JOURNAL OF ONCOLOGY 2020; 2020:7282846. [PMID: 32411242 PMCID: PMC7201584 DOI: 10.1155/2020/7282846] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/13/2019] [Accepted: 12/24/2019] [Indexed: 02/07/2023]
Abstract
Background Primary bone and soft tissue sarcomas are rare tumors requiring wide surgical resection and reconstruction to achieve local control. Postoperative complications can lead to delays in adjuvant therapy, potentially affecting long-term oncologic outcomes. Understanding postoperative complication risks is essential; however, past studies are limited by small sample sizes. Purpose This study uses a large national registry to characterize the incidence of complications and mortality in the first thirty days following surgical management of primary bone and soft tissue sarcomas of the extremities. Methods A retrospective review of patients in the National Surgical Quality Improvement Program database was performed. Cases were identified using diagnosis codes for malignant neoplasm of soft tissue or bone and procedure codes for amputation and radical resection. The cohort was subdivided by bone versus soft tissue sarcoma, upper versus lower extremity, and amputation versus limb salvage. Results One thousand, one hundred eleven patients were identified. The most frequent complications were surgical site infections, sepsis, and venous thromboembolism. The overall incidence of complications was 14.0%. Unplanned readmission and reoperation occurred after 7.0% and 8.0% of cases, respectively. Thirty-day mortality was 0.3%, with one intraoperative death. Patient factors and complication rates varied by tumor location and surgical modality. Lower extremity cases were associated with higher rates of wound complications and infectious etiologies such as surgical site infections, urinary tract infections, and systemic sepsis. In contrast, patients undergoing amputation were more likely to experience major medical complications including acute renal failure, cardiac arrest, and myocardial infarction. Conclusion Approximately 1 in 7 patients will experience a complication in the first thirty days following surgery for primary bone and soft tissue sarcomas of the extremities. The unique risk profiles of lower extremity and amputation cases should be considered during perioperative planning and surveillance.
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Fauske L, Bondevik H, Ahlberg K, Bjørndal A. Identifying bone sarcoma survivors facing psychosocial challenges. A study of trajectories following treatment. Eur J Cancer Care (Engl) 2019; 28:e13119. [DOI: 10.1111/ecc.13119] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Revised: 03/08/2019] [Accepted: 05/14/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Lena Fauske
- Department of Oncology Norwegian Radium Hospital, Oslo University Hospital Oslo Norway
- Institute of Health and Society, Department of Interdisciplinary Health Sciences University of Oslo Oslo Norway
| | - Hilde Bondevik
- Institute of Health and Society, Department of Interdisciplinary Health Sciences University of Oslo Oslo Norway
| | - Karin Ahlberg
- Institute of Health and Care Sciences Sahlgrenska Academy, University of Gothenburg Gothenburg Sweden
| | - Arild Bjørndal
- Institute of Health and Society, Department of Interdisciplinary Health Sciences University of Oslo Oslo Norway
- Regional Centre for Child and Adolescent Mental Health, Eastern and Southern Oslo Norway
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Liang H, Guo W, Yang R, Tang X, Yan T, Ji T, Yang Y, Li D, Xie L, Xu J. Radiological characteristics and predisposing factors of venous tumor thrombus in pelvic osteosarcoma: A mono-institutional retrospective study of 115 cases. Cancer Med 2018; 7:4903-4913. [PMID: 30141256 PMCID: PMC6198205 DOI: 10.1002/cam4.1739] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Revised: 07/29/2018] [Accepted: 07/30/2018] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Venous tumor thrombus (VTT) in pelvic osteosarcoma has been regarded as a rare oncological condition and few literatures investigated this issue. METHODS We retrospectively reviewed 115 cases of pelvic osteosarcoma treated in our center from 2006 to 2016. Diagnosis of VTTs was made based on histo-pathological findings. We summarized the radiological manifestations of VTTs on CT, MRI, and PET/CT. We also compared the demographical, oncological, and radiological data between cases with or without VTTs to identify its predisposing factors. RESULTS Seventeen cases (14.8%) were diagnosed with VTT. Manifestations of VTTs on CT included increased caliber (64.7%), calcification (47.1%), low density on plain scan (100%), filling defect (100%), and streak-like enhancement (35.7%) on contrast enhancement. On MRI, the VTTs could be hypo- or iso-intense on T1WI (100%), hyperintense on T2WI (100%), and filling defect on contrast enhancement (100%). PET/CT showed high metabolic activity of the VTTs. The ranges of the VTTs included unilateral external iliac vein (EIV) (two cases), unilateral internal iliac vein (IIV) (one case), unilateral common iliac vein (CIV) and IIV (five cases), unilateral CIV + EIV (two cases), inferior vena cava (IVC) and unilateral CIV + EIV (one case), IVC and unilateral CIV + IIV (four cases), IVC and bilateral CIVs + IIVs (two cases). Multivariate analysis indicated that chondroblastic subtype and involvement of L5/S1 intervertebral foramen might predispose to VTTs. CONCLUSION The incidence of VTTs in pelvic osteosarcoma was 14.8%. Comprehensive radiological studies help preoperative diagnosis of VTTs. Predisposing factors included chondroblasic subtype and involvement of L5/S1 intervertebral foramen.
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Affiliation(s)
- Haijie Liang
- Musculoskeletal Tumor CenterPeking University People's HospitalBeijingChina
| | - Wei Guo
- Musculoskeletal Tumor CenterPeking University People's HospitalBeijingChina
| | - Rongli Yang
- Musculoskeletal Tumor CenterPeking University People's HospitalBeijingChina
| | - Xiaodong Tang
- Musculoskeletal Tumor CenterPeking University People's HospitalBeijingChina
| | - Taiqiang Yan
- Musculoskeletal Tumor CenterPeking University People's HospitalBeijingChina
| | - Tao Ji
- Musculoskeletal Tumor CenterPeking University People's HospitalBeijingChina
| | - Yi Yang
- Musculoskeletal Tumor CenterPeking University People's HospitalBeijingChina
| | - Dasen Li
- Musculoskeletal Tumor CenterPeking University People's HospitalBeijingChina
| | - Lu Xie
- Musculoskeletal Tumor CenterPeking University People's HospitalBeijingChina
| | - Jie Xu
- Musculoskeletal Tumor CenterPeking University People's HospitalBeijingChina
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Wang Z, Li S, Li Y, Lin N, Huang X, Liu M, Pan W, Yan X, Sun L, Li H, Li B, Qu H, Wu Y, Lin P, Ye Z. Prognostic factors for survival among patients with primary bone sarcomas of small bones. Cancer Manag Res 2018; 10:1191-1199. [PMID: 29795990 PMCID: PMC5958943 DOI: 10.2147/cmar.s163229] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Background Primary bone sarcomas of the hands or feet are rare lesions and poorly documented. Moreover, the prognostic determinants of bone sarcomas of the hands or feet have not been reported. Materials and methods The Surveillance, Epidemiology, and End Results (SEER) program database was used to screen patients with bone sarcomas of the hands or feet from 1973 to 2013, with attention paid to chondrosarcoma, Ewing sarcoma, and osteosarcoma. The prognostic values of overall survival (OS) and cancer-specific survival (CSS) were assessed using Cox proportional hazards regression model with univariate and multivariate analyses. The Kaplan–Meier method was used to obtain OS and CSS curves. Results A total of 457 cases were selected from the SEER database. Chondrosarcoma was the most common form of lesion in hands or feet or both, followed by Ewing sarcoma and osteosarcoma. The 5- and 10-year OS rates of the entire group were 75.7% and 66.1%, respectively. The 5- and 10-year CSS rates were 78.7% and 73.7%, respectively. Multivariate analysis revealed that age under 40 years, localized stage, low grade, surgical treatment, and first primary tumor were associated with improved OS, and decade of diagnosis, stage, grade, and surgery were independent predictors of CSS. However, no significant differences were observed in OS and CSS among patients with different primary tumor locations and tumor subtypes. Additionally, the most significant prognostic factor was whether metastasis had occurred at the time of initial diagnosis. Conclusion Among patients with primary bone sarcomas of the hands or feet, younger age (<40 years), localized stage, low grade, surgical treatment, and first primary tumor are favorable factors for prolonging survival.
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Affiliation(s)
- Zhan Wang
- Department of Orthopaedics, The Second Affiliated Hospital of Zhejiang University School of Medicine, Centre for Orthopaedic Research, Orthopedics Research Institute of Zhejiang University, Hangzhou, China
| | - Shu Li
- Key Laboratory of Cancer Prevention and Intervention, Key Laboratory of Molecular Biology in Medical Sciences, National Ministry of Education, Department of Hematology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Cancer Institute, Hangzhou, China
| | - Yong Li
- Department of Orthopaedics, The Second Affiliated Hospital of Zhejiang University School of Medicine, Centre for Orthopaedic Research, Orthopedics Research Institute of Zhejiang University, Hangzhou, China
| | - Nong Lin
- Department of Orthopaedics, The Second Affiliated Hospital of Zhejiang University School of Medicine, Centre for Orthopaedic Research, Orthopedics Research Institute of Zhejiang University, Hangzhou, China
| | - Xin Huang
- Department of Orthopaedics, The Second Affiliated Hospital of Zhejiang University School of Medicine, Centre for Orthopaedic Research, Orthopedics Research Institute of Zhejiang University, Hangzhou, China
| | - Meng Liu
- Department of Orthopaedics, The Second Affiliated Hospital of Zhejiang University School of Medicine, Centre for Orthopaedic Research, Orthopedics Research Institute of Zhejiang University, Hangzhou, China
| | - Weibo Pan
- Department of Orthopaedics, The Second Affiliated Hospital of Zhejiang University School of Medicine, Centre for Orthopaedic Research, Orthopedics Research Institute of Zhejiang University, Hangzhou, China
| | - Xiaobo Yan
- Department of Orthopaedics, The Second Affiliated Hospital of Zhejiang University School of Medicine, Centre for Orthopaedic Research, Orthopedics Research Institute of Zhejiang University, Hangzhou, China
| | - Lingling Sun
- Department of Orthopaedics, The Second Affiliated Hospital of Zhejiang University School of Medicine, Centre for Orthopaedic Research, Orthopedics Research Institute of Zhejiang University, Hangzhou, China
| | - Hengyuan Li
- Department of Orthopaedics, The Second Affiliated Hospital of Zhejiang University School of Medicine, Centre for Orthopaedic Research, Orthopedics Research Institute of Zhejiang University, Hangzhou, China
| | - Binghao Li
- Department of Orthopaedics, The Second Affiliated Hospital of Zhejiang University School of Medicine, Centre for Orthopaedic Research, Orthopedics Research Institute of Zhejiang University, Hangzhou, China
| | - Hao Qu
- Department of Orthopaedics, The Second Affiliated Hospital of Zhejiang University School of Medicine, Centre for Orthopaedic Research, Orthopedics Research Institute of Zhejiang University, Hangzhou, China
| | - Yan Wu
- Department of Orthopaedics, The Second Affiliated Hospital of Zhejiang University School of Medicine, Centre for Orthopaedic Research, Orthopedics Research Institute of Zhejiang University, Hangzhou, China
| | - Peng Lin
- Department of Orthopaedics, The Second Affiliated Hospital of Zhejiang University School of Medicine, Centre for Orthopaedic Research, Orthopedics Research Institute of Zhejiang University, Hangzhou, China
| | - Zhaoming Ye
- Department of Orthopaedics, The Second Affiliated Hospital of Zhejiang University School of Medicine, Centre for Orthopaedic Research, Orthopedics Research Institute of Zhejiang University, Hangzhou, China
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Song K, Shi X, Wang H, Zou F, Lu F, Ma X, Xia X, Jiang J. Can a Nomogram Help to Predict the Overall and Cancer-specific Survival of Patients With Chondrosarcoma? Clin Orthop Relat Res 2018; 476:987-996. [PMID: 29470233 PMCID: PMC5916629 DOI: 10.1007/s11999.0000000000000152] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Many factors have been reported to be associated with the prognosis of patients with chondrosarcoma, but clinicians have few tools to estimate precisely an individual patient's likelihood of surviving the illness. We therefore sought to develop effective nomograms to better estimate the survival of patients with chondrosarcoma. QUESTIONS/PURPOSES (1) Which clinicopathologic features are independent prognostic factors for patients with chondrosarcoma? (2) Can we develop a nomogram to predict 3- and 5-year overall and cancer-specific survival of individual patients with chondrosarcoma based on personalized information? METHODS We collected information on patients diagnosed with chondrosarcoma between 1988 and 2011 from the Surveillance, Epidemiology, and End Results (SEER) database. The SEER database consists of 18 cancer registries and covers approximately 30% of the total United States population. One thousand thirty-four adult patients with grade II or III chondrosarcoma were included in the cohort (patients with grade I chondrosarcoma were not evaluated in this study), while 327 patients were excluded from the study owing to missing data regarding tumor size or metastasis. Nine hundred nineteen patients (89%) in the cohort had complete followup for at least 1 year. The X-tile program was used to determine optimal cutoff points. Univariate and multivariate analyses were applied to identify independent factors that were further included in the nomograms predicting 3- and 5-year overall survival and cancer-specific survival. Records of 1034 patients were collected and randomly divided into training (n = 517) and validation (n = 517) cohorts. The nomograms were developed based on training cohort. Data for the training cohort were obtained for internal validation of the nomograms, whereas data for the validation cohort were obtained for external validation of the nomograms. Bootstrapped validation, which used a resample with 500 iterations, was applied to validate the nomograms internally and externally. RESULTS Six independent prognostic factors for overall survival and six for cancer-specific survival were identified and incorporated to construct nomograms for 3- and 5-year overall and cancer-specific survival. These nomograms can easily be used by providers in the office to estimate a patient's prognosis; the only clinical details a provider needs to use these nomograms effectively are age, histologic subtype, tumor grade, whether surgery was performed, tumor size, and the presence or absence of metastases. Internal and external calibration plots for the probability of 3- and 5-year overall survival and cancer-specific survival showed good agreement between nomogram prediction and observed outcomes. The concordance indices (C-indices) for internal validation of overall survival and cancer-specific survival prediction were 0.803 and 0.829, respectively, whereas the C-indices for external validation were 0.753 and 0.759, respectively. CONCLUSIONS We were able to develop effective nomograms to predict overall survival and cancer-specific survival for patients with chondrosarcoma; these nomograms require only basic information, which should be available to all providers in the office setting. If these observations can be validated in different registries or databases, the nomograms can assist clinicians in counseling patients regarding therapeutic choices. LEVEL OF EVIDENCE Level III, prognostic study.
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Affiliation(s)
- Kehan Song
- K. Song, H. Wang, F. Zou, F. Lu, X. Ma, X. Xia, J. Jiang, Department of Orthopaedics, Huashan Hospital, Fudan University, Shanghai, China X. Shi, Department of Head and Neck Surgery, Shanghai Cancer Center, Fudan University, Shanghai, China
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Song K, Shi X, Liang X, Wang H, Zou F, Lu F, Ma X, Jiang J. Risk factors for metastasis at presentation with conventional chondrosarcoma: a population-based study. INTERNATIONAL ORTHOPAEDICS 2018; 42:2941-2948. [PMID: 29681020 DOI: 10.1007/s00264-018-3942-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Accepted: 04/10/2018] [Indexed: 10/17/2022]
Abstract
PURPOSE The aim of the study was to investigate risk factors for metastasis at diagnosis. METHODS We collected patients diagnosed with conventional chondrosarcoma between 1983 and 2014 from the Surveillance, Epidemiology, and End Results (SEER) database. Each patient was classified as having metastatic or localized disease. Univariate and multivariate logistic regression analyses were applied to determine which characteristics were risk factors for metastasis at diagnosis. RESULTS Two thousand three hundred forty-nine patients were collected and 180 patients had metastasis at presentation. Data on age, gender, primary site, grade, and tumour size were enrolled into the multivariate logistic analysis. Greater age (60 years or older: OR = 1.872, 95% CI, 1.206 to 2.904), axial or craniofacial location (spine: OR = 1.775, 95% CI, 1.188 to 2.651; thoracic cage: OR = 2.034, 95% CI, 1.321 to 3.134; craniofacial bones: OR = 5.507, 95% CI, 3.001 to 10.107), higher grade (grade II: OR = 1.849, 95%CI, 1.181 to 2.895; grade III: OR = 4.016, 95%CI, 2.513 to 6.418), and larger tumour size (size over 10 cm: OR = 7.135, 95%CI, 2.130 to 23.893) were associated with an increased risk of metastasis at presentation. CONCLUSIONS Conventional chondrosarcoma patients with greater age, axial or craniofacial tumour location, higher grade, and larger tumor size were more likely to have metastasis at diagnosis.
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Affiliation(s)
- Kehan Song
- Department of Orthopaedics, Huashan Hospital, Fudan University, No.12 Wulumuqizhong Road, Shanghai, 200040, China
| | - Xiao Shi
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Xin Liang
- Department of Ophthalmology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Hongli Wang
- Department of Orthopaedics, Huashan Hospital, Fudan University, No.12 Wulumuqizhong Road, Shanghai, 200040, China
| | - Fei Zou
- Department of Orthopaedics, Huashan Hospital, Fudan University, No.12 Wulumuqizhong Road, Shanghai, 200040, China
| | - Feizhou Lu
- Department of Orthopaedics, Huashan Hospital, Fudan University, No.12 Wulumuqizhong Road, Shanghai, 200040, China
| | - Xiaosheng Ma
- Department of Orthopaedics, Huashan Hospital, Fudan University, No.12 Wulumuqizhong Road, Shanghai, 200040, China
| | - Jianyuan Jiang
- Department of Orthopaedics, Huashan Hospital, Fudan University, No.12 Wulumuqizhong Road, Shanghai, 200040, China.
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Successful Complete Response of Tumor Thrombus after Combined with Chemotherapy and Irradiation for Ewing Sarcoma. Case Rep Orthop 2018; 2018:5238512. [PMID: 29610692 PMCID: PMC5828491 DOI: 10.1155/2018/5238512] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Accepted: 12/05/2017] [Indexed: 11/17/2022] Open
Abstract
Pelvic Ewing sarcoma is associated with a worse prognosis. Thromboembolic events are relatively common in pediatric patients with cancers including sarcomas. We have presented a case of Ewing sarcoma arising from the left iliac bone with tumor thrombus of inferior vena cava (IVC) which was obtained complete response by both chemotherapy and irradiation. Magnetic resonance imaging (MRI) scan demonstrated that the tumor arising from the left iliac bone extended into the left side of sacral bone, suggesting the difficulty of surgical resection. Computed tomography (CT) revealed the existence of the tumor thrombus of IVC. We performed irradiation (31.2 Gy) and chemotherapy (combination of VCR, Act-D, IFM, and ADR). The tumor was controlled successfully, and the tumor thrombus of IVC has completely vanished. Four years after the treatment, coin lesion in the left upper lung appeared. Suspected of metastasis, segmental resection of the left upper lung was performed. Fourteen years after the surgery, the patient has been remained free of recurrence. It is clinically significant for surgeons to treat pelvic Ewing sarcoma with tumor thrombus.
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Zhang WT, Zhang WW, He ZY, Sun JY, Zhang L, Xia Q, Wu SG. Comparison of the effects of local treatment strategies in non-metastatic Ewing sarcoma of bone. Expert Rev Anticancer Ther 2018. [PMID: 29537323 DOI: 10.1080/14737140.2018.1453360] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND To investigate the optimal local treatment strategies for patients with non-metastatic Ewing sarcoma (ES) of bone. METHODS Patients with ES of bone were identified using the Surveillance Epidemiology and End Results database. Kaplan-Meier log-rank test and Cox regression models were performed to assess the effect of the types of local treatment strategies on cause-specific survival and overall survival. RESULTS 560 patients were included with a median age of 16 years. A total of 284, 162 and 114 patients received surgery alone, surgery and radiotherapy, and radiotherapy alone, respectively. The types of local treatment strategies had no effect on survival outcomes in multivariate analysis. In the subgroup analysis of patients with tumor diameter <8 cm, surgery ± radiotherapy had a significantly improved cause-specific survival (P = 0.039), and had potential to improve overall survival (P = 0.070) in multivariate analysis. The local treatment strategies had no effect on survival in patients with different tumor location. CONCLUSION There is no local treatment of choice for non-metastatic ES of bone in terms of survival. More well-designed studies are needed to confirm our findings and investigate the role of various local treatment strategies in relation to primary tumor diameter.
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Affiliation(s)
- Wen-Tong Zhang
- a Department of Orthopaedic Surgery, Xiamen branch , Zhongshan Hospital, Fudan University , Xiamen , China
| | - Wen-Wen Zhang
- b Department of Radiation Oncology , Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine , Guangzhou , China
| | - Zhen-Yu He
- b Department of Radiation Oncology , Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine , Guangzhou , China
| | - Jia-Yuan Sun
- b Department of Radiation Oncology , Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine , Guangzhou , China
| | - Lei Zhang
- a Department of Orthopaedic Surgery, Xiamen branch , Zhongshan Hospital, Fudan University , Xiamen , China
| | - Qing Xia
- a Department of Orthopaedic Surgery, Xiamen branch , Zhongshan Hospital, Fudan University , Xiamen , China.,c Department of Orthopaedic Surgery , Zhongshan Hospital, Fudan University , Shanghai , China
| | - San-Gang Wu
- d Department of Radiation Oncology , Xiamen Cancer Hospital, the First Affiliated Hospital of Xiamen University , Xiamen , China
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Ferrari S, Palmerini E, Fabbri N, Staals E, Ferrari C, Alberghini M, Picci P. Osteosarcoma of the Pelvis: A Monoinstitutional Experience in Patients Younger than 41 Years. TUMORI JOURNAL 2018; 98:702-8. [DOI: 10.1177/030089161209800605] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Aims and background Information is scarce on systemic treatment of pelvic osteosarcoma because most chemotherapy protocols for osteosarcoma include patients with extremity tumors and aged up to 30–40 years. Methods Data on patients <41 years of age with high-grade pelvic osteosarcoma were prospectively collected. Patients received two chemotherapy protocols consisting of methotrexate, cisplatin, doxorubicin (MAP) and standard-dose or high-dose ifosfamide. Results Forty patients between 11 and 36 years were included. The most frequent histological subtype was osteoblastic followed by chondroblastic (37.5%). Complete surgical remission was achieved in 65% of patients. Eighteen patients had MAP/standard-dose ifosfamide, 22 MAP/high-dose ifosfamide. Primary chemotherapy was given to 25 patients and 6 (24%) of them had a good histological response. Median follow-up was 32 months (range, 4–134). Five-year overall survival was 27.5%: 33% in localized and 0 in metastatic patients (P = 0.02); 45% in patients with complete surgical remission and 0 for patients without complete surgical remission (P = 0.001). Local recurrence rate was 46%. In patients with complete surgical remission, 5-year overall survival was 32% with MAP/standard-dose ifosfamide and 59% with MAP/high-dose ifosfamide regimen (P = 0.3). Conclusions Local control is the major issue in the treatment of pelvic osteosarcoma. Poor pathological response and high incidence of chondroblastic variant indicate different characteristics between pelvic and extremity osteosarcoma. Chemotherapy with MAP and high-dose ifosfamide might be beneficial in patients with pelvic osteosarcoma and warrants further investigation.
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Affiliation(s)
| | | | - Nicola Fabbri
- Surgical Oncology Department, Rizzoli Institute, Bologna, Italy
| | - Eric Staals
- Surgical Oncology Department, Rizzoli Institute, Bologna, Italy
| | - Cristina Ferrari
- Surgical Pathology Department, Rizzoli Institute, Bologna, Italy
| | - Marco Alberghini
- Surgical Pathology Department, Rizzoli Institute, Bologna, Italy
| | - Piero Picci
- Surgical Pathology Department, Rizzoli Institute, Bologna, Italy
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Tang F, Min L, Ye Y, Tang B, Zhou Y, Zhang W, Tu C. Classic Hodgkin lymphoma in pelvis: A case report highlights diagnosis and treatment challenges. Medicine (Baltimore) 2017; 96:e8196. [PMID: 28953683 PMCID: PMC5626326 DOI: 10.1097/md.0000000000008196] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
RATIONALE Classic Hodgkin lymphoma with pelvic involvement is a rare entity. Diagnosis and treatment for such an uncommon disease are challenging. Here we report a special case of classic Hodgkin lymphoma in pelvis. PATIENT CONCERNS A 20-year-old woman was admitted to our department due to left hip symptoms. The patient reported a history of drenching night sweats, low-grade fever, pruritic rash on the body, and an almost 15% weight loss during the previous 3 months. DIAGNOSES Imaging studies revealed osteolytic destruction of the left hemi-pelvic with a huge soft-tissue mass. Open biopsy established the pathological diagnosis of classic Hodgkin lymphoma. INTERVENTIONS Considering the B symptom, bulky disease, and high risk of pathological fracture of the patient, we performed limb-salvage surgery and 6 cycles ABVD chemotherapy with 2 cycles before surgery. OUTCOMES Up to now, at the 3-year follow-up, there is no sign of disease relapse and metastasis. Besides, her limb function recovered well. LESSONS Based on this case and literature we reviewed, diagnoses for primary bone Hodgkin lymphoma should be cautious. For the treatment, chemotherapy was the main treatment option. Classic Hodgkin lymphoma patients seldom received tumor resection surgery, but for the special bone classic Hodgkin lymphoma individual with a huge tumor volume and high risk of pathological fracture in our study, limb-salvage surgery based on ABVD chemotherapy provided a satisfying clinical outcome.
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Affiliation(s)
- Fan Tang
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, China
- Sarcoma Biology Laboratory, Center for Sarcoma and Connective Tissue Oncology, Massachusetts General Hospital, Boston, MA
| | - Li Min
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, China
- Sarcoma Biology Laboratory, Center for Sarcoma and Connective Tissue Oncology, Massachusetts General Hospital, Boston, MA
| | - Yunxia Ye
- Department of Pathology, West China Hospital, Sichuan University, Chengdu, China
| | - Bo Tang
- Institute of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yong Zhou
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, China
| | - Wenli Zhang
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, China
| | - Chongqi Tu
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, China
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Puchner SE, Funovics PT, Böhler C, Kaider A, Stihsen C, Hobusch GM, Panotopoulos J, Windhager R. Oncological and surgical outcome after treatment of pelvic sarcomas. PLoS One 2017; 12:e0172203. [PMID: 28199377 PMCID: PMC5310872 DOI: 10.1371/journal.pone.0172203] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2016] [Accepted: 02/01/2017] [Indexed: 12/04/2022] Open
Abstract
Background and objectives Treatment of pelvic tumors remains challenging due to complex anatomy, poor oncological outcome and high complication rates. We sought to investigate the long-term oncological and surgical outcome of these patients. Methods Between 1980 and 2012, 147 patients underwent surgical treatment for pelvic sarcoma. Histological diagnosis was Chondrosarcoma in 54, Ewing’s Sarcoma/PNET in 37, Osterosarcoma in 32 and others in 24 patients. Statistical analysis for the evaluation of oncological and surgical outcome was performed by applying Cox proportional hazards regression and Fine-Gray regression models for competing risk (CR) endpoints. Results The estimated overall survival (OS) to death was 80%, 45% and 37% at 1, 5 and 10 years, respectively. Univariate analyses revealed a statistically significant unadjusted influence of age age (p = 0.038; HR = 1.01), margin (p = 0.043; HR = 0.51) and grade (p = 0.001; HR = 2.27) on OS. Considering the multivariable model, grade (p = 0.005; HR = 3.04) and tumor volume (p = 0.014; HR = 1.18) presented themselves as independent prognostic factors on OS. CR analysis showed a cumulative incidence for major complication of 31% at 5 years. Endoprosthetic reconstruction had a higher risk for experiencing a major complication (p<0.0001) and infection (p = 0.001). Conclusions Pelvic resections are still associated with a high incidence of complications. Patients with pelvic reconstruction and high volume tumors are especially at risk. Consequently, a cautious decision-making process is necessary when indicating pelvic reconstruction, although a restrictive approach to pelvic reconstruction is not necessarily reasonable when the other option is major amputation.
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Affiliation(s)
- Stephan E. Puchner
- Department of Orthopedics, Medical University of Vienna Waehringer Guertel 18–20 Vienna. Austria
- * E-mail:
| | - Philipp T. Funovics
- Department of Orthopedics, Medical University of Vienna Waehringer Guertel 18–20 Vienna. Austria
| | - Christoph Böhler
- Department of Orthopedics, Medical University of Vienna Waehringer Guertel 18–20 Vienna. Austria
| | - Alexandra Kaider
- Center for Medical Statistics, Informatics, and Intelligent Systems—Section for Clinical Biometrics, Medical University of Vienna Waehringer Guertel 18–20 Vienna. Austria
| | - Christoph Stihsen
- Department of Orthopedics, Medical University of Vienna Waehringer Guertel 18–20 Vienna. Austria
| | - Gerhard M. Hobusch
- Department of Orthopedics, Medical University of Vienna Waehringer Guertel 18–20 Vienna. Austria
| | - Joannis Panotopoulos
- Department of Orthopedics, Medical University of Vienna Waehringer Guertel 18–20 Vienna. Austria
| | - Reinhard Windhager
- Department of Orthopedics, Medical University of Vienna Waehringer Guertel 18–20 Vienna. Austria
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Scudday TS, Danisa OA, Zuckerman LM. Management of Pelvic Chondroblastic Osteosarcoma after Urgent Spinal Decompression - A Report of 2 Cases. J Orthop Case Rep 2016; 6:72-5. [PMID: 27299134 PMCID: PMC4845420 DOI: 10.13107/jocr.2250-0685.383] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Introduction: Pelvic sarcoma presenting with neurologic symptoms is rare. Workup of neurological deficits, whether elective or emergent should address the possibility of a space occupying lesion including pelvic sarcoma. Poor biopsy technique and incomplete workup of musculoskeletal tumors results in misdiagnosis or major errors in 18% of biopsies. The sequelae of a suboptimal biopsy include local recurrence, a more extensive resection, or extremity amputation. Pelvic chondroblastic osteosarcoma presenting with neurological deficits has not been previously reported. We report two cases of chondroblastic osteosarcoma that were treated with urgent decompression of the lumbar spine due to neurologic symptoms. Case presentations: Our two cases, a 25 year old Hispanic female and 22 year old Hispanic male, both presented with neurologic changes due to a space occupying tumor in the lumbar spine and pelvis. Both underwent spinal decompression following incomplete workup. A repeat biopsy was required in both cases due to a questionable initial diagnosis. Once the diagnosis was confirmed, they underwent definitive resection and treatment that was more morbid due to the primary decompressions. Conclusion: We stress the importance of proper biopsy techniques as well as the need to complete a full preoperative staging workup prior to any surgical procedures involving musculoskeletal tumors. We review the current literature on lumbar chondroblastic osteosarcomas and review the issues surrounding biopsy of musculoskeletal tumors. Our cases underline the need for complete workup and correct biopsy techniques to ensure patients have the best chance at tumor free survival with minimal morbidity.
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Affiliation(s)
- Travis Spencer Scudday
- Department of Orthopaedic Surgery, Loma Linda University Medical Center. Loma Linda, CA, USA
| | - Olumide Ayodele Danisa
- Department of Orthopaedic Surgery, Loma Linda University Medical Center. Loma Linda, CA, USA
| | - Lee Michael Zuckerman
- Department of Orthopaedic Surgery, Loma Linda University Medical Center. Loma Linda, CA, USA
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Hesla AC, Tsagozis P, Jebsen N, Zaikova O, Bauer H, Brosjö O. Improved Prognosis for Patients with Ewing Sarcoma in the Sacrum Compared with the Innominate Bones: The Scandinavian Sarcoma Group Experience. J Bone Joint Surg Am 2016; 98:199-210. [PMID: 26842410 DOI: 10.2106/jbjs.o.00362] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Treatment of Ewing sarcoma of the pelvic bones remains one of the most difficult tasks in the treatment of bone sarcomas. Whether surgery or radiation therapy is the best local treatment is still a matter of debate. The aim of the present study was to compare sacral and nonsacral sites with regard to the treatment and outcome of pelvic Ewing sarcomas. METHODS Patients with Ewing sarcoma of the osseous pelvis diagnosed between 1986 and 2011 were identified through the Scandinavian Sarcoma Group registry. Data regarding tumor size, local treatment (surgery or radiation therapy), metastatic disease, surgical margins, local recurrence, and overall survival were analyzed. RESULTS Of the 117 patients examined, eighty-eight had tumors in the innominate bones and twenty-nine, in the sacrum. Radiation therapy was the sole local treatment for 40% of the innominate bone tumors in contrast to 79% of the sacral tumors. The five-year disease-free survival rate in the latter group (66%) was greater than that in the group with tumors in the innominate bones (40%) (p = 0.02 adjusted for size). CONCLUSIONS Disease-free survival among patients with Ewing sarcoma was improved when the tumor was localized in the sacrum compared with the innominate bones, where these tumors are generally larger. Local radiation therapy alone appears to result in good local tumor control and may be the treatment of choice for sacral tumors.
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Affiliation(s)
- Asle Charles Hesla
- Department of Orthopaedic Surgery, Karolinska University Hospital, Solna, Sweden
| | - Panagiotis Tsagozis
- Department of Orthopaedic Surgery, Karolinska University Hospital, Solna, Sweden
| | - Nina Jebsen
- Department of Oncology, Haukeland University Hospital, Bergen, Norway
| | - Olga Zaikova
- Department of Orthopaedic Surgery, Norwegian Radium Hospital, Oslo, Norway
| | - Henrik Bauer
- Department of Orthopaedic Surgery, Karolinska University Hospital, Solna, Sweden
| | - Otte Brosjö
- Department of Orthopaedic Surgery, Karolinska University Hospital, Solna, Sweden
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Arnal-Burró J, Calvo-Haro J, Igualada-Blazquez C, Gil-Martínez P, Cuervo-Dehesa M, Vaquero-Martín J. Hemipelvectomy for the treatment of high-grade sarcomas: Pronostic of chondrosarcomas compared to other histological types. Rev Esp Cir Ortop Traumatol (Engl Ed) 2016. [DOI: 10.1016/j.recote.2015.11.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Fauske L, Lorem G, Grov EK, Bondevik H. Changes in the body image of bone sarcoma survivors following surgical treatment--A qualitative study. J Surg Oncol 2015; 113:229-34. [PMID: 26714610 PMCID: PMC4736459 DOI: 10.1002/jso.24138] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2015] [Accepted: 12/05/2015] [Indexed: 11/25/2022]
Abstract
Background and Objectives Among several long‐term effects, people treated for cancer may experience an altered appearance. Our study aims to identify how visible body changes following surgical treatment affect the life and identity of primary bone sarcoma survivors 3–10 years after diagnosis. A qualitative, phenomenological, and hermeneutic design was applied. Methods Sarcoma survivors (n = 18) who were previously treated at Norwegian Radium Hospital, Oslo University Hospital, participated in the study. In‐depth and semi‐structured interviews were conducted and analyzed using inductive thematic analysis. Results The main finding of this study concerned how altered appearance after bone cancer treatment in the hip/pelvis or lower extremities affected the participants’ self‐esteem. Half of the participants expressed concerns about their visible differences, particularly those with functional impairment. They felt that it is important to hide the bodily signs of changes to appear as normal as possible, as well as attractive and healthy. They describe, with specific examples, how these changes influence their self‐realization, especially their social life. Conclusions Healthcare providers who guide bone sarcoma survivors during follow‐up should develop a comprehensive understanding of what it means to cope with a changed and challenging body. J. Surg. Oncol. 2016;113:229–234. © 2015 The Authors. Journal of Surgical Oncology Published by Wiley Periodicals, Inc.
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Affiliation(s)
- Lena Fauske
- Department of Oncology, Norwegian Radium Hospital, Oslo University Hospital, Nydalen, Oslo, Norway
| | - Geir Lorem
- Department of Health and Care Sciences, UiT The Arctic University of Norway, Tromsø, Norway
| | - Ellen K Grov
- Faculty of Health Sciences, Department of Nursing, Oslo and Akershus University College of Applied Sciences, Oslo, Norway
| | - Hilde Bondevik
- Department of Health Sciences, Institute of Health and Society, University of Oslo, Blindern, Oslo, Norway
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Monitoring bone and soft-tissue tumors after carbon-ion radiotherapy using ¹⁸F-FDG positron emission tomography: a retrospective cohort study. Radiat Oncol 2015; 10:259. [PMID: 26691334 PMCID: PMC4687301 DOI: 10.1186/s13014-015-0571-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Accepted: 12/15/2015] [Indexed: 11/29/2022] Open
Abstract
Background The results of treatment for malignant bone and soft-tissue tumors arising from the deep trunk and pelvis are still not acceptable due to the relatively high recurrence and low overall survival rates. Recently, carbon ion radiotherapy (CIRT) was applied for several malignancies, including bone and soft-tissue sarcomas, and provided favorable results. However, it has been unclear what modalities should be used for evaluating the response and for the follow-up of these patients. Here, we analyzed the methods used to predict local recurrence and to find local failures or metastases. Methods We analyzed 37 patients with bone and soft-tissue tumors who received CIRT at our institute. The patients were examined with FDG positron emission tomography (PET) and enhanced MRI before and three months after CIRT. The pre-treatment maximum standardized uptake value (SUVmax), and that three months after treatment, the difference between the pre- and post-CIRT SUVmax, the ratio of the post- to pre-SUVmax in FDG-PET and the size of the tumors were evaluated as predictors for local recurrence. FDG-PET and enhanced MRI were used to detect local recurrence. Results Local recurrence appeared in 10 cases after CIRT. Nine of the 10 lesions (90.0 %) were detected with FDG-PET, while enhanced MRI detected just 50.0 % of the recurrences. One case of local recurrence, in which the lesion was negative on FDG-PET, was detected using enhanced MRI. A receiver operating characteristic curve analysis showed that neither the SUVmax on FDG-PET nor the tumor size before or three months after CIRT could be used to predict local recurrence. Conclusions The combination of FDG-PET and enhanced MRI is recommended to detect local recurrence for patients with sarcomas who have received CIRT; however, no parameters obtained during the examinations performed before and three months after CIRT accurately predicted the development of local recurrence.
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Bedetti B, Wiebe K, Ranft A, Aebert H, Schmidt J, Jürgens H, Dirksen U. Local Control in Ewing Sarcoma of the Chest Wall: Results of the EURO-EWING 99 Trial. Ann Surg Oncol 2015; 22:2853-9. [DOI: 10.1245/s10434-015-4630-0] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2014] [Indexed: 01/12/2023]
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[Hemipelvectomy for the treatment of high-grade sarcomas: Pronostic of chondrosarcomas compared to other histological types]. Rev Esp Cir Ortop Traumatol (Engl Ed) 2015; 60:67-74. [PMID: 26091572 DOI: 10.1016/j.recot.2015.04.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2015] [Revised: 04/22/2015] [Accepted: 04/29/2015] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION The low incidence and histological heterogeneity of primary sarcomas located in the pelvis makes it difficult to find homogeneous cohorts. OBJECTIVE To describe the life and functional prognosis depending on the histological type of sarcoma in a series of locally advanced high-grade pelvis located sarcomas treated by hemipelvectomy. METHODS A descriptive epidemiological and functional study was conducted on 15 cases treated between 2006 and 2012. Survival analysis, functional assessment, and a comparative study by histological type were performed, comparing chondrosarcomas to other histological diagnoses. RESULTS The most frequent histological type was chondrosarcoma (46%), and the most frequent location was P2 (periacetabular) (73%). An internal hemipelvectomy was performed in 66% of cases, with a higher incidence (83%) in chondrosarcomas. Overall two-year survival was 54%, with higher survival in the chondrosarcoma group (67%) than in the other sarcomas (43%). Functional status depended on the type of intervention, with no differences in histological type or the performance of the reconstruction. DISCUSSION AND CONCLUSIONS Hemipelvectomy is a surgical procedure that is indicated for the treatment of locally advanced high grade pelvis located sarcomas, regardless of histological type. The incidence of limb preservation and overall survival is higher in chondrosarcomas compared to other sarcomas.
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Cheung MR. Optimization of predictors of Ewing sarcoma cause-specific survival: a population study. Asian Pac J Cancer Prev 2015; 15:4143-5. [PMID: 24935360 DOI: 10.7314/apjcp.2014.15.10.4143] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This study used receiver operating characteristic curve to analyze Surveillance, Epidemiology and End RESULTS (SEER) Ewing sarcoma (ES) outcome data. The aim of this study was to identify and optimize ES-specific survival prediction models and sources of survival disparities. MATERIALS AND METHODS This study analyzed socio-economic, staging and treatment factors available in the SEER database for ES. 1844 patients diagnosed between 1973-2009 were used for this study. For the risk modeling, each factor was fitted by a Generalized Linear Model to predict the outcome (bone and joint specific death, yes/no). The area under the receiver operating characteristic curve (ROC) was computed. Similar strata were combined to construct the most parsimonious models. RESULTS The mean follow up time (S.D.) was 74.48 (89.66) months. 36% of the patients were female. The mean (S.D.) age was 18.7 (12) years. The SEER staging has the highest ROC (S.D.) area of 0.616 (0.032) among the factors tested. We simplified the 4-layered risk levels (local, regional, distant, un-staged) to a simpler non-metastatic (I and II) versus metastatic (III) versus un-staged model. The ROC area (S.D.) of the 3-tiered model was 0.612 (0.008). Several other biologic factors were also predictive of ES-specific survival, but not the socio-economic factors tested here. CONCLUSIONS ROC analysis measured and optimized the performance of ES survival prediction models. Optimized models will provide a more efficient way to stratify patients for clinical trials.
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Affiliation(s)
- Min Rex Cheung
- New York Cyberknife Center, 40-20 Main Street, 4th floor, Flushing, NY 11354, USA E-mail :
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Francis M, Dennis N, Charman J, Lawrence G. Identifying Prognostic Indicators in Staging Metastatic Sarcomas Using Hospital Episode Statistics. Cancer Invest 2015; 33:205-12. [DOI: 10.3109/07357907.2015.1019675] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Cured of primary bone cancer, but at what cost: a qualitative study of functional impairment and lost opportunities. Sarcoma 2015; 2015:484196. [PMID: 25949211 PMCID: PMC4407620 DOI: 10.1155/2015/484196] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2015] [Accepted: 03/26/2015] [Indexed: 11/17/2022] Open
Abstract
Purpose. Our study aims to explore how former cancer patients experience physical and psychosocial late effects 3–7 years after they underwent treatment for primary bone sarcoma in the hip/pelvic region. A qualitative, phenomenological, and hermeneutic design was applied. Methods. Sarcoma survivors (n = 10) previously treated at Oslo University Hospital, Norwegian Radium Hospital were selected to participate. In-depth and semistructured interviews were conducted. The interviews were analysed using inductive thematic analysis. Results. The participants reported that the late effects had three core spheres of impact: “their current daily life,” “their future opportunities,” and “their identity.” They expressed negative changes in activity, increased dependence on others, and exclusion from participation in different areas. Their daily life, work, sports activities, and social life were all affected. Several of their experiences are similar to those described by people with functional impairment or disability. Conclusion. Patients cured of bone cancer in the hip/pelvic region pay a significant price in terms of functional impairment, practical challenges, exclusion from important aspects of life, and loss of previous identity. It is important to appreciate this in order to help bone cancer survivors who struggle to reorient their life and build a secure new identity.
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Serlo J, Helenius I, Vettenranta K, Perkkiö M, Riikonen P, Sampo M, Tarkkanen M. Surgically treated patients with axial and peripheral Ewing's sarcoma family of tumours: A population based study in Finland during 1990-2009. Eur J Surg Oncol 2015; 41:893-8. [PMID: 25817983 DOI: 10.1016/j.ejso.2015.02.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2014] [Revised: 01/28/2015] [Accepted: 02/10/2015] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND The surgical treatment of Ewing's sarcoma family tumours (ESFTs) is challenging especially with axial tumours. The aim of the study was to analyse surgical treatment and outcome in a nationwide, population-based material consisting of surgically treated axial and peripheral ESFTs of bone and soft tissue. METHODS The data were collected from the Finnish National Cancer Registry and the medical records of patients diagnosed during 1990-2009. Fifty-seven patients with surgically treated ESFTs were included, 22 with an axial and 35 with a peripheral primary tumours. The surgical treatment, its complications, survival and prognostic factors were analysed. RESULTS Fifty-four patients underwent surgery with a curative intent and three underwent de-bulking operations. Bone reconstruction was performed in six patients with an axial and 15 with a peripheral tumour. Positive resection margins were associated with a worse five-year local relapse-free survival (33% vs. 84% for those with resection margins free of tumour cells, p = 0.003). The five-year sarcoma-specific survival was affected only by an axial location of the primary (61% vs. 89% for those with a peripheral tumour, p = 0.031). The late complications were mainly associated with bone reconstruction and more frequent among patients with a peripheral compared to an axial tumour (p = 0.031). CONCLUSIONS In the treatment of ESFTs, achieving adequate resection margins is crucial to avoid local relapses. Surgical complications are common particularly with bone reconstruction.
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Affiliation(s)
- J Serlo
- Department of Oncology, Helsinki University Central Hospital, Haartmaninkatu 4, PL 180, HUS, 00029 Helsinki, Finland; Department of Pediatric Orthopedic Surgery, Turku University Hospital, Kiinamyllynkatu 4-8, PL 52, 20521 Turku, Finland.
| | - I Helenius
- Department of Pediatric Orthopedic Surgery, Turku University Hospital, Kiinamyllynkatu 4-8, PL 52, 20521 Turku, Finland
| | - K Vettenranta
- Department of Pediatrics, Helsinki University Central Hospital, Stenbäckinkatu 11, PL 281, HUS, 00029 Helsinki, Finland
| | - M Perkkiö
- Department of Pediatrics, Kuopio University Hospital, Puijonlaaksontie 2, PL 100, KYS, 70029 Kuopio Finland
| | - P Riikonen
- Department of Pediatrics, Kuopio University Hospital, Puijonlaaksontie 2, PL 100, KYS, 70029 Kuopio Finland
| | - M Sampo
- Department of Oncology, Helsinki University Central Hospital, Haartmaninkatu 4, PL 180, HUS, 00029 Helsinki, Finland
| | - M Tarkkanen
- Department of Oncology, Helsinki University Central Hospital, Haartmaninkatu 4, PL 180, HUS, 00029 Helsinki, Finland
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Irtan S, Mascard E, Bolle S, Brugières L, Sarnacki S. The small bowel in its hammock: how to avoid irradiation thanks to the sigmoid. J Laparoendosc Adv Surg Tech A 2014; 25:77-80. [PMID: 25531859 DOI: 10.1089/lap.2014.0270] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND High-dose irradiation is the cornerstone treatment of bone cancers of the pelvic rim. To protect the small bowel from irradiation and following consequences, we described the laparoscopic use of the sigmoid to perform a hammock. MATERIALS AND METHODS Three patients were diagnosed with metastatic Ewing's sarcoma, localized malignant peripheral nerve sheath tumor, and localized BCOR-CCNB3 (Ewing-like) sarcoma of the pelvic rim at 13.1, 5.7, and 12.9 years, respectively. After neoadjuvant chemotherapy, the 2 female patients underwent a hemisacrectomy under S2 only by the posterior approach, whereas no orthopedic surgery was required for the male patient because of excellent local response to chemotherapy. A 54-Gy intensity-modulated radiotherapy of the posterior part of the pelvis was intended for all patients. RESULTS The laparoscopic procedure consisted in the fixation of the sigmoid loop to the anterior parietal wall on a transverse line just below the umbilicus, associated with a colostomy in the right iliac fossa. The anterior transposition of the two ovaries, uterus, and rectum and the dissection of left iliac vessels to move them anteriorly were added in female patients. Stomas were closed around 6 months after completion of the radiotherapy course, associated with the repositioning of the uterus, ovaries, and colon. With a mean follow-up of 22 months, all patients are alive without any recurrences or radiation-related symptoms. CONCLUSIONS The laparoscopic "hammock technique" both protects the small bowel from irradiation and secures the orthopedic procedure by displacing the abdominal organs forward.
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Affiliation(s)
- Sabine Irtan
- 1 Department of Paediatric Surgery, Hôpital Necker Enfants Malades, Paris Descartes University , Paris, France
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Raciborska A, Bilska K, Rychlowska-Pruszynska M, Drabko K, Chaber R, Pogorzała M, Połczyńska K, Godziński J, Rodriguez-Galindo C, Wożniak W. Internal hemipelvectomy in the management of pelvic Ewing sarcoma - are outcomes better than with radiation therapy? J Pediatr Surg 2014; 49:1500-4. [PMID: 25280655 DOI: 10.1016/j.jpedsurg.2014.04.013] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2013] [Revised: 03/10/2014] [Accepted: 04/25/2014] [Indexed: 12/18/2022]
Abstract
BACKGROUND Pelvic Ewing sarcoma (ES) is commonly associated with a worse prognosis. Large size and location limit local control options to radiation therapy, and local recurrences are common. We evaluated the impact of hemipelvectomy and radiation on outcomes, including function. MATERIALS AND METHODS Thirty-nine patients (median age 13.5years) with ES of the pelvis and sacral bones were treated during the period 2000-2012. Fifteen were treated with definitive radiotherapy (RT), 9 patients underwent hemipelvectomy alone, and 15 were treated with combined hemipelvectomy and RT. RESULTS Twenty patients (51.2%) are alive with a median follow-up 3.2years from diagnosis. Median time from diagnosis to relapse was 1.3years. Three-year estimates of EFS and OS were 47% and 61%, respectively. Patients treated with surgery or surgery with RT had better outcome than patients treated with RT only (3-year OS 78% or 81% vs. 36%, respectively, p=0.00083). The outcome of patients with pelvic ES treated with hemipelvectomy was not significantly different from the outcome of all patients with Ewing sarcoma treated on the national Polish protocol. CONCLUSIONS Internal hemipelvectomy offers good chances of cure for patients with pelvic ES, with a reasonable rate of complications and good function.
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Affiliation(s)
- Anna Raciborska
- Department of Surgical Oncology for Children and Youth, Institute of Mother and Child, Warsaw, Poland.
| | - Katarzyna Bilska
- Department of Surgical Oncology for Children and Youth, Institute of Mother and Child, Warsaw, Poland
| | | | - Katarzyna Drabko
- Department of Pediatric Hematology, Oncology and Transplantology, Medical University of Lublin, Lublin, Poland
| | - Radosław Chaber
- Department and Clinic of Pediatric Oncology, Hematology and Bone Marrow Transplantation, Wroclaw Medical University, Wroclaw, Poland
| | - Monika Pogorzała
- Department of Pediatric Hematology and Oncology Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland
| | - Katarzyna Połczyńska
- Department of Pediatric Hematology and Oncology, Medical University of Gdansk, Gdansk, Poland
| | - Jan Godziński
- Department of Paediatric Surgery Marciniak Hospital, Chair of Emergency Medicine, Medical University, Wroclaw, Poland
| | - Carlos Rodriguez-Galindo
- Pediatric Oncology, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Harvard Medical School, Boston, TX
| | - Wojciech Wożniak
- Department of Surgical Oncology for Children and Youth, Institute of Mother and Child, Warsaw, Poland
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Duclos J, Maggiori L, Zappa M, Ferron M, Panis Y. Laparoscopic resection of retrorectal tumors: a feasibility study in 12 consecutive patients. Surg Endosc 2013; 28:1223-9. [PMID: 24263459 DOI: 10.1007/s00464-013-3312-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2013] [Accepted: 09/04/2013] [Indexed: 12/23/2022]
Abstract
BACKGROUND Surgical approaches for retrorectal tumors (RRT) are either abdominal, dorsal trans-sacrococcygeal, or perineal. Very few cases have been reported so far concerning a laparoscopic approach. The aim of this study was to assess the results of laparoscopy for the treatment of RRT. METHODS All patients who underwent laparoscopy for RRT between 2003 and 2012 were reviewed. Data included patient and tumor characteristics, surgical morbidity, and mortality. RESULTS A total of 12 consecutive women with a median age of 55 years underwent laparoscopy for RRT. Median operative time was 145 min (range 70-215). Two conversions in laparotomy occurred, and one patient needed a temporary diverting ileostomy for rectal injury. Postoperatively, two patients presented urinary tract infections. Median length of stay was 8 days (range 4-16). Pathological examinations showed complete resections (R0) for ten benign tumors and one malignant tumor (Ewing sarcoma). One lesion was incompletely resected, a colloid sarcoma (R1 status), and was re-operated on by laparotomy after neoadjuvant chemoradiation. No local recurrence was observed after a median follow-up of 34 months (range 12-79) for benign lesions, and 28 and 71 months for the two patients who underwent resection of Ewing and colloid sarcoma, respectively. CONCLUSIONS Laparoscopic resection for RRT seems feasible and safe. It allows complete excision of tumors located in the retrorectal space with low morbidity. Thus, this approach can be a valid alternative to standard Kraske or open abdominal approaches for the treatment of RRT.
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Affiliation(s)
- Julie Duclos
- Department of Colorectal Surgery, Pôle des Maladies de l'Appareil Digestif (PMAD), Beaujon Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), University Denis Diderot (Paris VII), 100 Boulevard du Général Leclerc, 92110, Clichy, France
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Needle D, McKnight CA, Kiupel M. Chondroblastic Osteosarcoma in Two Related Spiny-Tailed Monitor Lizards (Varanus acanthurus). J Exot Pet Med 2013. [DOI: 10.1053/j.jepm.2013.08.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Douis H, Saifuddin A. The imaging of cartilaginous bone tumours. II. Chondrosarcoma. Skeletal Radiol 2013; 42:611-26. [PMID: 23053201 DOI: 10.1007/s00256-012-1521-3] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2012] [Revised: 08/27/2012] [Accepted: 08/30/2012] [Indexed: 02/07/2023]
Abstract
Chondrosarcoma is the third most common primary malignant bone tumour. There are various histological subtypes of chondrosarcomas, of which conventional intramedullary chondrosarcoma is by far the most common. Rarer sub-types include clear cell chondrosarcoma, myxoid chondrosarcoma, mesenchymal chondrosarcoma and dedifferentiated chondrosarcoma. Chondrosarcoma is also classified into central, peripheral and periosteal, dependent upon the lesion site, and into primary chondrosarcoma if the lesion arises de novo and secondary chondrosarcoma if the tumour arises in a pre-existing lesion. The various subtypes of chondrosarcoma have characteristic imaging features that may aid diagnosis and may guide biopsy, therefore potentially preventing misdiagnosis. The aim of this article is to provide an overview of the pertinent clinical and imaging findings of the different forms of chondrosarcoma.
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Affiliation(s)
- H Douis
- Department of Radiology, The Royal National Orthopaedic Hospital NHS Trust, Brockley Hill, Stanmore, Middlesex, HA7 4LP, UK.
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Serlo JA, Helenius IJ, Sampo M, Vettenranta K, Saarinen-Pihkala UM, Kivivuori SM, Riikonen P, Kivioja A, Böhling T, Kallajoki M, Ristimäki A, Vasama K, Tarkkanen M. Ewing's sarcoma family of tumors in Finland during 1990-2009: a population-based study. Acta Oncol 2013; 52:767-75. [PMID: 23173760 DOI: 10.3109/0284186x.2012.728714] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Ewing's sarcoma family of tumors (ESFTs) are rare bone and soft tissue tumors characterized by specific genetic alterations. Our aim was to carry out a nationwide analysis of ESFT, to survey the treatments used and to report the five-year disease specific and event-free survival rates (EFS and DSS). MATERIAL AND METHODS The study data was gathered from the Finnish National Cancer Registry and all five University Hospitals and consisted of 76 bone and soft tissue ESFT patients diagnosed during 1990-2009. Their medical records were reviewed and data on their disease, treatments, complications and outcome were analyzed. RESULTS The five-year EFS and DSS of patients with localized disease at diagnosis (n = 57) were 70% and 60%, respectively. Factors contributing to DSS and EFS were the axial vs. peripheral site of primary tumor and adequate surgical resection of the primary tumor. DSS was also affected by patient's age at diagnosis and the treatment employed. The five-year DSS of patients with metastatic disease at diagnosis (n = 19) was 33% and both preoperative and high dose chemotherapy were associated with improved survival. CONCLUSION Population-based studies including both bone and soft tissue ESFTs are few. In this nationwide, population-based study on Finnish bone and soft tissue ESFT patients, we find their treatment successful and results comparable to those previously published. Absence of metastases, young age at diagnosis and a peripheral primary tumor site were associated with a better prognosis. It seems that surgical resection of the primary tumor should be performed whenever adequate resection margins can be achieved. The role of high dose chemotherapy merits further studies in this setting.
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Affiliation(s)
- Joni A Serlo
- Faculty of Medicine, University of Helsinki, Helsinki, Finland.
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Williams R, Foote M, Deverall H. Strategy in the surgical treatment of primary spinal tumors. Global Spine J 2012; 2:249-66. [PMID: 24353976 PMCID: PMC3864485 DOI: 10.1055/s-0032-1329886] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2012] [Accepted: 08/04/2012] [Indexed: 11/18/2022] Open
Abstract
Primary spine tumors are rare, accounting for only 4% of all tumors of the spine. A minority of the more common primary benign lesions will require surgical treatment, and most amenable malignant lesions will proceed to attempted resection. The rarity of malignant primary lesions has resulted in a paucity of historical data regarding optimal surgical and adjuvant treatment and, although we now derive benefit from standardized guidelines of overall care, management of each neoplasm often proceeds on a case-by-case basis, taking into account the individual characteristics of patient operability, tumor resectability, and biological potential. This article aims to provide an overview of diagnostic techniques, staging algorithms and the authors' experience of surgical treatment alternatives that have been employed in the care of selected benign and malignant lesions. Although broadly a review of contemporary management, it is hoped that the case illustrations given will serve as additional "arrows in the quiver" of the treating surgeon.
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Affiliation(s)
- Richard Williams
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia,Address for correspondence and reprint requests Richard Williams Institute of Health and Biomedical Innovation, Queensland University of Technology8/259 Wickham Tce, Brisbane 4000, QueenslandAustralia
| | - Matthew Foote
- Department of Radiation Oncology, Princess Alexandra Hospital, University of Queensland, Brisbane, Queensland, Australia
| | - Hamish Deverall
- Department of Orthopaedics, Princess Alexandra Hospital, University of Queensland, Brisbane, Queensland, Australia
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von Eisenhart-Rothe R, Toepfer A, Salzmann M, Schauwecker J, Gollwitzer H, Rechl H. [Primary malignant bone tumors]. DER ORTHOPADE 2012; 40:1121-42. [PMID: 22130624 DOI: 10.1007/s00132-011-1866-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Abstract
Among human neoplasms, primary malignant bone tumors are fairly rare. They present an incidence rate of roughly 10 cases per 1 million inhabitants per year. During childhood (<15 years), the percentage of malignant bone tumors amounts to 6% of all infantile malignancies. Only leukemia and lymphoma show a higher incidence in adolescence. Of all primary malignant bone tumors, 60% affect patients younger than 45 years and the peak incidence of all bone tumors occurs between 15 and 19 years. The most common primary malignant bone tumors are osteosarcoma (35%), chondrosarcoma (25%), and Ewing's sarcoma (16%). Less frequently (≤ 5%) occurring tumors are chordoma, malignant fibrous histiocytoma of bone, and fibrosarcoma of bone. Vascular primary malignant tumors of bone and adamantinoma are very rare. Staging of the lesion is essential for systemic therapeutic decision-making and includes complete imaging and histo-pathological confirmation of the suspected entity. In most cases, this is established by open- or image-guided biopsy. Based on this information, an interdisciplinary tumor board will determine the individual therapeutic approach. Endoprosthetic or biological reconstruction following wide tumor resection is the most common surgical therapy for primary malignant bone tumors. There is vital importance in a thorough postoperative follow-up and continous after-care by a competent tumor center which is permanentely in charge of therapy.
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Affiliation(s)
- R von Eisenhart-Rothe
- Klinik für Orthopädie und Sportorthopädie, Klinikum rechts der Isar, Technische Universität München, Ismaninger Straße 22, 81675, München, Deutschland.
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Abstract
Sarcomas are the most common nonhematologic primary malignancies of bones in the pelvis. Chondrosarcoma, osteosarcoma, and Ewing's sarcoma are the most common sarcomas to originate from the pelvic bones. Various imaging modalities such as magnetic resonance imaging and computed tomography play an important role in the detection, characterization, and staging of these lesions. Biopsy, usually performed with imaging guidance, is essential for the histologic diagnosis of these tumors and for planning therapeutic options. Despite considerable advances in treatment options, sarcomas in the pelvic bones generally are associated with poorer outcomes than sarcomas in the appendicular skeleton because of the larger size of the lesions at the time of discovery and the difficulty of obtaining a wide surgical resection margin. In this review, we discuss the various types of pelvic bone sarcomas and the role of imaging in patients with these lesions.
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Affiliation(s)
- Prabhakar Rajiah
- Section of Musculoskeletal Radiology, Imaging Institute, Cleveland Clinic, Cleveland, OH, USA.
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Koroukian SM, Bakaki PM, Raghavan D. Survival disparities by Medicaid status: an analysis of 8 cancers. Cancer 2011; 118:4271-9. [PMID: 22213271 DOI: 10.1002/cncr.27380] [Citation(s) in RCA: 72] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2011] [Revised: 10/08/2011] [Accepted: 11/10/2011] [Indexed: 11/08/2022]
Abstract
BACKGROUND A study was undertaken to compare survival and 5-year mortality by Medicaid status in adults diagnosed with 8 select cancers. METHODS Linking records from the Ohio Cancer Incidence Surveillance System (OCISS) with Ohio Medicaid enrollment data, the authors identified Medicaid and non-Medicaid patients aged 15 to 54 years and diagnosed with the following incident cancers in the years 1996-2002: cancer of the testis; Hodgkin and non-Hodgkin lymphoma; early stage melanoma, colon, lung, and bladder cancer; and pediatric malignancies (n = 12,703). Medicaid beneficiaries were placed in the pre-diagnosis group if they were enrolled in Medicaid at least 3 months before cancer diagnosis, and in the peri/post-diagnosis group if they enrolled in Medicaid upon or after being diagnosed with cancer. The authors also linked the OCISS with death certificates and data from the US Census. By using Cox and logistic regression analysis, they examined the association between Medicaid status and survival and 5-year mortality, respectively, after adjusting for patient covariates. RESULTS Nearly 11% of the study population were Medicaid beneficiaries. Of those, 45% were classified in the peri/post-diagnosis group. Consistent with higher mortality, findings from the Cox regression model indicated that compared with non-Medicaid, patients in the Medicaid pre-diagnosis and peri/post-diagnosis groups experienced unfavorable survival outcomes (adjusted hazard ratio [AHR], 1.52; 95% confidence interval [CI], 1.27-1.82 and AHR, 2.01; 95% CI, 1.70-2.38, respectively). CONCLUSIONS Medicaid status was associated with unfavorable survival, even after adjusting for confounders. The findings reflect the vulnerability of Medicaid beneficiaries and possible inadequacies in the process of care.
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Affiliation(s)
- Siran M Koroukian
- Department of Epidemiology and Biostatistics, School of Medicine, Case Western Reserve University, Cleveland, Ohio, USA.
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