1
|
Welsh C, Hull P, Meckmongkol T, Mumith A, Lovejoy J, Giangarra C, Coathup M. Osseointegration reduces aseptic loosening of primary distal femoral implants in pediatric and adolescent osteosarcoma patients: a retrospective clinical and radiographic study. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2023; 33:3585-3596. [PMID: 37246989 DOI: 10.1007/s00590-023-03590-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 05/11/2023] [Indexed: 05/30/2023]
Abstract
AIM The challenge of distal femoral replacement (DFR) longevity remains a priority for orthopaedic oncologists as the overall survival and activity level of young patients with osteosarcoma continues to improve. This study hypothesized that increased extracortical osseointegration at the bone-implant shoulder (i.e., where the metal implant shaft abuts the femur) will improve stress transfer adjacent to the implant, as evidenced by reduced cortical bone loss, radiolucent line progression and implant failure in young patients (< 20 years) following DFR surgery. METHODS Twenty-nine patients of mean age 13.09 ± 0.56 years received a primary DFR. The clinical outcome of 11 CPS®, 10 GMRS®, 5 Stanmore® and 3 Repiphysis® implants was evaluated over a mean follow-up period of 4.25 ± 0.55 years. The osseous response to a bone-implant shoulder composed of either a hydroxyapatite-coated grooved ingrowth collar (Stanmore®), a porous metal coating (GMRS®) or a polished metal surface (Repiphysis®) was quantified radiographically. RESULTS All (100.0%) of the Stanmore® implants, 90.0% of GMRS®, 81.8% of CPS® and 33.3% of the Repiphysis® implants survived. Significantly increased extracortical bone and osseointegration were measured adjacent to the Stanmore® bone-implant shoulder when compared with the GMRS® and Repiphysis® implants (p < 0.0001 in both cases). Significantly decreased cortical loss was identified in the Stanmore® group (p = 0.005, GMRS® and p < 0.0001, Repiphysis®) and at 3 years, the progression of radiolucent lines adjacent to the intramedullarly stem was reduced when compared with the GMRS® and Repiphysis® implants (p = 0.012 and 0.026, respectively). CONCLUSIONS Implants designed to augment osseointegration at the bone-implant shoulder may be critical in reducing short- (≤ 2 years) to mid- (≤ 5 years) term aseptic loosening in this vulnerable DFR patient group. Further longer-term studies are required to confirm these preliminary findings.
Collapse
Affiliation(s)
- Clayton Welsh
- College of Medicine, University of Central Florida, Orlando, FL, USA
| | - Peyton Hull
- College of Medicine, University of Central Florida, Orlando, FL, USA
| | - Teerin Meckmongkol
- College of Medicine, University of Central Florida, Orlando, FL, USA
- Department of General Surgery, Nemours Children's Hospital, Orlando, FL, USA
- Department of Internal Medicine, College of Medicine, Biionix (Bionic Materials, Implants & Interfaces) Cluster, University of Central Florida, Orlando, FL, USA
| | - Aadil Mumith
- College of Medicine, University of Central Florida, Orlando, FL, USA
- Department of Internal Medicine, College of Medicine, Biionix (Bionic Materials, Implants & Interfaces) Cluster, University of Central Florida, Orlando, FL, USA
- Sunnybrook Holland Orthopaedic Centre, Toronto, Canada
| | - John Lovejoy
- College of Medicine, University of Central Florida, Orlando, FL, USA
- Department of Orthopaedics, Sports Medicine and Physical Medicine and Rehabilitation, Nemours Children's Hospital, Orlando, FL, USA
| | - Charles Giangarra
- Department of Orthopaedic Surgery, Marshall University, Huntington, WV, USA
| | - Melanie Coathup
- College of Medicine, University of Central Florida, Orlando, FL, USA.
- Department of Internal Medicine, College of Medicine, Biionix (Bionic Materials, Implants & Interfaces) Cluster, University of Central Florida, Orlando, FL, USA.
| |
Collapse
|
2
|
Hidalgo L, Somovilla-Crespo B, Garcia-Rodriguez P, Morales-Molina A, Rodriguez-Milla MA, Garcia-Castro J. Switchable CAR T cell strategy against osteosarcoma. Cancer Immunol Immunother 2023; 72:2623-2633. [PMID: 37062034 PMCID: PMC10361906 DOI: 10.1007/s00262-023-03437-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 03/22/2023] [Indexed: 04/17/2023]
Abstract
Immunotherapy with chimeric antigen receptor T (CAR T) cells has changed the treatment of hematological malignances, but they are still a challenge for solid tumors, including pediatric sarcomas. Here, we report a switchable CAR T cell strategy based on anti-FITC CAR T cells and a switch molecule conjugated with FITC for targeting osteosarcoma (OS) tumors. As a potential target, we analyzed the expression of B7-H3, an immune checkpoint inhibitor, in OS cell lines. In addition, we evaluate the capacity of an anti-B7-H3 monoclonal antibody conjugated with FITC (anti-B7-H3-FITC mAb) to control the antitumor activity of anti-FITC CAR T cells. The effector functions of anti-FITC CAR T cells against OS, measured in vitro by tumor cell killing activity and cytokine production, are dependent on the presence of the anti-B7-H3-FITC mAb switch. Moreover, OS cells stimulate anti-FITC CAR T cells migration. In vivo, anti-B7-H3 mAb penetrates in the tumor and binds 143B OS tumor cells. Furthermore, anti-FITC CAR T cells reach tumor region and exert antitumor effect in an OS NSG mouse model only in the presence of the switch molecule. We demonstrate that anti-B7-H3-FITC mAb redirects the cytotoxic activity of anti-FITC CAR T cells against OS tumors suggesting that switchable CAR T cell platforms might be a plausible strategy against OS.
Collapse
Affiliation(s)
- Laura Hidalgo
- Cellular Biotechnology Unit, Instituto de Investigación de Enfermedades Raras, Instituto de Salud Carlos III (ISCIII), 28220, Madrid, Spain.
| | - Beatriz Somovilla-Crespo
- Cellular Biotechnology Unit, Instituto de Investigación de Enfermedades Raras, Instituto de Salud Carlos III (ISCIII), 28220, Madrid, Spain
| | - Patricia Garcia-Rodriguez
- Cellular Biotechnology Unit, Instituto de Investigación de Enfermedades Raras, Instituto de Salud Carlos III (ISCIII), 28220, Madrid, Spain
- Universidad Nacional de Educación a Distancia (UNED), 28015, Madrid, Spain
| | - Alvaro Morales-Molina
- Cellular Biotechnology Unit, Instituto de Investigación de Enfermedades Raras, Instituto de Salud Carlos III (ISCIII), 28220, Madrid, Spain
| | - Miguel Angel Rodriguez-Milla
- Cellular Biotechnology Unit, Instituto de Investigación de Enfermedades Raras, Instituto de Salud Carlos III (ISCIII), 28220, Madrid, Spain
| | - Javier Garcia-Castro
- Cellular Biotechnology Unit, Instituto de Investigación de Enfermedades Raras, Instituto de Salud Carlos III (ISCIII), 28220, Madrid, Spain.
| |
Collapse
|
3
|
Ottaviani G. Prof Norman Jaffe, DSc, MD (1933-2022): The Osteosarcoma Giant. Cancer 2023; 129:819-821. [PMID: 36639827 DOI: 10.1002/cncr.34599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Affiliation(s)
- Giulia Ottaviani
- Lino Rossi Research Center, Department of Biomedical, Surgical, and Dental Sciences, Università degli Studi di Milano, Milan, Italy.,Department of Pathology and Laboratory Medicine, University of Texas Health Science Center at Houston, McGovern Medical School, Houston, Texas, USA
| |
Collapse
|
4
|
Ruger LN, Hay AN, Vickers ER, Coutermarsh-Ott SL, Gannon JM, Covell HS, Daniel GB, Laeseke PF, Ziemlewicz TJ, Kierski KR, Ciepluch BJ, Vlaisavljevich E, Tuohy JL. Characterizing the Ablative Effects of Histotripsy for Osteosarcoma: In Vivo Study in Dogs. Cancers (Basel) 2023; 15:cancers15030741. [PMID: 36765700 PMCID: PMC9913343 DOI: 10.3390/cancers15030741] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 01/19/2023] [Accepted: 01/23/2023] [Indexed: 01/27/2023] Open
Abstract
Osteosarcoma (OS) is a malignant bone tumor treated by limb amputation or limb salvage surgeries and chemotherapy. Histotripsy is a non-thermal, non-invasive focused ultrasound therapy using controlled acoustic cavitation to mechanically disintegrate tissue. Recent ex vivo and in vivo pilot studies have demonstrated the ability of histotripsy for ablating OS but were limited in scope. This study expands on these initial findings to more fully characterize the effects of histotripsy for bone tumors, particularly in tumors with different compositions. A prototype 500 kHz histotripsy system was used to treat ten dogs with suspected OS at an intermediate treatment dose of 1000 pulses per location. One day after histotripsy, treated tumors were resected via limb amputation, and radiologic and histopathologic analyses were conducted to determine the effects of histotripsy for each patient. The results of this study demonstrated that histotripsy ablation is safe and feasible in canine patients with spontaneous OS, while offering new insights into the characteristics of the achieved ablation zone. More extensive tissue destruction was observed after histotripsy compared to that in previous reports, and radiographic changes in tumor size and contrast uptake following histotripsy were reported for the first time. Overall, this study significantly expands our understanding of histotripsy bone tumor ablation and informs future studies for this application.
Collapse
Affiliation(s)
- Lauren N. Ruger
- Department of Biomedical Engineering and Mechanics, Virginia Polytechnic Institute and State University, Blacksburg, VA 24016, USA
| | - Alayna N. Hay
- Department of Small Animal Clinical Sciences, Virginia-Maryland Regional College of Veterinary Medicine, Blacksburg, VA 24016, USA
- Virginia Tech Animal Cancer Care and Research Center, Virginia-Maryland Regional College of Veterinary Medicine, Roanoke, VA 24016, USA
| | - Elliana R. Vickers
- Department of Biomedical Engineering and Mechanics, Virginia Polytechnic Institute and State University, Blacksburg, VA 24016, USA
- Virginia Tech Animal Cancer Care and Research Center, Virginia-Maryland Regional College of Veterinary Medicine, Roanoke, VA 24016, USA
- Graduate Program in Translational Biology, Medicine, and Health, Virginia Polytechnic Institute and State University, Roanoke, VA 24016, USA
| | - Sheryl L. Coutermarsh-Ott
- Department of Biological Sciences and Pathobiology, Virginia Polytechnic Institute and State University, Blacksburg, VA 24016, USA
| | - Jessica M. Gannon
- Department of Biomedical Engineering and Mechanics, Virginia Polytechnic Institute and State University, Blacksburg, VA 24016, USA
| | - Hannah S. Covell
- Department of Biomedical Engineering and Mechanics, Virginia Polytechnic Institute and State University, Blacksburg, VA 24016, USA
| | - Gregory B. Daniel
- Department of Small Animal Clinical Sciences, Virginia-Maryland Regional College of Veterinary Medicine, Blacksburg, VA 24016, USA
- Virginia Tech Animal Cancer Care and Research Center, Virginia-Maryland Regional College of Veterinary Medicine, Roanoke, VA 24016, USA
| | - Paul F. Laeseke
- Department of Radiology, University of Wisconsin-Madison, Madison, WI 53705, USA
| | | | - Katharine R. Kierski
- Department of Small Animal Clinical Sciences, Virginia-Maryland Regional College of Veterinary Medicine, Blacksburg, VA 24016, USA
- Virginia Tech Animal Cancer Care and Research Center, Virginia-Maryland Regional College of Veterinary Medicine, Roanoke, VA 24016, USA
| | - Brittany J. Ciepluch
- Department of Small Animal Clinical Sciences, Virginia-Maryland Regional College of Veterinary Medicine, Blacksburg, VA 24016, USA
- Virginia Tech Animal Cancer Care and Research Center, Virginia-Maryland Regional College of Veterinary Medicine, Roanoke, VA 24016, USA
| | - Eli Vlaisavljevich
- Department of Biomedical Engineering and Mechanics, Virginia Polytechnic Institute and State University, Blacksburg, VA 24016, USA
- Correspondence: (E.V.); (J.L.T.)
| | - Joanne L. Tuohy
- Department of Small Animal Clinical Sciences, Virginia-Maryland Regional College of Veterinary Medicine, Blacksburg, VA 24016, USA
- Virginia Tech Animal Cancer Care and Research Center, Virginia-Maryland Regional College of Veterinary Medicine, Roanoke, VA 24016, USA
- Correspondence: (E.V.); (J.L.T.)
| |
Collapse
|
5
|
Meng J, Wu J, Zhang X, Guo L, Li H. A longitudinal evaluation on 3-year change of anxiety and depression, and their risk factors among parents of childhood and adolescence patients with resectable osteosarcoma: A cohort study. Medicine (Baltimore) 2022; 101:e30981. [PMID: 36281181 PMCID: PMC9592357 DOI: 10.1097/md.0000000000030981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Psychological disorders often occur among parents of children with cancer. The current study aimed to explore the longitudinal change of anxiety and depression and their related factors among parents of childhood and adolescence patients with osteosarcoma. A total of 56 childhood and adolescence patients with osteosarcoma who underwent tumor resection and corresponding 104 parents were enrolled. Hospital Anxiety and Depression Scale-Anxiety (HADS-A) and HADS-Depression (HADS-D) of parents were evaluated at baseline (the day of patients' hospital discharge), 0.5 year, 1 year, 2 years, and 3 years. From baseline to the 3rd year, HADS-A (from 8.3 ± 3.1 to 9.4 ± 3.1. P < .001), HADS-D score (from 7.7 ± 3.2 to 8.8 ± 2.9, P = .001), anxiety rate (from 45.2% to 60.6%, P = .038), depression rate (from 38.5% to 57.7%, P = .002) were elevated; meanwhile, anxiety severity (P = .001) and depression severity (P = .001) were also increased. Furthermore, multivariate logistic regression analysis presented that the role of mother, divorced/widowed marital status, declined family annual income, elevated Enneking stage, and amputation were independently correlated with elevated risk of parents' baseline anxiety or depression (all P < .05). Additionally, declined family annual income, elevated Enneking stage, and amputation were independently correlated with increased risk of parents' 3-year anxiety or depression (all P < .05). Anxiety and depression deteriorate with time in parents of childhood and adolescence patients with osteosarcoma, which are affected by parental role, marital status, family annual income, surgery type, and Enneking stage.
Collapse
Affiliation(s)
- Jie Meng
- Department of Orthopedic Surgery, Harbin Medical University Cancer Hospital, Harbin, China
| | - Jing Wu
- Department of Orthopedic Surgery, Harbin Medical University Cancer Hospital, Harbin, China
| | - Xinying Zhang
- Department of Orthopedic Surgery, Harbin Medical University Cancer Hospital, Harbin, China
| | - Libo Guo
- Department of Orthopedic Surgery, Harbin Medical University Cancer Hospital, Harbin, China
| | - Honghe Li
- Department of Orthopedic Surgery, Harbin Medical University Cancer Hospital, Harbin, China
| |
Collapse
|
6
|
Vasquez L, Tello M, Maza I, Shah D, Silva J, Sialer L. Quality of Life and Limb Functionality in Adolescents and Young Adults Surviving Bone Tumors in the Lower Extremity in a Developing Country: A Cross-Sectional Study. Indian J Med Paediatr Oncol 2022. [DOI: 10.1055/s-0042-1755596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Abstract
Introduction Due to higher survival rates among patients with bone tumors, there is a growing interest in determining these individuals' limb functionality and psychosocial prognosis.
Objectives This study aimed to analyze the differences in functionality and quality of life (QoL) related to health in patients diagnosed with a malignant bone tumor during childhood, according to the type of surgery performed.
Materials and Methods A cross-sectional study was performed for patients older than 14 years who treated for osteosarcoma or Ewing's sarcoma of the lower limb by who receiving surgery. To assess lower limb functionality and QoL among patients surviving malignant bone tumors, 19 patients surviving osteosarcoma or Ewing's sarcoma of the lower extremity were studied. An evaluation of functionality and QoL was done using the “Enneking and Medical Outcomes Study Short-Form 36 scales.” We compared the functional results according to the surgical technique used. Categorical variables were compared according to the Mann–Whitney and Kruskal–Wallis tests, with an established 95% level of significance.
Results QoL among patients who had conservative surgery was not significantly better than amputee patients in the physical or mental aspects, nor in any of their components. Limb functionality, according to Enneking's staging, was significantly higher in non-amputee patients (p = 0.035).
Conclusion According to the data analysis done in this study, the QoL was found to be not significantly different, based on the type of surgery performed; however, there were differences in limb functionality.
Collapse
Affiliation(s)
- Liliana Vasquez
- Faculty of Medicine, University of San Martin de Porres, Research Center of Precision Medicine, Lima, Peru
| | - Mariela Tello
- Department of Pediatric and Adolescent Oncology, Rebagliati Hospital, Essalud, Lima, Peru
| | - Ivan Maza
- Department of Pediatric and Adolescent Oncology, Rebagliati Hospital, Essalud, Lima, Peru
| | - Darshi Shah
- Department of Biomedical Engineering, Boston University, Boston, Massachusetts, United States of America
| | - Jose Silva
- Orthopedic Oncology Division, Rebagliati Hospital, Essalud, Lima, Peru
| | - Luis Sialer
- Orthopedic Oncology Division, Rebagliati Hospital, Essalud, Lima, Peru
| |
Collapse
|
7
|
Ruger LN, Hay AN, Gannon JM, Sheppard HO, Coutermarsh-Ott SL, Daniel GB, Kierski KR, Ciepluch BJ, Vlaisavljevich E, Tuohy JL. Histotripsy Ablation of Spontaneously Occurring Canine Bone Tumors In Vivo. IEEE Trans Biomed Eng 2022; PP:10.1109/TBME.2022.3191069. [PMID: 35834467 PMCID: PMC9921194 DOI: 10.1109/tbme.2022.3191069] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Osteosarcoma (OS) is a devastating primary bone tumor in dogs and humans with limited non-surgical treatment options. As the first completely non-invasive and non-thermal ablation technique, histotripsy has the potential to significantly improve the standard of care for patients with primary bone tumors. INTRODUCTION Standard of care treatment for primary appendicular OS involves surgical resection via either limb amputation or limb-salvage surgery for suitable candidates. Biological similarities between canine and human OS make the dog an informative comparative oncology research model to advance treatment options for primary OS. Evaluating histotripsy for ablating spontaneous canine primary OS will build a foundation upon which histotripsy can be translated clinically into a standard of care therapy for canine and human OS. METHODS Five dogs with suspected spontaneous OS were treated with a 500 kHz histotripsy system guided by real-time ultrasound image guidance. Spherical ablation volumes within each tumor (1.25-3 cm in diameter) were treated with single cycle histotripsy pulses applied at a pulse repetition frequency of 500 Hz and a dose of 500 pulses/point. RESULTS Tumor ablation was successfully identified grossly and histologically within the targeted treatment regions of all subjects. Histotripsy treatments were well-tolerated amongst all patients with no significant clinical adverse effects. Conclusion & Significance: Histotripsy safely and effectively ablated the targeted treatment volumes in all subjects, demonstrating its potential to serve as a non-invasive treatment modality for primary bone tumors.
Collapse
|
8
|
Double Endoprosthesis in the Management of Refractory Metastatic Primary Bone Tumors in Children and Young Adults. Adv Orthop 2021; 2021:9944702. [PMID: 34336294 PMCID: PMC8324344 DOI: 10.1155/2021/9944702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 06/07/2021] [Accepted: 07/17/2021] [Indexed: 11/23/2022] Open
Abstract
Background Although not all children can be cured yet, much more emphasis is placed on the quality of life during and after cancer treatment. In the case of recurrence, mutilating treatment is still the prevalent option. In our study, we explored the role of limb salvage surgery for young patients with metastatic malignant bone tumors after endoprosthesis reconstruction during the first line of treatment and evaluated the impact of the local control modality in disease control and functional outcomes. Materials and Methods Eleven patients with bone tumor treated between 2007 and 2018 were included in this study. Both during primary treatment and during recurrence, limb salvage surgery was performed using a modular or expandable custom-made replacement system. Peri- and postoperative care for both surgeries were similar. All patients were given chemotherapy before and after both surgeries, according to the oncological guidelines. Results Seven patients (63.6%) are alive with a median follow-up of 6.5 years from diagnosis. None had local recurrence. Five-year estimates of event-free survival and overall survival were 36.27% and 79.55%, respectively. Median time between the first and second surgery was 2.7 years. Three patients presented with postoperative complications following both surgeries and required resurgical intervention. Three months following the second surgery, the Musculoskeletal Tumor Society Scale (MSTS) scores were 15–27 points (21 points on average—60%). Conclusions Limb salvage surgery is feasible and offers good chance of cure with a reasonable rate of complications and good function in patients with recurrent bone sarcoma after endoprosthesis reconstruction during the first line of treatment.
Collapse
|
9
|
Eldesouqi AA, Yau RCH, Ho WYK, Lam YL. Plate-assisted bone segment transport: Novel application on distal tibia defect after tumour resection. A case report. Int J Surg Case Rep 2021; 84:106079. [PMID: 34144314 PMCID: PMC8220237 DOI: 10.1016/j.ijscr.2021.106079] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 05/26/2021] [Accepted: 06/03/2021] [Indexed: 11/29/2022] Open
Abstract
Introduction Reconstruction of a large bone defect of the distal tibia after limb salvage surgery is difficult. The options include custom-made ankle endoprosthetic replacement, arthrodesis, and biological or metallic intercalary reconstructions. This report introduces a technique that provides the patient with a long-lasting biological reconstruction while preserving the native ankle. Presentation of case We present the case of a 47-year-old man with osteosarcoma of the distal tibia. After neoadjuvant chemotherapy, wide excision was performed while preserving the ankle joint. Bone reconstruction by Plate-assisted bone segment transport (PABST) was performed with a non-invasive growing intramedullary nail. At 34 months of follow-up, there was solid union and the Musculoskeletal Tumour Society Score was 26/30. Discussion This is the first report of PABST after distal tibia tumour resection. It shows that this is a viable and safe method of reconstruction. Despite the use of adjuvant chemotherapy, regenerate was formed and union was achieved. Conclusion PABST is a useful tool in the armamentarium to tackle difficult large bone defects. Large distal tibia bone defects are difficult to manage. First report of Plate-assisted bone segment transport after distal tibia tumour resection Regenerate was formed and bone union was achieved despite adjuvant chemotherapy. Good outcome and function at 34 months of follow-up Plate-assisted bone segment transport is a useful reconstructive technique.
Collapse
Affiliation(s)
- Ahmed A Eldesouqi
- Department of Orthopaedic Surgery and Traumatology, Alexandria University, Egypt
| | | | - Wai-Yip Kenneth Ho
- Department of Orthopaedics & Traumatology, Queen Mary Hospital, Hong Kong
| | - Ying-Lee Lam
- Department of Orthopaedics & Traumatology, Queen Mary Hospital, Hong Kong
| |
Collapse
|
10
|
Yulian ED, Pandelaki J, Kodrat E, Wibisana IGNG. Forequarter amputation post transarterial chemoembolization and radiation in synovial sarcoma: A case report. Int J Surg Case Rep 2021; 81:105824. [PMID: 33887868 PMCID: PMC8027265 DOI: 10.1016/j.ijscr.2021.105824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 03/21/2021] [Accepted: 03/21/2021] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION AND IMPORTANCE Forequarter amputation or interscapulathoracalis amputation is a major amputation procedure that involves the entire upper extremity, scapula, and a whole or part of the clavicula. Forequarter amputation is commonly used to control bleeding in malignant tumor cases in which no treatment is available for the extremities. CASE PRESENTATION We report a case of forequarter amputation in a 25-year-old patient with synovial sarcoma. Transarterial chemoembolization (TACE) and radiation synovial sarcoma were performed in the patient to reduce bleeding. This technique may also be used for treating synovial sarcoma with massive bleeding. CLINICAL DISCUSSION Despite forequarter amputation indications in malignant tumor cases and recurrent cancer cases, the effectiveness of this technique remains unclear. The patient was readmitted with a recurrent mass three months after surgery. CONCLUSION In this study, TACE and radiotherapy are effective in controlling bleeding preoperatively and intraoperatively in patients with synovial sarcoma.
Collapse
Affiliation(s)
- Erwin Danil Yulian
- Surgical Oncology Division, Department of Surgery, Dr. Cipto Mangunkusumo General Hospital, Faculty of Medicine Universitas Indonesia, Indonesia.
| | - Jacub Pandelaki
- Interventional Radiology Division, Department of Radiology, Dr. Cipto Mangunkusumo General Hospital, Faculty of Medicine Universitas Indonesia, Indonesia
| | - Evelina Kodrat
- Department of Anatomical Pathology, Dr. Cipto Mangunkusumo General Hospital, Faculty of Medicine Universitas Indonesia, Indonesia
| | - I Gusti Ngurah Gunawan Wibisana
- Surgical Oncology Division, Department of Surgery, Dr. Cipto Mangunkusumo General Hospital, Faculty of Medicine Universitas Indonesia, Indonesia
| |
Collapse
|
11
|
Mechanisms of Resistance to Conventional Therapies for Osteosarcoma. Cancers (Basel) 2021; 13:cancers13040683. [PMID: 33567616 PMCID: PMC7915189 DOI: 10.3390/cancers13040683] [Citation(s) in RCA: 66] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 02/02/2021] [Accepted: 02/03/2021] [Indexed: 02/06/2023] Open
Abstract
Osteosarcoma (OS) is the most common primary bone tumor, mainly occurring in children and adolescents. Current standard therapy includes tumor resection associated with multidrug chemotherapy. However, patient survival has not evolved for the past decades. Since the 1970s, the 5-year survival rate is around 75% for patients with localized OS but dramatically drops to 20% for bad responders to chemotherapy or patients with metastases. Resistance is one of the biological processes at the origin of therapeutic failure. Therefore, it is necessary to better understand and decipher molecular mechanisms of resistance to conventional chemotherapy in order to develop new strategies and to adapt treatments for patients, thus improving the survival rate. This review will describe most of the molecular mechanisms involved in OS chemoresistance, such as a decrease in intracellular accumulation of drugs, inactivation of drugs, improved DNA repair, modulations of signaling pathways, resistance linked to autophagy, disruption in genes expression linked to the cell cycle, or even implication of the micro-environment. We will also give an overview of potential therapeutic strategies to circumvent resistance development.
Collapse
|
12
|
Desai SA, Manjappa A, Khulbe P. Drug delivery nanocarriers and recent advances ventured to improve therapeutic efficacy against osteosarcoma: an overview. J Egypt Natl Canc Inst 2021; 33:4. [PMID: 33555490 DOI: 10.1186/s43046-021-00059-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 01/18/2021] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Osteosarcoma (OS) is one of the key cancers affecting the bone tissues, primarily occurred in children and adolescence. Recently, chemotherapy followed by surgery and then post-operative adjuvant chemotherapy is widely used for the treatment of OS. However, the lack of selectivity and sensitivity to tumor cells, the development of multi-drug resistance (MDR), and dangerous side effects have restricted the use of chemotherapeutics. MAIN BODY There is an unmet need for novel drug delivery strategies for effective treatment and management of OS. Advances in nanotechnology have led to momentous progress in the design of tumor-targeted drug delivery nanocarriers (NCs) as well as functionalized smart NCs to achieve targeting and to treat OS effectively. The present review summarizes the drug delivery challenges in OS, and how organic nanoparticulate approaches are useful in overcoming barriers will be explained. The present review describes the various organic nanoparticulate approaches such as conventional nanocarriers, stimuli-responsive NCs, and ligand-based active targeting strategies tested against OS. The drug conjugates prepared with copolymer and ligand having bone affinity, and advanced promising approaches such as gene therapy, gene-directed enzyme prodrug therapy, and T cell therapy tested against OS along with their reported limitations are also briefed in this review. CONCLUSION The nanoparticulate drugs, drug conjugates, and advanced therapies such as gene therapy, and T cell therapy have promising and potential application in the effective treatment of OS. However, many of the above approaches are still at the preclinical stage, and there is a long transitional period before their clinical application.
Collapse
Affiliation(s)
- Sujit Arun Desai
- School of Pharmacy, Suresh Gyan Vihar University, Mahal Rd, Mahal, Jagatpura, Jaipur, Rajasthan, 302017, India. .,Annasaheb Dange College of D Pharmacy, Ashta, Tal: Walwa, Dist., Sangli, Maharashtra, 416301, India.
| | - Arehalli Manjappa
- Tatyasaheb Kore College of Pharmacy, Warananagar, Tal: Panhala, Dist., Kolhapur, Maharashtra, 416113, India
| | - Preeti Khulbe
- School of Pharmacy, Suresh Gyan Vihar University, Mahal Rd, Mahal, Jagatpura, Jaipur, Rajasthan, 302017, India
| |
Collapse
|
13
|
Suresh Nathan S, Tan Lay Hua G, Mei Yoke C, Mann Hong T, Peter Pereira B. Outcome satisfaction in long-term survivors of oncologic limb salvage procedures. Eur J Cancer Care (Engl) 2020; 30:e13377. [PMID: 33289196 DOI: 10.1111/ecc.13377] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 09/01/2020] [Accepted: 10/14/2020] [Indexed: 12/01/2022]
Abstract
OBJECTIVE We present data from our recently completed study that suggests that joint salvage is the key parameter in keeping the limb salvage ethos relevant. METHODS We reviewed all patients operated on nationally over 30 years (1978 to 2008). We identified 265 survivors of which 162 were available for evaluation at the time of survey. RESULTS There were 92 males and 70 females followed an average 9.1±SD3.1 years. Average age at survey was 38±SD17 years. ANOVA for mental health and TESS degree of importance for ADL identified that all categories of joint preservation were similar to an average group of people from the population. Physical health scores were significantly better amongst joint-preserved versus joint replacement patients (p = 0.003). Nevertheless, there was no significant difference between amputees with respect to physical health scores compared to arthrodesed and joint-replaced individuals. Biological reconstructions scored significantly better than metallic segmentary reconstructions (p < 0.001). Dissatisfaction appeared to correlate best with the presence of pain following reconstruction (p < 0.001). CONCLUSIONS While our study supports the finding of amputations being as satisfactory as arthrodeses and joint replacement salvage surgery, joint salvage was superior to all other categories. Assessments of equivalence should incorporate joint salvage and materials used as evaluable parameters.
Collapse
Affiliation(s)
- Saminathan Suresh Nathan
- Limb Salvage and Revision Arthroplasty Surgery, Mount Elizabeth Medical Center, Singapore, Singapore
| | - Grace Tan Lay Hua
- Department of Orthopaedic Surgery, National University of Singapore Yong Loo Lin School of Medicine, Singapore, Singapore
| | - Chan Mei Yoke
- Department of Paediatric Subspecialties, KK Woman and Children's Hospital, Singapore, Singapore
| | - Tan Mann Hong
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore
| | - Barry Peter Pereira
- Department of Orthopaedic Surgery, National University of Singapore Yong Loo Lin School of Medicine, Singapore, Singapore
| |
Collapse
|
14
|
Wu Z, Wang C, Chen Y, Sun Z, Yan W. SRPX2 Promotes Cell Proliferation and Invasion in Osteosarcoma Through Regulating Hippo Signaling Pathway. Onco Targets Ther 2020; 13:1737-1749. [PMID: 32161469 PMCID: PMC7049857 DOI: 10.2147/ott.s225602] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Accepted: 11/15/2019] [Indexed: 12/19/2022] Open
Abstract
Background/Purpose Osteosarcoma (OS), a primary bone malignancy, is characterized by a high rate of metastasis. It has been found that Sushi repeat containing protein X-linked 2 (SRPX2) is involved in tumor cell proliferation, adhesion, invasion and migration. The current work aimed to explore the effect of SRPX2 on OS cell invasion and proliferation. Methods Immunohistochemistry (IHC), Western blotting and reverse transcription-polymerase chain reaction (RT-PCR) were used to detect the expression of the associated protein in OS tissues and cell lines. Cell counting kit-8 (CCK8), transwell and colony formation assays were used to determine cell viability, invasion, and proliferation, respectively. The in vivo tumorigenic ability of SRPX2 gene was determined using nude mouse tumorigenesis test. Results SRPX2 knockdown suppressed the viability, while SRPX2 overexpression increased the invasion and colony formation ability of the cells in vitro. In vivo experiments demonstrated that SRPX2 knockdown inhibited tumor growth and invasion as evidenced by decreased Ki67 and N-cadherin levels, and increased E-cadherin level. Downregulation of SRPX2 increased YAP phosphorylation resulting in reduced nuclear translocation to activate Hippo signaling pathway. The promotion of cell viability, colony-forming ability, and invasion, and the inhibition of CTGF, Cyr61, and Birc5 levels promoted by SRPX2 overexpression were reversed by YAP inhibition. Conclusion SRPX2 increased cell proliferation and invasion in osteosarcoma by activating Hippo signaling pathway.
Collapse
Affiliation(s)
- Zhiqiang Wu
- Department of Musculoskeletal Oncology, Fudan University Shanghai Cancer Center, Shanghai 200032, People's Republic of China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, People's Republic of China
| | - Chunmeng Wang
- Department of Musculoskeletal Oncology, Fudan University Shanghai Cancer Center, Shanghai 200032, People's Republic of China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, People's Republic of China
| | - Yong Chen
- Department of Musculoskeletal Oncology, Fudan University Shanghai Cancer Center, Shanghai 200032, People's Republic of China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, People's Republic of China
| | - Zhengwang Sun
- Department of Musculoskeletal Oncology, Fudan University Shanghai Cancer Center, Shanghai 200032, People's Republic of China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, People's Republic of China
| | - Wangjun Yan
- Department of Musculoskeletal Oncology, Fudan University Shanghai Cancer Center, Shanghai 200032, People's Republic of China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, People's Republic of China
| |
Collapse
|
15
|
Witek L, Alifarag AM, Tovar N, Lopez CD, Cronstein BN, Rodriguez ED, Coelho PG. Repair of Critical-Sized Long Bone Defects Using Dipyridamole-Augmented 3D-Printed Bioactive Ceramic Scaffolds. J Orthop Res 2019; 37:2499-2507. [PMID: 31334868 DOI: 10.1002/jor.24424] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Accepted: 07/10/2019] [Indexed: 02/04/2023]
Abstract
There are over two million long bone defects treated in the United States annually, of which ~5% will not heal without significant surgical intervention. While autogenous grafting is the standard of care in simple defects, a customized scaffold for large defects in unlimited quantities is not available. Recently, a three-dimensionally (3D)-printed bioactive ceramic (3DPBC) scaffold has been successfully utilized in the of repair critical-sized (CSD) long bone defects in vivo. In this study, 3DPBC scaffolds were augmented with dipyridamole (DIPY), an adenosine A2A receptor (A2A R) indirect agonist, because of its known effect to enhance bone formation. CSD full thickness segmental defects (~11 mm × full thickness) defects were created in the radial diaphysis in New Zealand white rabbits (n = 24). A customized 3DPBC scaffold composed of β-tricalcium phosphate was placed into the defect site. Groups included scaffolds that were collagen-coated (COLL), or immersed in 10, 100, or 1,000 μM DIPY solution. Animals were euthanized 8 weeks post-operatively and the radii/ulna-scaffold complex retrieved en bloc, for micro-CT, histological, and mechanical analysis. Bone growth was assessed exclusively within scaffold pores and evaluated by microCT and advanced reconstruction software. Biomechanical properties were evaluated utilizing nanoindentation to assess the newly regenerated bone for elastic modulus (E) and hardness (H). MicroCT reconstructions illustrated bone in-growth throughout the scaffold, with an increase in bone volume dependent on the DIPY dosage. The histological evaluation did not indicate any adverse immune response while revealing progressive remodeling of bone. These customized biologic 3DPBC scaffolds have the potential of repairing and regenerating bone. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 37:2499-2507, 2019.
Collapse
Affiliation(s)
- Lukasz Witek
- Department of Biomaterials, New York University College of Dentistry, New York, New York, 10010
| | - Adham M Alifarag
- College of Medicine, SUNY Upstate Medical University, Syracuse, New York, New York, 13210
| | - Nick Tovar
- Department of Biomaterials, New York University College of Dentistry, New York, New York, 10010.,New York University College of Dentistry, New York, New York, 10010
| | - Christopher D Lopez
- Department of Plastic and Reconstructive Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland, 21287
| | - Bruce N Cronstein
- Department of Medicine, New York University School of Medicine, New York, New York, 10016
| | - Eduardo D Rodriguez
- Hansjörg Wyss Department of Plastic Surgery, New York University School of Medicine, New York, New York, 10010
| | - Paulo G Coelho
- Department of Biomaterials, New York University College of Dentistry, New York, New York, 10010.,Department of Mechanical and Aerospace Engineering, New York University Tandon School of Engineering, New York, New York, 10010.,Hansjörg Wyss Department of Plastic Surgery, New York University School of Medicine, New York, New York, 10010
| |
Collapse
|
16
|
Comparing the Impact of Cancer and Treatment-Related Effects on Psychological Well-being and Quality of Life Between Hong Kong Survivors of Childhood Solid Tumors and Leukemia. Cancer Nurs 2019; 43:446-454. [PMID: 31361673 DOI: 10.1097/ncc.0000000000000736] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND Evidence shows that survivors of solid tumors have a lower survival rate and shorter disease-free survival time than survivors of leukemia. However, the psychological well-being and health-related quality of life (HRQOL) of these 2 groups of cancer survivors have not been compared. OBJECTIVE To examine and compare the impact of cancer and treatment-related effects on psychological well-being and HRQOL between survivors of childhood solid tumors and leukemia. METHODS We conducted a cross-sectional study involving 65 Hong Kong survivors of solid tumors and 70 survivors of leukemia aged 8 to 18 years who had their medical follow-up in a pediatric outpatient clinic. Participants' depressive symptoms, self-esteem, and HRQOL were assessed. Twenty-two survivors of childhood solid tumors and 15 survivors of childhood leukemia were then selected for semistructured interviews. RESULTS Survivors of childhood solid tumors reported significantly higher mean scores for depressive symptoms, and lower mean self-esteem and HRQOL scores than survivors of childhood leukemia. Qualitative data revealed that survivors of childhood solid tumors faced more challenges in their daily life than survivors of childhood leukemia. CONCLUSIONS Survivors of childhood solid tumors reported poorer psychological well-being and HRQOL than survivors of childhood leukemia. This vulnerable group warrants more attention and support. IMPLICATIONS FOR PRACTICE It is vital for healthcare professionals to understand the impact of cancer and treatment-related effects in the context of different types of cancer. This will facilitate development and evaluation of appropriate psychological interventions to promote psychological well-being and HRQOL among childhood cancer survivors.
Collapse
|
17
|
Stitzlein RN, Wojcik J, Sebro RA, Balamuth NJ, Weber KL. Team Approach: Osteosarcoma of the Distal Part of the Femur in Adolescents. JBJS Rev 2019; 5:e5. [PMID: 29278618 DOI: 10.2106/jbjs.rvw.17.00030] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Russell N Stitzlein
- Departments of Orthopaedic Surgery (R.N.S. and K.L.W.), Pathology and Laboratory Medicine (J.W.), Radiology (R.A.S.), and Pediatrics (N.J.B.), University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
| | - John Wojcik
- Departments of Orthopaedic Surgery (R.N.S. and K.L.W.), Pathology and Laboratory Medicine (J.W.), Radiology (R.A.S.), and Pediatrics (N.J.B.), University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
| | - Ronnie A Sebro
- Departments of Orthopaedic Surgery (R.N.S. and K.L.W.), Pathology and Laboratory Medicine (J.W.), Radiology (R.A.S.), and Pediatrics (N.J.B.), University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
| | - Naomi J Balamuth
- Departments of Orthopaedic Surgery (R.N.S. and K.L.W.), Pathology and Laboratory Medicine (J.W.), Radiology (R.A.S.), and Pediatrics (N.J.B.), University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania.,Divisions of Oncology (N.J.B.) and Orthopaedics (K.L.W.), Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Kristy L Weber
- Departments of Orthopaedic Surgery (R.N.S. and K.L.W.), Pathology and Laboratory Medicine (J.W.), Radiology (R.A.S.), and Pediatrics (N.J.B.), University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania.,Divisions of Oncology (N.J.B.) and Orthopaedics (K.L.W.), Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| |
Collapse
|
18
|
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
| |
Collapse
|
19
|
Lu Y, Chen G, Long Z, Li M, Ji C, Wang F, Li H, Lu J, Wang Z, Li J. Novel 3D-printed prosthetic composite for reconstruction of massive bone defects in lower extremities after malignant tumor resection. J Bone Oncol 2019; 16:100220. [PMID: 31044134 PMCID: PMC6479734 DOI: 10.1016/j.jbo.2019.100220] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Revised: 01/22/2019] [Accepted: 01/22/2019] [Indexed: 02/01/2023] Open
Abstract
OBJECTIVE To introduce a novel 3D-printed prosthetic composite for reconstruction of massive bone defects after resection for bone malignancy of lower extremities. The design concept, surgical technique, and the preliminary outcomes were elaborated. METHODS Patients with primary malignant tumors of lower extremities requiring tumor resection and reconstruction were recruited between Jun 2015 and Nov 2018. Patient-specific 3D-printed prostheses were designed according to preoperative imaging data. After tumor resection, reconstruction was performed with composites consisting of 3D- printed prosthesis, beta-tricalcium phosphate (β-TCP) bioceramics and/or vascularized fibula. All patients underwent regular follow-up postoperatively. The functional outcomes were assessed by the Musculoskeletal Tumor Society score (MSTS). Oncological outcomes, imaging results, and complications were recorded and analyzed. RESULTS Ten cases averaging 12.90 years of age participated in this study. There were five femur and five tibia reconstructions. The mean follow-up period was 16.90 months. At last follow-up, all patients were alive without tumor recurrence. Average MSTS functional score was 80.33 ± 11.05%. All prostheses were intact and stable without failure or systemic breakage. No serious complications occurred after the operation. Postoperative X-ray, computed tomography (CT) and single-photon emission computed tomography (SPECT) showed an ideal integration between the bone and the prosthetic composite. Moreover, vascularized fibula and implanted β-TCP bioceramics indicated relatively high metabolic activity in vivo. CONCLUSIONS Patient-specific 3D-printed prostheses combined with β-TCP bioceramics and/or vascularized fibula provide an excellent option for reconstruction of massive bone defects after lower extremity malignant tumor extirpation. Short-term follow up showed promising clinical results in recovering lower limb function, promoting osseointegration and reducing complications.
Collapse
Affiliation(s)
- Yajie Lu
- Department of Orthopedics, Xijing Hospital, The Air Force Medical University, No. 127 Changle West Road, Xi'an, Shaanxi 710032, PR China
| | - Guojing Chen
- Department of Orthopedics, Xijing Hospital, The Air Force Medical University, No. 127 Changle West Road, Xi'an, Shaanxi 710032, PR China
| | - Zuoyao Long
- Department of Orthopedics, Xijing Hospital, The Air Force Medical University, No. 127 Changle West Road, Xi'an, Shaanxi 710032, PR China
| | - Minghui Li
- Department of Orthopedics, Xijing Hospital, The Air Force Medical University, No. 127 Changle West Road, Xi'an, Shaanxi 710032, PR China
| | - Chuanlei Ji
- Department of Orthopedics, Xijing Hospital, The Air Force Medical University, No. 127 Changle West Road, Xi'an, Shaanxi 710032, PR China
| | - Fengwei Wang
- Department of Orthopedics, Shaanxi Zheng He Hospital, Xi'an, Shaanxi 710043, PR China
| | - Huanzhang Li
- Department of Orthopedics, Xijing Hospital, The Air Force Medical University, No. 127 Changle West Road, Xi'an, Shaanxi 710032, PR China
| | - Jianxi Lu
- Shanghai Bio-lu Biomaterials Co., Ltd., Shanghai 201100, PR China
| | - Zhen Wang
- Department of Orthopedics, Xijing Hospital, The Air Force Medical University, No. 127 Changle West Road, Xi'an, Shaanxi 710032, PR China
| | - Jing Li
- Department of Orthopedics, Xijing Hospital, The Air Force Medical University, No. 127 Changle West Road, Xi'an, Shaanxi 710032, PR China
| |
Collapse
|
20
|
Wang B, Qu XL, Liu J, Lu J, Zhou ZY. HOTAIR promotes osteosarcoma development by sponging miR-217 and targeting ZEB1. J Cell Physiol 2018; 234:6173-6181. [PMID: 30367466 DOI: 10.1002/jcp.27394] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Accepted: 08/16/2018] [Indexed: 12/23/2022]
Abstract
Long noncoding RNAs (lncRNAs) have drawn increasing attention because of the role which they play in various diseases, including osteosarcoma. So far, the function and mechanism of HOTAIR in osteosarcoma are unclear. In our study, we observed that HOTAIR was elevated accompanied with a decrease of miR-217 and an increase of ZEB1 in human osteosarcoma cells including U2OS, MG63, Saos-2, and SW1353 compared with human osteoblast cell line hFOB. In addition, the subsequent functional assay exhibited that silencing HOTAIR could significantly repress osteosarcoma cell growth, migration, invasion, and induce cell apoptosis capacity, which indicated that HOTAIR exerted an oncogenic role in osteosarcoma. Moreover, it was revealed by using bioinformatics analysis that HOTAIR can be targeted by microRNA-217 (miR-217). miR-217 has been recognized as a crucial tumor suppressive gene in cancers. We verified that mimics of miR-217 were able to suppress the osteosarcoma development. Furthermore, real-time quantitative PCR showed that HOTAIR siRNA increased miR-217 expression. Besides these, ZEB1 was identified as a downstream gene of miR-217 and we found that HOTAIR can mediate osteosarcoma progress by upregulating ZEB1 expression via acting as a competitive endogenous RNA (ceRNA) via miR-217. Taken these together, our findings in this study indicated that HOTAIR/miR-217/ZEB1 axis, as a novel research point can provide new insights into molecular mechanism of osteosarcoma development.
Collapse
Affiliation(s)
- Bing Wang
- Department of Oncological Surgery, Minhang Branch, Cancer Hospital, Fudan University, Shanghai, China
| | - Xing-Long Qu
- Department of Oncological Surgery, Minhang Branch, Cancer Hospital, Fudan University, Shanghai, China
| | - Jiaxiang Liu
- Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Junhui Lu
- Department of Rheumatology, Huai'an Second People's Hospital and The Affiliated Huai'an Hospital of Xuzhou Medical University, Huai'an, China
| | - Zong-Yu Zhou
- Department of Orthopedics, Huaiyin Hospital of Huai'an City, Huai'an, China
| |
Collapse
|
21
|
Min L, Yao K, Lu M, Zhou Y, Wang J, Tang F, Zhang W, Luo Y, Duan H, Tu C. First application of 3D design custom-made uncemented prosthetic stem for distal femoral cemented megaprosthesis revision. PRECISION CLINICAL MEDICINE 2018; 1:88-96. [PMID: 35693199 PMCID: PMC8985771 DOI: 10.1093/pcmedi/pby008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Revised: 07/10/2018] [Accepted: 08/05/2018] [Indexed: 02/05/2023] Open
Abstract
Objectives 3D design, which is widely used in orthopedics, can be applied for precise distal femoral megaprosthetic revision. This research aimed to present and evaluate the design, perioperative management, and mid-term clinical outcomes of a 3D design custom-made uncemented prosthetic stem. Methods Between January 2014 and January 2016, seven patients received 3D design custom-made uncemented prosthetic stem revision at our institution. Clinical records and radiographs were evaluated retrospectively. Results There were no hardware-related complications during the follow-up (average 24.3 months; range 24–48 months). The average Musculoskeletal Tumor Society (MSTS) score at the last follow-up after revision (27.7 points, range 25–28 points) was significantly higher than that before (16.0 points, range 13–18 points). In addition, the range of motion (ROM) of the affected knee, and the scores of pain, function, emotional acceptance, support, walking and gait all improved significantly. The antecurvature radian of the revision stem averaged at 3.6°. Of the seven patients, three received femoral stem revision and four received revision of the femoral stem and the femoral component; three of them used longer prostheses than the others. There were no significant differences in function between these two groups at the last follow-up after revision. Conclusion The 3D design custom-made prosthesis is a typical precision medicine technology in oncologic orthopedics. Characterized by its individually and precisely designed uncemented stem, it offers an alternative option for distal femoral cemented prosthesis revision. Besides the 3D design itself, the perioperative management, especially the techniques for stem implantation, and long-term follow-up are also crucial.
Collapse
Affiliation(s)
- Li Min
- Department of Orthopedics, West China Hospital, Sichuan University, Guoxue Xiang #37, Chengdu, Sichuan, People's Republic of China
| | - Kai Yao
- Department of Orthopedics, West China Hospital, Sichuan University, Guoxue Xiang #37, Chengdu, Sichuan, People's Republic of China
| | - Minxun Lu
- Department of Orthopedics, West China Hospital, Sichuan University, Guoxue Xiang #37, Chengdu, Sichuan, People's Republic of China
| | - Yong Zhou
- Department of Orthopedics, West China Hospital, Sichuan University, Guoxue Xiang #37, Chengdu, Sichuan, People's Republic of China
| | - Jie Wang
- Department of Orthopedics, West China Hospital, Sichuan University, Guoxue Xiang #37, Chengdu, Sichuan, People's Republic of China
| | - Fan Tang
- Department of Orthopedics, West China Hospital, Sichuan University, Guoxue Xiang #37, Chengdu, Sichuan, People's Republic of China
| | - Wenli Zhang
- Department of Orthopedics, West China Hospital, Sichuan University, Guoxue Xiang #37, Chengdu, Sichuan, People's Republic of China
| | - Yi Luo
- Department of Orthopedics, West China Hospital, Sichuan University, Guoxue Xiang #37, Chengdu, Sichuan, People's Republic of China
| | - Hong Duan
- Department of Orthopedics, West China Hospital, Sichuan University, Guoxue Xiang #37, Chengdu, Sichuan, People's Republic of China
| | - Chongqi Tu
- Department of Orthopedics, West China Hospital, Sichuan University, Guoxue Xiang #37, Chengdu, Sichuan, People's Republic of China
| |
Collapse
|
22
|
Gil S, Fernandez-Pineda I, Rao B, Neel MD, Baker JN, Wu H, Wu J, Anghelescu DL. Role of Amputation in Improving Mobility, Pain Outcomes, and Emotional and Psychological Well-Being in Children With Metastatic Osteosarcoma. Am J Hosp Palliat Care 2018; 36:105-110. [PMID: 30058346 DOI: 10.1177/1049909118791119] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND: Few studies have analyzed the benefit of limb amputations in children with metastatic osteosarcoma and limited life span. OBJECTIVE: We studied outcomes of limb amputations in children with metastatic osteosarcoma. DESIGN: We performed a retrospective review of patients who underwent limb amputations (January 1995-June 2015) and died within 1 year of surgery. SETTING/PARTICIPANTS: We studied 12 patients with osteosarcoma at a single institution. MEASUREMENTS: Data on mobility, pain, and emotional and psychological well-being were retrieved from medical records from 1 month before surgery to 6 months after surgery. RESULTS: Of the 12 patients (7 females and 5 males; median age at surgery 13 years [range, 7-20 years]) meeting study criteria, 3 patients and 9 patients had primary osteosarcoma in upper and lower limbs, respectively. Mobility improved postamputation in 8 bedridden/wheelchair-bound patients. Postamputation, emotional, and psychological well-being improved for 9 patients, 3 patients had persistent psychological and/or emotional symptoms, and no patient experienced signs of regret. Daily mean pain scores were significantly lower at 1 week (median 3 [range, 0-6]; P = .03) and 3 months (median 0 [range, 0-8]; P = .02) postsurgery than at 1 week presurgery (median 5.5 [range, 0-10]). Morphine consumption (mg/kg/d) showed a trend toward higher values at 1 week (median 0.2 [range, 0-7.6]; P = .6) and 3 months (median 0.2 [range, 0-0.5]; P = .3) postsurgery than at 1 week presurgery (median 0.1 [range, 0-0.5]). CONCLUSIONS: Patients undergoing limb amputations had reduced pain and improved mobility and emotional and psychological well-being. Amputations are likely to benefit children with limited life expectancy.
Collapse
Affiliation(s)
- Sebastian Gil
- 1 Department of Surgery, St Jude Children's Research Hospital, Memphis, TN, USA
| | | | - Bhaskar Rao
- 1 Department of Surgery, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Michael D Neel
- 1 Department of Surgery, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Justin N Baker
- 2 Department of Oncology, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Huiyun Wu
- 3 Department of Biostatistics, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Jianrong Wu
- 3 Department of Biostatistics, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Doralina L Anghelescu
- 4 Division of Anesthesiology, Department of Pediatric Medicine, St Jude Children's Research Hospital, Memphis, TN, USA
| |
Collapse
|
23
|
Hackenberg RK, Nessler J, König DP. First application of segmental trabecular metal cones in a custom-made revision tumor prosthesis of the knee: A technical note. Technol Health Care 2018; 26:195-202. [DOI: 10.3233/thc-170895] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Affiliation(s)
- Roslind Karolina Hackenberg
- LVR-Clinic of Orthopedic Surgery Viersen, Viersen, Germany
- Department of Orthopedic and Trauma Surgery, University Clinic of Bonn, Bonn, Germany
| | - Jochen Nessler
- LVR-Clinic of Orthopedic Surgery Viersen, Viersen, Germany
| | | |
Collapse
|
24
|
Association of anti-HER2 antibody with graphene oxide for curative treatment of osteosarcoma. NANOMEDICINE-NANOTECHNOLOGY BIOLOGY AND MEDICINE 2017; 14:581-593. [PMID: 29170110 DOI: 10.1016/j.nano.2017.11.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Revised: 09/21/2017] [Accepted: 11/03/2017] [Indexed: 01/26/2023]
Abstract
The finding of HER2 overexpression in osteosarcoma (OS) makes HER2 a potential therapeutic target. However, studies indicate OS cells are nonresponsive to anti-HER2 antibody trastuzumab (TRA) therapy. We established stable, non-covalent association of TRA with nanomaterial graphene oxide (GO) to generated multivalent TRA/GO complexes that demonstrated markedly enhanced HER2-binding activity and capacity to rapidly kill OS cells. TRA/GO simultaneously induced oxidative stress and HER2 signaling in the target cells, leading to rapid depletion of the cellular inhibitors of apoptosis protein (cIAP) and caspase-8, formation of RIP1/RIPK3/MLKL necroptosome and necroptosis of the OS cells. Intravenous administration of TRA/GO eradicated established xenograft the OS in immunodeficient mice, resulting in indefinite survival of the animals, whereas TRA in its original form failed to do so. No appreciable side effects were observed with TRA/GO therapy. The results demonstrate a novel, nontoxic, curative therapy for a HER2pos cancer in a preclinical animal model.
Collapse
|
25
|
Elsner U, Henrichs M, Gosheger G, Dieckmann R, Nottrott M, Hardes J, Streitbürger A. Forequarter amputation: a safe rescue procedure in a curative and palliative setting in high-grade malignoma of the shoulder girdle. World J Surg Oncol 2016; 14:216. [PMID: 27526689 PMCID: PMC4986170 DOI: 10.1186/s12957-016-0973-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Accepted: 08/04/2016] [Indexed: 12/15/2022] Open
Abstract
Background Forequarter amputation (FQA) is a surgical treatment of tumors in the upper extremity and shoulder girdle that infiltrate the neurovascular bundles. In both curative and palliative settings, FQA can serve as an effective oncological treatment. Methods This study presents the FQA-related data of 30 patients (mean age 50 years) treated between 2000 and 2012. Their medical condition was high-grade bone or soft tissue sarcoma in 26 and high-grade carcinoma in four cases. Results Mean operation time was 119 min. One major and five minor complications occurred in the postoperative period. Resection margins were wide in 91 % of patients. Local recurrence was observed in four patients after 19 months on average. Patients treated with curative intention had a 5-year survival chance of 39 %. Average survival after palliative amputation was 11 months. Conclusions FQA provides an opportunity for adequate oncological margins in large tumors, while offering relief from tumor-induced distress in palliative situations.
Collapse
Affiliation(s)
- Ulrich Elsner
- Department of Orthopedics and Tumororthopedics, University Hospital of Münster, Albert-Schweitzer-Campus 1, 48149, Münster, Germany.
| | - Marcel Henrichs
- Department of Orthopedics and Tumororthopedics, University Hospital of Münster, Albert-Schweitzer-Campus 1, 48149, Münster, Germany
| | - Georg Gosheger
- Department of Orthopedics and Tumororthopedics, University Hospital of Münster, Albert-Schweitzer-Campus 1, 48149, Münster, Germany
| | - Ralf Dieckmann
- Department of Orthopedics and Tumororthopedics, University Hospital of Münster, Albert-Schweitzer-Campus 1, 48149, Münster, Germany
| | - Markus Nottrott
- Department of Orthopedics and Tumororthopedics, University Hospital of Münster, Albert-Schweitzer-Campus 1, 48149, Münster, Germany
| | - Jendrik Hardes
- Department of Orthopedics and Tumororthopedics, University Hospital of Münster, Albert-Schweitzer-Campus 1, 48149, Münster, Germany
| | - Arne Streitbürger
- Department of Orthopedics and Tumororthopedics, University Hospital of Münster, Albert-Schweitzer-Campus 1, 48149, Münster, Germany
| |
Collapse
|
26
|
Knaus WJ, Alluri R, Bakri K, Iorio ML. Oncologic reconstruction of the hand and upper extremity: Maximizing functional outcomes. J Surg Oncol 2016; 113:946-54. [DOI: 10.1002/jso.24196] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2016] [Accepted: 01/21/2016] [Indexed: 11/08/2022]
Affiliation(s)
- William J. Knaus
- Division of Plastic Surgery, Beth Israel Deaconess Medical Center; Harvard Medical School; Boston Massachusetts
| | - Ram Alluri
- Department of Orthopaedic Surgery, University of Southern California; Keck School of Medicine; Los Angeles California
| | - Karim Bakri
- Division of Plastic Surgery; Mayo Clinic; Rochester Minnesota
| | - Matthew L. Iorio
- Division of Plastic Surgery, Beth Israel Deaconess Medical Center; Harvard Medical School; Boston Massachusetts
| |
Collapse
|
27
|
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.
Collapse
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
| |
Collapse
|
28
|
|
29
|
Jabir S, Sheikh F, Fitzgerald O’Connor E, Griffiths M, Niranjan N. A systematic review of the applications of free tissue transfer for paediatric lower limb salvage following trauma. J Plast Surg Hand Surg 2015; 49:251-259. [DOI: 10.3109/2000656x.2015.1047781] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
30
|
Henderson TO, Nathan PC. Childhood cancer survivors: considerations for surgeons in the transition from pediatric to adult care. Semin Pediatr Surg 2015; 24:93-9. [PMID: 25770371 DOI: 10.1053/j.sempedsurg.2015.01.007] [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: 11/11/2022]
Abstract
There are over 380,000 childhood cancer survivors (CCS) alive in the US, and the population is growing. CCS face significant long-term morbidity and mortality as a consequence of their cancer treatment and thus require lifelong, risk-based health care focused on surveillance and early intervention to minimize the impact of late effects and second malignant neoplasms (SMN). Surgeons play a critical role in the treatment of childhood cancer and the subsequent management of long-term health complications. In this review, we provide an overview of late effects associated with cancer surgeries, potential late effects that may require surgery as an adult, and cancer therapies that may impact future safe surgery and anesthesia. We also describe the barriers to successful transition from pediatric to adult health care for CCS and the importance of treatment summaries, surveillance guidelines, and survivorship care plans for surgeons caring for CCS.
Collapse
Affiliation(s)
- Tara O Henderson
- Department of Pediatrics, Section of Hematology, Oncology and Stem Cell Transplantation, Comer Children׳s Hospital, University of Chicago, 5841S. Maryland Ave. MC 4060, Chicago, Illinois 60637.
| | - Paul C Nathan
- Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada
| |
Collapse
|
31
|
Frequent complications and severe bone loss associated with the repiphysis expandable distal femoral prosthesis. Clin Orthop Relat Res 2015; 473:831-8. [PMID: 24664193 PMCID: PMC4317465 DOI: 10.1007/s11999-014-3564-3] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The treatment of choice for distal femur malignancies in skeletally immature patients remains controversial. An expandable endoprosthesis device (Repiphysis Limb Salvage System; Wright Medical Technology, Arlington, TN, USA) allows for limb preservation and noninvasive lengthening but has been associated with significant complications; however, the extent and implications of bone loss associated with this implant have not been reported. QUESTIONS/PURPOSES Our goals were to report (1) the 2-year minimum clinical outcomes after placement of the Repiphysis expandable prosthesis for pediatric distal femur malignancies; (2) the complications associated with this prosthesis; (3) the failure rate of this prosthesis; and (4) the revision alternatives available for salvage procedures. METHODS Between 2002 and 2010, one surgeon (SG) treated all skeletally immature patients (mean age, 10.1 years; range, 4.7-13.6 years) with distal femoral osteosarcoma using a Repiphysis expandable prosthesis. Of the 12 patients who met these criteria, two were excluded for death from disease before 2 years, and mean followup for the remaining 10 was 72 months (range, 26-119 months). Medical records were retrospectively reviewed for complications and clinical outcomes, as assessed by the Musculoskeletal Tumor Society (MSTS) scoring system. Radiographs at final followup were reviewed for bone loss and analyzed by the two senior authors (SG, WWV) to determine reconstruction options available for future revisions. RESULTS MSTS scores averaged 67%, and we observed 37 implant-related complications requiring a total of 15 reoperations. Six patients underwent implant revisions with aseptic loosening being the predominant mode of failure; ultimately, four of these were converted to adult modular oncology prostheses, and two underwent total femoral replacements. Bone loss in this series was severe in terms of femoral length, cortical thinning, and metadiaphyseal compromise, and most patients will not have sufficient bone stock to permit future revision using standard stem fixation. CONCLUSIONS The bone loss around the stem of this prosthesis limits subsequent revision options, often resulting in a total femoral prosthesis. Although the decision to use the Repiphysis device must be made on an individual basis, surgeons should recognize the potential for significant bone compromise limiting revision options and consider other options. LEVEL OF EVIDENCE Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
Collapse
|
32
|
Cipriano CA, Wunder JS, Ferguson PC. Surgical Management of Soft Tissue Sarcomas of the Extremities. ACTA ACUST UNITED AC 2014. [DOI: 10.1053/j.oto.2014.02.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
|
33
|
Chopra BK. Health related quality of life studies in Indian patients after limb salvage surgery: Need of the hour. Med J Armed Forces India 2014; 69:209-10. [PMID: 24600110 DOI: 10.1016/j.mjafi.2013.05.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Affiliation(s)
- B K Chopra
- Commandant, AMC Centre & College & OIC Recordes & Col Commandant, Lucknow 226002, India
| |
Collapse
|
34
|
Validation of the Brazilian version of the musculoskeletal tumor society rating scale for lower extremity bone sarcoma. Clin Orthop Relat Res 2013; 471:4020-6. [PMID: 23917993 PMCID: PMC3825918 DOI: 10.1007/s11999-013-3211-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2013] [Accepted: 07/24/2013] [Indexed: 01/31/2023]
Abstract
BACKGROUND The Musculoskeletal Tumor Society (MSTS) rating scale is an English-language instrument used worldwide to assess functional evaluation of patients with musculoskeletal cancer. Despite its use in several studies in English-speaking countries, its validity for assessing patients in other languages is unknown. The translation and validation of widely used scales can facilitate the comparison across international patient samples. OBJECTIVES/PURPOSES The objectives of this study were (1) to translate and culturally adapt the MSTS rating scale for functional evaluation in patients with lower extremity bone sarcomas to Brazilian Portuguese; (2) analyze its factor structure; and (3) test the reliability and (4) validity of this instrument. METHOD The MSTS rating scale for lower limbs was translated from English into Brazilian Portuguese. Translations were synthesized, translated back into English, and reviewed by a multidisciplinary committee for further implementation. The questionnaire was administered to 67 patients treated for malignant lower extremity bone tumors who were submitted to limb salvage surgery or amputation. They also completed a Brazilian version of the Toronto Extremity Salvage Score (TESS). Psychometric properties were analyzed including factor structure analysis, internal consistency, interobserver reliability, test-retest reliability, and construct validity (by comparing the adapted MSTS with TESS and discriminant validity). RESULTS The MSTS rating scale for lower limbs was translated and culturally adapted to Brazilian Portuguese. The MSTS-BR proved to be adequate with only one latent dimension. The scale was also found to be reliable in a population that speaks Brazilian Portuguese showing good internal consistency (Cronbach's alpha = 0.84) and reliability (test-retest reliability and interobserver agreement of 0.92 and 0.98, respectively). Validity of the Brazilian MSTS rating scale was proved by moderate with TESS and good discriminant validity. CONCLUSIONS The Brazilian version of the MSTS rating scale was translated and validated. It is a reliable tool to assess functional outcome in patients with lower extremity bone sarcomas. It can be used for functional evaluation of Brazilian patients and crosscultural comparisons.
Collapse
|
35
|
|
36
|
Ottaviani G, Robert RS, Huh WW, Palla S, Jaffe N. Sociooccupational and physical outcomes more than 20 years after the diagnosis of osteosarcoma in children and adolescents: limb salvage versus amputation. Cancer 2013; 119:3727-36. [PMID: 23907996 DOI: 10.1002/cncr.28277] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2013] [Revised: 06/15/2013] [Accepted: 06/18/2013] [Indexed: 11/11/2022]
Abstract
BACKGROUND To the best of the authors' knowledge, there has been relatively little research published to date regarding very long-term survivors of childhood and adolescent osteosarcoma. In the current study, the authors compared the very long-term survival outcomes of patients with osteosarcoma who were treated with either limb salvage procedures or amputation. METHODS A total of 38 patients with osteosarcoma who survived ≥ 20 years from the time of diagnosis were divided into 2 groups according to whether they underwent amputation or limb salvage. Participants were asked to complete a questionnaire concerning their education, employment, annual income, marital status, health insurance, lifestyle, siblings, and all current and past health issues. RESULTS Education, employment, marital status, and health insurance were not found to differ significantly between the 2 groups of survivors, who described themselves as being similar to their siblings. Eight percent of survivors underwent secondary amputation because of complications with an endoprosthesis. The cumulative incidence of second primary neoplasms was 13%, and this finding was significantly higher in females and in survivors who underwent radiotherapy and had a genetic predisposition. The second primary malignancies were breast cancer (ductal invasive carcinoma, ductal in situ carcinoma, and leiomyosarcoma), mediastinal leiomyosarcoma, and squamocellular carcinoma of the oral cavity and the uterine cervix. Amputees required more assistive walking support than survivors who received limb salvage treatment (P<.05, chi-square test). CONCLUSIONS Despite the many challenges that osteosarcoma survivors face, patients who survived ≥ 20 years after their initial diagnosis reported having overall adjusted well to their physical limitations and were productive individuals.
Collapse
Affiliation(s)
- Giulia Ottaviani
- Division of Pediatrics, Children's Cancer Hospital, The University of Texas MD Anderson Cancer Center, Houston, Texas; Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | | | | | | | | |
Collapse
|
37
|
Morii T, Morioka H, Ueda T, Araki N, Hashimoto N, Kawai A, Takeuchi K, Anazawa U, Mochizuki K, Ichimura S. Functional analysis of cases of tumor endoprostheses with deep infection around the knee: a multi institutional study by the Japanese Musculoskeletal Oncology Group (JMOG). J Orthop Sci 2013; 18:605-12. [PMID: 23616090 DOI: 10.1007/s00776-013-0389-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2012] [Accepted: 03/23/2013] [Indexed: 11/28/2022]
Abstract
BACKGROUND Although intensive studies have been conducted to clarify the incidence, risks, and management methods of deep infection of tumor endoprostheses, limited data have been published in respect of the impact of such deep infection on the function of the corresponding limb. METHODS Clinical data of 125 patients (infection group 57, control group 68) with malignant bone and soft tissue tumors around the knee enrolled with the Japanese Musculoskeletal Oncology Group were collected. We analyzed the impact of deep infection of tumor endoprostheses on the limb salvage status together with that on the function of the salvaged limb. The definition of deep infection was based on the recommendations of the Centers for Disease Control and Prevention. The functional evaluation was based on the functional classification system established by the International Society of Limb Salvage and the Musculoskeletal Tumor Society. RESULTS Infection together with extracapsular resection was demonstrated to be a risk factor for late amputation. There were no significant differences in the functional scores for "pain," "support," "walking," or "gait" between the infection and control groups. The risk factors identified for a loss of score for "functional activities" were deep infection, age, duration of operation, and extracapsular resection. The infection group also showed a significant lower score loss in "emotion". As for the overall functional scores, the risk factors identified for lower scores were deep infection and age. The mean scores for the infection group and control group were 19.3 (64.3 %) and 21.6 (72 %), respectively. Although the difference was confirmed to be statistically significant, the actual difference was only 2.3 (10.6 % reduction). CONCLUSIONS Infection was a major risk factor for late amputation. Limbs salvaged by management of deep infection may show loss of function; however, the impact may be limited.
Collapse
Affiliation(s)
- Takeshi Morii
- Department of Orthopaedic Surgery, Kyorin University, 6-20-2 Shinkawa, Mitaka, Tokyo 161-8611, Japan.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
38
|
Lamplot JD, Denduluri S, Qin J, Li R, Liu X, Zhang H, Chen X, Wang N, Pratt A, Shui W, Luo X, Nan G, Deng ZL, Luo J, Haydon RC, He TC, Luu HH. The Current and Future Therapies for Human Osteosarcoma. CURRENT CANCER THERAPY REVIEWS 2013; 9:55-77. [PMID: 26834515 PMCID: PMC4730918 DOI: 10.2174/1573394711309010006] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Osteosarcoma (OS) is the most common non-hematologic malignant tumor of bone in adults and children. As sarcomas are more common in adolescents and young adults than most other forms of cancer, there are a significant number of years of life lost secondary to these malignancies. OS is associated with a poor prognosis secondary to a high grade at presentation, resistance to chemotherapy and a propensity to metastasize to the lungs. Current OS management involves both chemotherapy and surgery. The incorporation of cytotoxic chemotherapy into therapeutic regimens escalated cure rates from <20% to current levels of 65-75%. Furthermore, limb-salvage surgery is now offered to the majority of OS patients. Despite advances in chemotherapy and surgical techniques over the past three decades, there has been stagnation in patient survival outcome improvement, especially in patients with metastatic OS. Thus, there is a critical need to identify novel and directed therapy for OS. Several Phase I trials for sarcoma therapies currently ongoing or recently completed have shown objective responses in OS. Novel drug delivery mechanisms are currently under phase II and III clinical trials. Furthermore, there is an abundance of preclinical research which holds great promise in the development of future OS-directed therapeutics. Our continuously improving knowledge of the molecular and cell-signaling pathways involved in OS will translate into more effective therapies for OS and ultimately improved patient survival. The present review will provide an overview of current therapies, ongoing clinical trials and therapeutic targets under investigation for OS.
Collapse
Affiliation(s)
- Joseph D. Lamplot
- Molecular Oncology Laboratory, Department of Orthopaedic Surgery, The University of Chicago Medical Center, Chicago, IL 60637, USA
| | - Sahitya Denduluri
- Molecular Oncology Laboratory, Department of Orthopaedic Surgery, The University of Chicago Medical Center, Chicago, IL 60637, USA
| | - Jiaqiang Qin
- Molecular Oncology Laboratory, Department of Orthopaedic Surgery, The University of Chicago Medical Center, Chicago, IL 60637, USA
- Stem Cell Biology and Therapy Laboratory of the Key Laboratory for Pediatrics co-designated by Chinese Ministry of Education, The Children’s Hospital of Chongqing Medical University, Chongqing 400014, China
| | - Ruidong Li
- Molecular Oncology Laboratory, Department of Orthopaedic Surgery, The University of Chicago Medical Center, Chicago, IL 60637, USA
- The Affiliated Hospitals and the Key Laboratory of Diagnostic Medicine designated by the Chinese Ministry of Education, Chongqing Medical University, Chongqing 400016, China
| | - Xing Liu
- Molecular Oncology Laboratory, Department of Orthopaedic Surgery, The University of Chicago Medical Center, Chicago, IL 60637, USA
- Stem Cell Biology and Therapy Laboratory of the Key Laboratory for Pediatrics co-designated by Chinese Ministry of Education, The Children’s Hospital of Chongqing Medical University, Chongqing 400014, China
| | - Hongyu Zhang
- Molecular Oncology Laboratory, Department of Orthopaedic Surgery, The University of Chicago Medical Center, Chicago, IL 60637, USA
- The Affiliated Hospitals and the Key Laboratory of Diagnostic Medicine designated by the Chinese Ministry of Education, Chongqing Medical University, Chongqing 400016, China
| | - Xiang Chen
- Molecular Oncology Laboratory, Department of Orthopaedic Surgery, The University of Chicago Medical Center, Chicago, IL 60637, USA
- Department of Orthopaedic Surgery, The Affiliated Tangdu Hospital of the Fourth Military Medical University, Xi’an 710032, China
| | - Ning Wang
- Molecular Oncology Laboratory, Department of Orthopaedic Surgery, The University of Chicago Medical Center, Chicago, IL 60637, USA
- Department of Oncology, the Affiliated Southwest Hospital of the Third Military Medical University, Chongqing 400038, China
| | - Abdullah Pratt
- Molecular Oncology Laboratory, Department of Orthopaedic Surgery, The University of Chicago Medical Center, Chicago, IL 60637, USA
| | - Wei Shui
- Molecular Oncology Laboratory, Department of Orthopaedic Surgery, The University of Chicago Medical Center, Chicago, IL 60637, USA
- The Affiliated Hospitals and the Key Laboratory of Diagnostic Medicine designated by the Chinese Ministry of Education, Chongqing Medical University, Chongqing 400016, China
| | - Xiaoji Luo
- Molecular Oncology Laboratory, Department of Orthopaedic Surgery, The University of Chicago Medical Center, Chicago, IL 60637, USA
- The Affiliated Hospitals and the Key Laboratory of Diagnostic Medicine designated by the Chinese Ministry of Education, Chongqing Medical University, Chongqing 400016, China
| | - Guoxin Nan
- Molecular Oncology Laboratory, Department of Orthopaedic Surgery, The University of Chicago Medical Center, Chicago, IL 60637, USA
- Stem Cell Biology and Therapy Laboratory of the Key Laboratory for Pediatrics co-designated by Chinese Ministry of Education, The Children’s Hospital of Chongqing Medical University, Chongqing 400014, China
| | - Zhong-Liang Deng
- Molecular Oncology Laboratory, Department of Orthopaedic Surgery, The University of Chicago Medical Center, Chicago, IL 60637, USA
- The Affiliated Hospitals and the Key Laboratory of Diagnostic Medicine designated by the Chinese Ministry of Education, Chongqing Medical University, Chongqing 400016, China
| | - Jinyong Luo
- Molecular Oncology Laboratory, Department of Orthopaedic Surgery, The University of Chicago Medical Center, Chicago, IL 60637, USA
- The Affiliated Hospitals and the Key Laboratory of Diagnostic Medicine designated by the Chinese Ministry of Education, Chongqing Medical University, Chongqing 400016, China
| | - Rex C Haydon
- Molecular Oncology Laboratory, Department of Orthopaedic Surgery, The University of Chicago Medical Center, Chicago, IL 60637, USA
| | - Tong-Chuan He
- Molecular Oncology Laboratory, Department of Orthopaedic Surgery, The University of Chicago Medical Center, Chicago, IL 60637, USA
- Stem Cell Biology and Therapy Laboratory of the Key Laboratory for Pediatrics co-designated by Chinese Ministry of Education, The Children’s Hospital of Chongqing Medical University, Chongqing 400014, China
- The Affiliated Hospitals and the Key Laboratory of Diagnostic Medicine designated by the Chinese Ministry of Education, Chongqing Medical University, Chongqing 400016, China
| | - Hue H. Luu
- Molecular Oncology Laboratory, Department of Orthopaedic Surgery, The University of Chicago Medical Center, Chicago, IL 60637, USA
| |
Collapse
|
39
|
Watanabe K, Tsuchiya H, Yamamoto N, Shirai T, Nishida H, Hayashi K, Takeuchi A, Matsubara H, Nomura I. Over 10-year follow-up of functional outcome in patients with bone tumors reconstructed using distraction osteogenesis. J Orthop Sci 2013; 18:101-9. [PMID: 23096952 DOI: 10.1007/s00776-012-0327-4] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2011] [Accepted: 10/04/2012] [Indexed: 02/06/2023]
Abstract
BACKGROUND The aim of this study was to investigate the long-term functional capabilities of patients who underwent bone distraction for the treatment of bone defects caused by bone tumor excision. METHODS Bone distraction was indicated for patients with stage IIB malignant bone tumors when chemotherapy was judged to be effective and an epiphysis could be preserved or for patients with low-grade or aggressive benign bone tumors. Twenty-two patients who underwent reconstruction with bone distraction and were followed up for at least 10 years were retrospectively investigated. Patients included 8 males and 14 females, with a mean age of 25.3 years. Tumor types included seven osteosarcomas, two osteofibrous dysplasias, one Ewing's sarcoma, five low-grade osteosarcomas, two adamantinomas, and five giant cell tumors. Chemotherapy was performed during bone distraction in 8 cases. Bone transport was used in 17 cases, while shortening distraction was used in 5 cases. RESULTS The mean distraction length was 8.1 cm, and the mean external fixation period was 301 days. The average Musculoskeletal Tumor Society score (used to measure functional outcome) was 91.5 % at mean follow-up of 202 months. Fourteen patients were able to play sports without any difficulty. CONCLUSIONS Epiphyseal preservation and reconstruction by bone distraction require both time and effort, but can provide excellent long-term outcomes, resulting in a stable reconstruction that functionally restores the natural limb.
Collapse
Affiliation(s)
- Koji Watanabe
- Department of Orthopaedic Surgery, Graduate School of Medical Science, Kanazawa University, 13-1 Takara-machi, Kanazawa 920-8641, Japan
| | | | | | | | | | | | | | | | | |
Collapse
|
40
|
Tan PX, Yong BC, Wang J, Huang G, Yin JQ, Zou CY, Xie XB, Tang QL, Shen JN. Analysis of the efficacy and prognosis of limb-salvage surgery for osteosarcoma around the knee. Eur J Surg Oncol 2012; 38:1171-7. [PMID: 22809860 DOI: 10.1016/j.ejso.2012.07.003] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2011] [Revised: 05/25/2012] [Accepted: 07/02/2012] [Indexed: 11/29/2022] Open
Abstract
AIM Limb-salvage surgery has become the standard of care for extremity osteosarcoma. In this study, we investigated the survival and functional outcomes of patients with osteosarcoma around the knee who were treated with limb-salvage surgery. METHODS We retrospectively reviewed the clinical data for 120 patients with osteosarcoma around the knee who were treated with limb-salvage surgery between 1998 and 2008. The sample included 75 males and 45 females. The mean age of the patients was 18.9 years. Osteosarcoma was diagnosed in the distal femur in 78 patients and in the proximal tibia in 42 patients. Statistical analyses were conducted to process and record the patient data and analyse the surgery's efficacy, prognosis and survival rates. RESULTS All patients were followed for 6-144 months (mean of 56.8 months). The overall 5-year survival rate was 61.8%. Lung metastasis developed in 31 patients. Local recurrence developed in 9 patients. The average Musculoskeletal Tumor Society Score (MSTS) was 25.5 points on a 30-point scale. Sixteen patients underwent prosthesis revision and twelve patients underwent amputation. The overall survivorship of the prosthesis based on Kaplan-Meier estimates was 77% at five years and 71% at ten years. There was a higher incidence of extensor lag for the patients with osteosarcoma in the proximal tibia than for those with osteosarcoma in the distal femur (P < 0.01). CONCLUSIONS Treating osteosarcoma around the knee with limb-salvage surgery can preserve most of the knee's functionality. Attention must be paid to prevent the relatively high incidence of postoperative complications.
Collapse
Affiliation(s)
- P X Tan
- Musculoskeletal Tumor Center, Department of Orthopaedic Surgery, First Affiliated Hospital of Sun Yat-Sen University, 14th floor, # 58, Zhongshan 2nd Road, Guangzhou 510080, PR China
| | | | | | | | | | | | | | | | | |
Collapse
|
41
|
Malek F, Somerson JS, Mitchel S, Williams RP. Does limb-salvage surgery offer patients better quality of life and functional capacity than amputation? Clin Orthop Relat Res 2012; 470:2000-6. [PMID: 22302658 PMCID: PMC3369104 DOI: 10.1007/s11999-012-2271-1] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2011] [Accepted: 01/19/2012] [Indexed: 01/31/2023]
Abstract
INTRODUCTION Patients with aggressive lower extremity musculoskeletal tumors may be candidates for either above-knee amputation or limb-salvage surgery. However, the subjective and objective benefits of limb-salvage surgery compared with amputation are not fully clear. QUESTIONS/PURPOSES We therefore compared functional status and quality of life for patients treated with above-knee amputation versus limb-salvage surgery. METHODS We reviewed 20 of 51 patients aged 15 years and older treated with above-knee amputation or limb-salvage surgery for aggressive musculoskeletal tumors around the knee between 1994 and 2004 as a retrospective cohort study. At last followup we obtained the Physiological Cost Index, the Reintegration to Normal Living Index, SF-36, and the Toronto Extremity Salvage Score questionnaires. The minimum followup was 12 months (median, 56 months; range, 12-108 months). RESULTS Compared with patients having above-knee amputation, patients undergoing limb-salvage surgery had superior Physiological Cost Index scores and Reintegration to Normal Living Index. The Toronto Extremity Salvage scores and SF-36 scores were similar in the two groups. CONCLUSION These data suggest that limb-salvage surgery offers better gait efficiency and return to normal living compared with above-knee amputation, but does not improve the patient's perception of quality of life.
Collapse
Affiliation(s)
- Farbod Malek
- Department of Orthopaedics, University of Texas Health Science Center San Antonio, Cancer Therapy and Research Center, San Antonio, TX 78229 USA
| | - Jeremy S. Somerson
- Department of Orthopaedics, University of Texas Health Science Center San Antonio, Cancer Therapy and Research Center, San Antonio, TX 78229 USA
| | - Shannon Mitchel
- Department of Orthopaedics, University of Texas Health Science Center San Antonio, Cancer Therapy and Research Center, San Antonio, TX 78229 USA
| | - Ronald P. Williams
- Department of Orthopaedics, University of Texas Health Science Center San Antonio, Cancer Therapy and Research Center, San Antonio, TX 78229 USA
| |
Collapse
|
42
|
Ji Z, Ma Y, Li W, Li X, Zhao G, Yun Z, Qian J, Fan Q. The healing process of intracorporeally and in situ devitalized distal femur by microwave in a dog model and its mechanical properties in vitro. PLoS One 2012; 7:e30505. [PMID: 22276207 PMCID: PMC3262834 DOI: 10.1371/journal.pone.0030505] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2011] [Accepted: 12/17/2011] [Indexed: 11/18/2022] Open
Abstract
Background Limb-salvage surgery has been well recognized as a standard treatment and alternative to amputation for patients with malignant bone tumors. Various limb-sparing techniques have been developed including tumor prosthesis, allograft, autograft and graft-prosthesis composite. However, each of these methods has short- and long-term disadvantages such as nonunion, mechanical failures and poor limb function. The technique of intracorporeal devitalization of tumor-bearing bone segment in situ by microwave-induced hyperthermia after separating it from surrounding normal tissues with a safe margin is a promising limb-salvage method, which may avoid some shortcomings encountered by the above-mentioned conventional techniques. The purpose of this study is to assess the healing process and revitalization potential of the devitalized bone segment by this method in a dog model. In addition, the immediate effect of microwave on the biomechanical properties of bone tissue was also explored in an in vitro experiment. Methods We applied the microwave-induced hyperthermia to devitalize the distal femurs of dogs in situ. Using a monopole microwave antenna, we could produce a necrotic bone of nearly 20 mm in length in distal femur. Radiography, bone scintigraphy, microangiography, histology and functional evaluation were performed at 2 weeks and 1, 2, 3, 6, 9 and 12 months postoperatively to assess the healing process. In a biomechanical study, two kinds of bone specimens, 3 and 6 cm in length, were used for compression and three-point bending test respectively immediately after extracorporeally devitalized by microwave. Findings An in vivo study showed that intracorporeally and in situ devitalized bone segment by microwave had great revitalization potential. An in vitro study revealed that the initial mechanical strength of the extracorporeally devitalized bone specimen may not be affected by microwave. Conclusion Our results suggest that the intracorporeal microwave devitalization of tumor-bearing bone segment in situ may be a promising limb-salvage method.
Collapse
Affiliation(s)
- Zhenwei Ji
- Orthopedic Oncology Institute of Chinese PLA, Tangdu Hospital, The Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Yunlei Ma
- Orthopedic Oncology Institute of Chinese PLA, Tangdu Hospital, The Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Wei Li
- Orthopedic Oncology Institute of Chinese PLA, Tangdu Hospital, The Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Xiaoxiang Li
- Orthopedic Oncology Institute of Chinese PLA, Tangdu Hospital, The Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Guangyi Zhao
- Orthopedic Oncology Institute of Chinese PLA, Tangdu Hospital, The Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Zhe Yun
- Orthopedic Oncology Institute of Chinese PLA, Tangdu Hospital, The Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Jixian Qian
- Orthopedic Oncology Institute of Chinese PLA, Tangdu Hospital, The Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Qingyu Fan
- Orthopedic Oncology Institute of Chinese PLA, Tangdu Hospital, The Fourth Military Medical University, Xi'an, Shaanxi, China
- * E-mail:
| |
Collapse
|
43
|
Bekkering WP, Vliet Vlieland TPM, Fiocco M, Koopman HM, Schoones JW, Nelissen RGHH, Taminiau AHM. Quality of life, functional ability and physical activity after different surgical interventions for bone cancer of the leg: A systematic review. Surg Oncol 2011; 21:e39-47. [PMID: 21974808 DOI: 10.1016/j.suronc.2011.09.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2011] [Revised: 09/13/2011] [Accepted: 09/14/2011] [Indexed: 11/16/2022]
Abstract
PURPOSE To systematically review published studies comparing Quality of Life (QoL), functional ability and/or physical activity between different surgical interventions due to a malignant bone tumour of the leg. METHODS A systematic literature search, covering the years 2000-2010 was performed using the PubMed, Embase, Web of science and Cochrane databases. Studies were included if they described and statistically compared QoL, functional ability and/or physical activity of at least two surgical interventions for lower extremity bone cancer. In addition, the methodological quality of the selected studies was evaluated by using a 24-point scale. Where appropriate, a qualitative analysis or meta-analysis was performed. RESULTS The search strategy resulted in a list of 246 citations. Based on titles and abstracts 50 full-text articles were selected, of which 13 articles describing 12 studies, were finally included. Overall, the methodological quality of the studies was moderate. Studies were heterogeneous with respect to their categorisation of surgical interventions, average age of patients and average duration of follow-up. Overall, results regarding differences between ablative and limb-sparing surgery varied largely. Meta-analysis was considered to be not appropriate due to clinical heterogeneity, methodological differences and flaws. CONCLUSION Twelve studies comparing the outcomes of QoL, functional ability and physical activity between limb-sparing and ablative surgery groups were identified, with an overall moderate methodological quality. Their largely varying outcomes suggest that no general conclusions on the advantage of either limb-sparing or ablative surgery in patients with malignant bone tumours of the lower extremity can be drawn.
Collapse
Affiliation(s)
- W Peter Bekkering
- Department of Physical Therapy, Leiden University Medical Center, The Netherlands.
| | | | | | | | | | | | | |
Collapse
|
44
|
Reconstructive treatment of soft tissue sarcoma of the upper extremity. J Hand Surg Am 2011; 36:1241-7. [PMID: 21664071 DOI: 10.1016/j.jhsa.2011.04.017] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2011] [Accepted: 04/27/2011] [Indexed: 02/02/2023]
Abstract
Limb-sparing surgery is currently the cornerstone of treatment for most patients with soft-tissue sarcoma of the upper extremity. To achieve the best outcome, the reconstructive surgeon must be part of a multidisciplinary team and is required to have a thorough understanding of the whole treatment concept. This article provides an update for the current surgical management of patients with soft tissue sarcoma of the upper extremity. Relevant nonsurgical aspects are also highlighted.
Collapse
|