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He S, Zhong A, Lei J, Deng Z, Zhu X, Wei R, Huang H, Chen Z, Cai L, Xie Y. Application of Indocyanine Green Fluorescence Imaging in Assisting Biopsy of Musculoskeletal Tumors. Cancers (Basel) 2023; 15:cancers15082402. [PMID: 37190330 DOI: 10.3390/cancers15082402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 04/07/2023] [Accepted: 04/18/2023] [Indexed: 05/17/2023] Open
Abstract
(1) Background: Biopsies are the gold standard for the diagnosis of musculoskeletal tumors. In this study, we aimed to explore whether indocyanine green near-infrared fluorescence imaging can assist in the biopsy of bone and soft tissue tumors and improve the success rate of biopsy. (2) Method: We recruited patients with clinically considered bone and soft tissue tumors and planned biopsies. In the test group, indocyanine green (0.3 mg/kg) was injected. After identifying the lesion, a near-infrared fluorescence camera system was used to verify the ex vivo specimens of the biopsy in real time. If the biopsy specimens were not developed, we assumed that we failed to acquire lesions, so the needle track and needle position were adjusted for the supplementary biopsy, and then real-time imaging was performed again. Finally, we conducted a pathological examination. In the control group, normal biopsy was performed. (3) Results: The total diagnosis rate of musculoskeletal tumors in the test group was 94.92% (56/59) and that in the control group was 82.36% (42/51). In the test group, 14 cases were not developed, as seen from real-time fluorescence in the core biopsy, and then underwent the supplementary biopsy after changing the puncture direction and the location of the needle channel immediately, of which 7 cases showed new fluorescence. (4) Conclusions: Using the near-infrared fluorescence real-time development technique to assist the biopsy of musculoskeletal tumors may improve the accuracy of core biopsy and help to avoid missed diagnoses, especially for some selected tumors.
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Affiliation(s)
- Siyuan He
- Department of Spine Surgery and Musculoskeletal Tumor, Zhongnan Hospital of Wuhan University, Wuhan 430071, China
| | - Ang Zhong
- Department of Spine Surgery and Musculoskeletal Tumor, Zhongnan Hospital of Wuhan University, Wuhan 430071, China
| | - Jun Lei
- Department of Spine Surgery and Musculoskeletal Tumor, Zhongnan Hospital of Wuhan University, Wuhan 430071, China
| | - Zhouming Deng
- Department of Spine Surgery and Musculoskeletal Tumor, Zhongnan Hospital of Wuhan University, Wuhan 430071, China
| | - Xiaobin Zhu
- Department of Spine Surgery and Musculoskeletal Tumor, Zhongnan Hospital of Wuhan University, Wuhan 430071, China
| | - Renxiong Wei
- Department of Spine Surgery and Musculoskeletal Tumor, Zhongnan Hospital of Wuhan University, Wuhan 430071, China
| | - Huayi Huang
- Department of Spine Surgery and Musculoskeletal Tumor, Zhongnan Hospital of Wuhan University, Wuhan 430071, China
| | - Zhenyi Chen
- Department of Spine Surgery and Musculoskeletal Tumor, Zhongnan Hospital of Wuhan University, Wuhan 430071, China
| | - Lin Cai
- Department of Spine Surgery and Musculoskeletal Tumor, Zhongnan Hospital of Wuhan University, Wuhan 430071, China
| | - Yuanlong Xie
- Department of Spine Surgery and Musculoskeletal Tumor, Zhongnan Hospital of Wuhan University, Wuhan 430071, China
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Michalik R, Hildebrand F, Delbrück H. Stabilisation of Pathologic Proximal Femoral Fracture near the Growth Plate with Use of a Locking Plate and Transphyseal Screws. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9121932. [PMID: 36553375 PMCID: PMC9777171 DOI: 10.3390/children9121932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 12/05/2022] [Accepted: 12/07/2022] [Indexed: 12/13/2022]
Abstract
Aneurysmal bone cyst (ABC) is a benign osseus lesion with a high pathologic fracture risk. The described treatment options are varied and inconsistent. For successful treatment results, it is essential to prevent recurrence and sufficiently stabilise the weakened bone. Lesions close to the growth plates, especially in the femoral neck region, are challenging to stabilise in children. In this study, 27 clinics, including 11 sarcoma centres, 15 paediatric orthopaedic clinics, and one sarcoma/paediatric orthopaedic centre, were surveyed and asked about their treatment approaches for an exemplary case of ABC in the femoral neck causing a pathological fracture in a 20-month-old infant, with a response rate of 81%. The heterogeneity of treatment options described in the literature is consistent with the survey results. The most favoured approach was curettage, defect filling of any kind, and surgical stabilisation. However, the lesion stabilisation option introduced in this paper, which involves the use of transphyseal screws, was not mentioned in the survey and has not been reported in the literature. Contrary to the existing concepts, our technique offers high stability without significant growth restriction. Transphyseal screws are also suitable for the treatment of femoral neck fractures of other aetiologies in children.
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The Surgical Management of Proximal Femoral Metastases: A Narrative Review. ACTA ACUST UNITED AC 2021; 28:3748-3757. [PMID: 34677238 PMCID: PMC8534449 DOI: 10.3390/curroncol28050320] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 09/24/2021] [Accepted: 09/26/2021] [Indexed: 12/26/2022]
Abstract
The proximal femur is a common location for the development of bony metastatic disease. Metastatic bone disease in this location can cause debilitating pain, pathologic fractures, reduced quality of life, anemia or hypercalcemia. A thorough history, physical examination and preoperative investigations are required to ensure accurate diagnosis and prognosis. The goals of surgical management is to provide pain relief and return to function with a construct that provides stability to allow for immediate weightbearing. Current surgical treatment options include intramedullary nailing, hemiarthroplasty or total hip arthroplasty and endoprosthetic reconstructions. Oligometastatic renal cell carcinoma must be given special consideration as tumor resection and reconstruction has survival benefit. Both tumor and patient characteristics must be taken into account before deciding on the appropriate surgical intervention.
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Miwa S, Yamamoto N, Hayashi K, Takeuchi A, Igarashi K, Tada K, Yonezawa H, Morinaga S, Araki Y, Asano Y, Saito S, Okuda M, Taki J, Ikeda H, Nojima T, Tsuchiya H. A Radiological Scoring System for Differentiation between Enchondroma and Chondrosarcoma. Cancers (Basel) 2021; 13:cancers13143558. [PMID: 34298772 PMCID: PMC8304621 DOI: 10.3390/cancers13143558] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Revised: 07/09/2021] [Accepted: 07/13/2021] [Indexed: 12/26/2022] Open
Abstract
Simple Summary Background: It is challenging to differentiate between enchondromas and atypical cartilaginous tumors (ACTs)/chondrosarcomas. Methods: To evaluate the diagnostic usefulness of radiological findings for differentiation between enchondromas and chondrosarcomas, correlations between various radiological findings and final diagnoses were investigated. Based on the correlations, a scoring system combining these findings was developed. Results: In a cohort of 81 patients, periosteal reaction on X-ray, endosteal scalloping and cortical defect on CT, extraskeletal mass, multilobular lesion, abnormal signal in adjacent tissue on MRI, and increased uptake in bone scan and thallium scan was significantly correlated with final diagnoses. Based on the correlations, a radiological scoring system combining radiological findings was developed. In another cohort of 17 patients, the sensitivity, specificity, and accuracy of the radiological score rates for differentiation between enchondromas and chondrosarcomas were 88%, 89%, and 88%, respectively. Conclusion: Comprehensive assessment combining radiological findings is recommended to differentiate between enchondromas and ACTs/chondrosarcomas. Abstract Background: It is challenging to differentiate between enchondromas and atypical cartilaginous tumors (ACTs)/chondrosarcomas. In this study, correlations between radiological findings and final diagnosis were investigated in patients with central cartilaginous tumors. Methods: To evaluate the diagnostic usefulness of radiological findings, correlations between various radiological findings and final diagnoses were investigated in a cohort of 81 patients. Furthermore, a new radiological scoring system was developed by combining radiological findings. Results: Periosteal reaction on X-ray (p = 0.025), endosteal scalloping (p = 0.010) and cortical defect (p = 0.002) on CT, extraskeletal mass (p < 0.001), multilobular lesion (p < 0.001), abnormal signal in adjacent tissue (p = 0.004) on MRI, and increased uptake in bone scan (p = 0.002) and thallium scan (p = 0.027) was significantly correlated with final diagnoses. Based on the correlations between each radiological finding and postoperative histological diagnosis, a radiological scoring system combining these findings was developed. In another cohort of 17 patients, the sensitivity, specificity, and accuracy of the radiological score rates for differentiation between enchondromas and ACTs/chondrosarcomas were 88%, 89%, and 88%, respectively (p = 0.003). Conclusion: Radiological assessment with combined radiological findings is recommended to differentiate between enchondromas and ACT/chondrosarcomas.
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Affiliation(s)
- Shinji Miwa
- Department of Orthopedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa 920-8640, Japan; (N.Y.); (K.H.); (A.T.); (K.I.); (K.T.); (H.Y.); (S.M.); (Y.A.); (Y.A.); (S.S.); (T.N.); (H.T.)
- Correspondence: ; Tel.: +81-762-652-374; Fax: +81-762-344-261
| | - Norio Yamamoto
- Department of Orthopedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa 920-8640, Japan; (N.Y.); (K.H.); (A.T.); (K.I.); (K.T.); (H.Y.); (S.M.); (Y.A.); (Y.A.); (S.S.); (T.N.); (H.T.)
| | - Katsuhiro Hayashi
- Department of Orthopedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa 920-8640, Japan; (N.Y.); (K.H.); (A.T.); (K.I.); (K.T.); (H.Y.); (S.M.); (Y.A.); (Y.A.); (S.S.); (T.N.); (H.T.)
| | - Akihiko Takeuchi
- Department of Orthopedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa 920-8640, Japan; (N.Y.); (K.H.); (A.T.); (K.I.); (K.T.); (H.Y.); (S.M.); (Y.A.); (Y.A.); (S.S.); (T.N.); (H.T.)
| | - Kentaro Igarashi
- Department of Orthopedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa 920-8640, Japan; (N.Y.); (K.H.); (A.T.); (K.I.); (K.T.); (H.Y.); (S.M.); (Y.A.); (Y.A.); (S.S.); (T.N.); (H.T.)
| | - Kaoru Tada
- Department of Orthopedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa 920-8640, Japan; (N.Y.); (K.H.); (A.T.); (K.I.); (K.T.); (H.Y.); (S.M.); (Y.A.); (Y.A.); (S.S.); (T.N.); (H.T.)
| | - Hirotaka Yonezawa
- Department of Orthopedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa 920-8640, Japan; (N.Y.); (K.H.); (A.T.); (K.I.); (K.T.); (H.Y.); (S.M.); (Y.A.); (Y.A.); (S.S.); (T.N.); (H.T.)
| | - Sei Morinaga
- Department of Orthopedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa 920-8640, Japan; (N.Y.); (K.H.); (A.T.); (K.I.); (K.T.); (H.Y.); (S.M.); (Y.A.); (Y.A.); (S.S.); (T.N.); (H.T.)
| | - Yoshihiro Araki
- Department of Orthopedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa 920-8640, Japan; (N.Y.); (K.H.); (A.T.); (K.I.); (K.T.); (H.Y.); (S.M.); (Y.A.); (Y.A.); (S.S.); (T.N.); (H.T.)
| | - Yohei Asano
- Department of Orthopedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa 920-8640, Japan; (N.Y.); (K.H.); (A.T.); (K.I.); (K.T.); (H.Y.); (S.M.); (Y.A.); (Y.A.); (S.S.); (T.N.); (H.T.)
| | - Shiro Saito
- Department of Orthopedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa 920-8640, Japan; (N.Y.); (K.H.); (A.T.); (K.I.); (K.T.); (H.Y.); (S.M.); (Y.A.); (Y.A.); (S.S.); (T.N.); (H.T.)
| | - Miho Okuda
- Department of Radiology, Graduate School of Medical Sciences, Kanazawa University, Kanazawa 920-8640, Japan;
| | - Junichi Taki
- Department of Nuclear Medicine, Graduate School of Medical Sciences, Kanazawa University, Kanazawa 920-8640, Japan;
| | - Hiroko Ikeda
- Department of Pathology, Graduate School of Medical Sciences, Kanazawa University, Kanazawa 920-8640, Japan;
| | - Takayuki Nojima
- Department of Orthopedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa 920-8640, Japan; (N.Y.); (K.H.); (A.T.); (K.I.); (K.T.); (H.Y.); (S.M.); (Y.A.); (Y.A.); (S.S.); (T.N.); (H.T.)
- Department of Pathology, Graduate School of Medical Sciences, Kanazawa University, Kanazawa 920-8640, Japan;
| | - Hiroyuki Tsuchiya
- Department of Orthopedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa 920-8640, Japan; (N.Y.); (K.H.); (A.T.); (K.I.); (K.T.); (H.Y.); (S.M.); (Y.A.); (Y.A.); (S.S.); (T.N.); (H.T.)
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Kobayashi T, Ito K, Kojima T, Maruyama S, Mukai S, Tsutsumi M, Miki J, Okuno T, Yoshio Y, Matsumoto H, Shimazui T, Segawa T, Karashima T, Masui K, Fukuta F, Tashiro K, Imai K, Suekane S, Nagasawa S, Higashi S, Fukui T, Ogawa O, Kitamura H, Nishiyama H. Pre-pembrolizumab neutrophil-to-lymphocyte ratio (NLR) predicts the efficacy of second-line pembrolizumab treatment in urothelial cancer regardless of the pre-chemo NLR. Cancer Immunol Immunother 2021; 71:461-471. [PMID: 34235546 DOI: 10.1007/s00262-021-03000-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 06/28/2021] [Indexed: 12/18/2022]
Abstract
Neutrophil-to-lymphocyte ratio (NLR) was reported to be associated with prognosis of urothelial cancer (UC) patients receiving systemic chemotherapy or immunotherapy. However, it has not been elucidated how preceding first-line chemotherapy affects NLR and subsequent second-line pembrolizumab treatment. This multicenter study analyzed 458 patients with metastatic UC who received first-line chemotherapy and second-line pembrolizumab with regard to pre-chemotherapy and pre-pembrolizumab NLR in association with the efficacy of chemotherapy and pembrolizumab treatment. NLR was increased in 47% while decreased in 53% of patients before and after first-line chemotherapy. High pre-chemotherapy NLR (≥ 3) was significantly associated with unfavorable overall (OS, P = 0.0001) and progression-free (P < 0.0001) survivals after first-line chemotherapy. However, pre-chemotherapy NLR showed only modest influence on radiological response and survival after second-line pembrolizumab treatment, whereas pre-pembrolizumab NLR showed higher association. NLR decrease was associated with partial response or greater objective response by first-line chemotherapy, while NLR increase was associated with higher patient age. In conclusion, immediate pre-chemotherapy and pre-pembrolizumab NLR was significantly associated with efficacy of the following treatment, respectively. However, even patients with high pre-chemotherapy NLR achieved favorable OS if they had their NLR reduced by chemotherapy, whereas those with high pre-chemotherapy NLR yielded unfavorable OS if they had their NLR remained high after chemotherapy, suggesting that chemotherapy may have differential effect on the efficacy of subsequent pembrolizumab treatment in UC patients.
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Affiliation(s)
- Takashi Kobayashi
- Department of Urology, Kyoto University Graduate School of Medicine, 54 Shogoinkawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan.
| | - Katsuhiro Ito
- Department of Urology, Ijinkai Takeda General Hospital, Kyoto, Japan
| | - Takahiro Kojima
- Department of Urology, University of Tsukuba, Tsukuba, Japan
| | - Satoru Maruyama
- Department of Urology, Hokkaido Cancer Center, Sapporo, Japan
| | - Shoichiro Mukai
- Department of Urology, University of Miyazaki, Miyazaki, Japan
| | | | - Jun Miki
- Department of Urology, Jikei University Kashiwa Hospital, Kashiwa, Japan
| | - Tomoya Okuno
- Department of Urology, Shimada Municipal Hospital, Shimada, Japan
| | - Yuko Yoshio
- Department of Urology, Mie University, Tsu, Japan
| | | | - Toru Shimazui
- Department of Urology, Ibaraki Prefectural Central Hospital, Kasama, Japan
| | | | | | | | - Fumimasa Fukuta
- Department of Urology, Sapporo Medical University, Sapporo, Japan
| | - Kojiro Tashiro
- Department of Urology, Jikei University School of Medicine, Tokyo, Japan
| | - Kazuto Imai
- Department of Urology, Kansai Electric Power Hospital, Osaka, Japan
| | - Shigetaka Suekane
- Department of Urology, Kurume University School of Medicine, Kurume, Japan
| | - Seiji Nagasawa
- Department of Urology, Hyogo College of Medicine, Nishinomiya, Japan
| | - Shin Higashi
- Department of Urology, Hirakata Kohsai Hospital, Hirakata, Japan
| | - Tomohiro Fukui
- Department of Urology, Rakuwakai Otowa Hospital, Kyoto, Japan
| | - Osamu Ogawa
- Department of Urology, Kyoto University Graduate School of Medicine, 54 Shogoinkawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
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Stereotactic ablative radiotherapy in castration-resistant prostate cancer patients with oligoprogression during androgen receptor-targeted therapy. Clin Transl Oncol 2021; 23:1577-1584. [PMID: 33495981 DOI: 10.1007/s12094-021-02553-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Accepted: 01/08/2021] [Indexed: 10/22/2022]
Abstract
OBJECTIVES To report outcomes of stereotactic body radiotherapy (SBRT) in metastatic castration-resistant prostate cancer (mCRPC) patients with oligoprogression (≤ 5 metastases) during first-line treatment with androgen receptor-targeted therapy (ARTT). PATIENTS AND METHODS Retrospective multi-institutional analysis of mCRPC patients treated with SBRT to oligoprogressive lesions during ARTT. End-points were time to next-line systemic treatment (NEST), radiological progression-free survival (r-PFS) and overall survival (OS). Toxicity was registered according to Common Terminology Criteria for Adverse Events (CTCAE) v4.0. Survival analysis was performed using the Kaplan-Meier method, univariate and multivariate analysis (MVA) were performed. RESULTS Data from 34 patients were analyzed. Median NEST-free survival, r-PFS, and OS were 16.97, 13.47, and 38.3 months, respectively. At MVA, factors associated with worse NEST-free survival and r-PFS were polymetastatic burden at diagnosis of metastatic hormone-sensitive disease (hazard ratio [HR] 3.66, p = 0.009; HR 3.03, p = 0.034), PSA ≤ 7 ng/ml at mCRPC diagnosis (HR 0.23, p = 0.017; HR 0.19, p = 0.006) and PSADT ≤ 3 months at mCRPC diagnosis (HR 3.39, p = 0.026; HR 2.79, p = 0.037). Polymetastatic state at mHSPC diagnosis was associated with a decreased OS (HR 4.68, p = 0.029). No patient developed acute or late grade ≥ 2 toxicity. CONCLUSION Our results suggest that SBRT in oligoprogressive mCPRC is safe, effective and seems to prolong the efficacy of the ongoing systemic treatment positively affecting disease progression. Prospective trials are needed.
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