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Miura J, Sabharwal S, Ghert M, Karakousis G, Roland CL. Great Debate: Systematic Re-Resection After Macroscopic Complete Unplanned Excision of Soft Tissue Sarcoma. Ann Surg Oncol 2024; 31:2047-2050. [PMID: 38112886 DOI: 10.1245/s10434-023-14780-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 12/01/2023] [Indexed: 12/21/2023]
Affiliation(s)
- John Miura
- Hospital of the University of Pennsylvania, Pennsylvania, PA, USA
| | | | - Michelle Ghert
- McMaster University, Hamilton, ON, Canada
- The University of Maryland, College Park, MD, USA
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Priester JI, Simister SK, Sario M, Choi J, Pina D, Theriault R, Bateni C, Ghasemiesfe A, Carr-Ascher J, Monjazeb AM, Canter RJ, Randall RL, Thorpe SW. Scrutinizing the use of contrasted chest CTs in extremity sarcoma staging and surveillance. J Surg Oncol 2024; 129:523-530. [PMID: 37997294 DOI: 10.1002/jso.27510] [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: 04/30/2023] [Revised: 10/18/2023] [Accepted: 10/31/2023] [Indexed: 11/25/2023]
Abstract
BACKGROUND Since 2015, the American College of Radiology (ACR) has recommended staging for lung metastasis via chest computed tomography (CT) without contrast for extremity sarcoma staging and surveillance. The purpose of this study was to determine our institutional compliance with this recommendation. METHODS This was a retrospective chart review of patients diagnosed with sarcoma in the extremities who received CT imaging of the chest for pulmonary staging and surveillance at our institution from 2005 to 2023. A total of 1916 CT studies were included for analysis. We scrutinized ordering patterns before and after 2015 based on the ACR-published metastasis staging and screening guidelines. An institutional and patient cost analysis was performed between CT modalities. RESULTS The prevalence of CT scans ordered and performed with contrast was greater than those without contrast both prior and post-ACR 2015 guidelines. Furthermore, 79.2% of patient's final surveillance CTs after 2015 were performed with contrast. A cost analysis was performed and demonstrated an additional $297 704 in patient and institutional costs. CONCLUSIONS At our institution, upon review of CT chest imaging for pulmonary staging and surveillance in patients with extremity sarcoma the use of contrast has been routinely utilized despite a lack of evidence for its necessity and contrary to ACR guidelines.
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Affiliation(s)
- Jacob I Priester
- Department of Orthopaedic Surgery, University of California, Davis, Sacramento, California, USA
| | - Samuel K Simister
- Department of Orthopaedic Surgery, University of California, Davis, Sacramento, California, USA
| | - Matthew Sario
- Department of Orthopaedic Surgery, University of California, Davis, Sacramento, California, USA
| | - Justin Choi
- Department of Radiology, Cardiothoracic Imaging, University of California, Davis, Sacramento, California, USA
| | - Dagoberto Pina
- Department of Orthopaedic Surgery, University of California, Davis, Sacramento, California, USA
| | - Raminta Theriault
- Department of Orthopaedic Surgery, Ochsner Medical Center, New Orleans, Louisiana, USA
| | - Cyrus Bateni
- Department of Radiology, Musculoskeletal Radiology, University of California, Davis, Sacramento, California, USA
| | - Ahmadreza Ghasemiesfe
- Department of Radiology, Cardiothoracic Imaging, University of California, Davis, Sacramento, California, USA
| | - Janai Carr-Ascher
- Department of Orthopaedic Surgery, University of California, Davis, Sacramento, California, USA
- Department of Internal Medicine, Hematology and Oncology, University of California, Davis, Sacramento, California, USA
| | - Arta M Monjazeb
- Department of Orthopaedic Surgery, University of California, Davis, Sacramento, California, USA
- Department of Radiation Oncology, University of California, Davis, Sacramento, California, USA
| | - Robert J Canter
- Department of Surgery, Surgical Oncology, University of California, Davis, Sacramento, California, USA
| | - R L Randall
- Department of Orthopaedic Surgery, University of California, Davis, Sacramento, California, USA
| | - Steven W Thorpe
- Department of Orthopaedic Surgery, University of California, Davis, Sacramento, California, USA
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Walker K, Simister SK, Carr-Ascher J, Monument MJ, Thorpe SW, Randall RL. Emerging innovations and advancements in the treatment of extremity and truncal soft tissue sarcomas. J Surg Oncol 2024; 129:97-111. [PMID: 38010997 DOI: 10.1002/jso.27526] [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: 11/06/2023] [Accepted: 11/07/2023] [Indexed: 11/29/2023]
Abstract
In this special edition update on soft tissue sarcomas (STS), we cover classifications, emerging technologies, prognostic tools, radiation schemas, and treatment disparities in extremity and truncal STS. We discuss the importance of enhancing local control and reducing complications, including the role of innovative imaging, surgical guidance, and hypofractionated radiation. We review advancements in systemic and immunotherapeutic treatments and introduce disparities seen in this vulnerable population that must be considered to improve overall patient care.
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Affiliation(s)
- Kyle Walker
- Department of Orthopaedics, University of California, Davis, Sacramento, California, USA
| | - Samuel K Simister
- Department of Orthopaedics, University of California, Davis, Sacramento, California, USA
| | - Janai Carr-Ascher
- Department of Hematology and Oncology, University of California, Davis, Sacramento, California, USA
| | - Michael J Monument
- Department of Surgery, The University of Calgary, Calgary, Alberta, Canada
| | - Steven W Thorpe
- Department of Orthopaedics, University of California, Davis, Sacramento, California, USA
| | - R Lor Randall
- Department of Orthopaedics, University of California, Davis, Sacramento, California, USA
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Serban B, Cretu B, Cursaru A, Nitipir C, Orlov-Slavu C, Cirstoiu C. Local recurrence management of extremity soft tissue sarcoma. EFORT Open Rev 2023; 8:606-614. [PMID: 37526250 PMCID: PMC10441250 DOI: 10.1530/eor-23-0095] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/02/2023] Open
Abstract
Patients diagnosed with soft tissue sarcoma (STS) present a number of challenges for physicians, due to the vast array of subtypes and aggressive tumor biology. There is currently no agreed-upon management strategy for these tumors, which has led to the ongoing debate surrounding how frequently surveillance scans should be performed following surgery. However, advances in multidisciplinary care have improved patient outcomes over recent years. The early detection of local recurrence reflects a more aggressive tumor, even in association with the same histopathologic entity. Treating the local recurrence of extremity STS is a difficult clinical challenge. The goal should be to salvage limbs when possible, with treatments such as resection and irradiation, although amputation may be necessary in some cases. Regional therapies such as high-intensity, low-dose or interleukin-1 receptor antagonist treatment are appealing options for either definitive or adjuvant therapy, depending on the location of the disease's recurrence. The higher survival rate following late recurrence may be explained by variations in tumor biology. Since long-term survival is, in fact, inferior in patients with high-grade STS, this necessitates the implementation of an active surveillance approach.
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Affiliation(s)
- Bogdan Serban
- Department of Orthopedics and Traumatology, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
- University Emergency Hospital Bucharest, Romania
| | - Bogdan Cretu
- Department of Orthopedics and Traumatology, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
- University Emergency Hospital Bucharest, Romania
| | - Adrian Cursaru
- Department of Orthopedics and Traumatology, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
- University Emergency Hospital Bucharest, Romania
| | - Cornelia Nitipir
- Department of Oncology, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
- Elias University Emergency Hospital, Bucharest, Romania
| | - Cristina Orlov-Slavu
- Department of Oncology, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
- Elias University Emergency Hospital, Bucharest, Romania
| | - Catalin Cirstoiu
- Department of Orthopedics and Traumatology, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
- University Emergency Hospital Bucharest, Romania
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Brookes MJ, Chan CD, Crowley TP, Ragbir M, Beckingsale T, Ghosh KM, Rankin KS. What Is the Significance of Indeterminate Pulmonary Nodules in High-Grade Soft Tissue Sarcomas? A Retrospective Cohort Study. Cancers (Basel) 2023; 15:3531. [PMID: 37444641 DOI: 10.3390/cancers15133531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 06/29/2023] [Accepted: 07/05/2023] [Indexed: 07/15/2023] Open
Abstract
BACKGROUND Sarcomas are rare, aggressive cancers which frequently metastasise to the lungs. Following diagnosis, patients typically undergo staging by means of a CT scan of their chest. This often identifies indeterminate pulmonary nodules (IPNs), but the significance of these in high-grade soft tissue sarcoma (STS) is unclear. Identifying whether these are benign or malignant is important for clinical decision making. This study analyses the clinical relevance of IPNs in high-grade STS. METHODS All patients treated at our centre for high-grade soft tissue sarcoma between 2010 and 2020 were identified from a prospective database. CT scans and their reports were reviewed, and survival data were collected from patient records. RESULTS 389 suitable patients were identified; 34.4% had IPNs on their CT staging scan and 20.1% progressed into lung metastases. Progression was more likely with IPNs ≥ 5 mm in diameter (p = 0.006), multiple IPNs (p = 0.013) or bilateral IPNs (p = 0.022), as well as in patients with primaries ≥ 5 cm (p = 0.014), grade 3 primaries (p = 0.009) or primaries arising deep to the fascia (p = 0.041). The median time to progression was 143 days. IPNs at diagnosis were associated with an increased risk of developing lung metastases and decreased OS in patients with grade 3 STS (p = 0.0019 and p = 0.0016, respectively); this was not observed in grade 2 patients. CONCLUSIONS IPNs at diagnosis are associated with significantly worse OS in patients with grade 3 STS. It is crucial to consider the primary tumour as well as the IPNs when considering the risk of progression. Surveillance CT scans should be carried out within 6 months.
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Affiliation(s)
- Marcus J Brookes
- North of England Bone and Soft Tissue Tumour Service, Royal Victoria Infirmary, Queen Victoria Road, Newcastle upon Tyne NE1 4LP, UK
| | - Corey D Chan
- North of England Bone and Soft Tissue Tumour Service, Royal Victoria Infirmary, Queen Victoria Road, Newcastle upon Tyne NE1 4LP, UK
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne NE1 7RU, UK
| | - Timothy P Crowley
- North of England Bone and Soft Tissue Tumour Service, Royal Victoria Infirmary, Queen Victoria Road, Newcastle upon Tyne NE1 4LP, UK
| | - Maniram Ragbir
- North of England Bone and Soft Tissue Tumour Service, Royal Victoria Infirmary, Queen Victoria Road, Newcastle upon Tyne NE1 4LP, UK
| | - Thomas Beckingsale
- North of England Bone and Soft Tissue Tumour Service, Royal Victoria Infirmary, Queen Victoria Road, Newcastle upon Tyne NE1 4LP, UK
| | - Kanishka M Ghosh
- North of England Bone and Soft Tissue Tumour Service, Royal Victoria Infirmary, Queen Victoria Road, Newcastle upon Tyne NE1 4LP, UK
| | - Kenneth S Rankin
- North of England Bone and Soft Tissue Tumour Service, Royal Victoria Infirmary, Queen Victoria Road, Newcastle upon Tyne NE1 4LP, UK
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne NE1 7RU, UK
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Baia M, Ford SJ, Dumitra S, Samà L, Naumann DN, Spolverato G, Callegaro D. Follow-up of patients with retroperitoneal sarcoma. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2023; 49:1125-1132. [PMID: 35277304 DOI: 10.1016/j.ejso.2022.02.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 02/14/2022] [Indexed: 12/16/2022]
Abstract
Retroperitoneal sarcomas (RPS) are rare malignancies that are potentially curable by complete surgical resection. A regular surveillance program is normally commenced following surgery due to the risk of local recurrence (LR), especially in low-intermediate grade disease, and distant metastases (DM), especially in high-grade RPS. Consensus guidelines usually advocate for more frequent imaging during the first 2-3 years and less intensive imaging over a prolonged period thereafter, reflecting the incidence pattern of LR and DM. Definitive evidence for the most effective imaging schedule has never been provided, and retrospective studies have not shown an association between follow-up intensity and survival. Improvement in the prediction of recurrence patterns has been sustained by prognostic dynamic nomograms, which are now capable of forecasting disease behaviour in each patient according to specific features. Incorporation of such tools in clinical practice may help to stratify patients and tailor ongoing surveillance to the risk of recurrence. This may help to relieve patients' anxiety while awaiting results of surveillance investigations, and also reduce the economic and environmental burden of repeated imaging. A randomized controlled study (SARveillance Trial) is proposed to shed light on this controversial topic, allowing clinicians to harmonize the follow-up protocol of patients undergoing surgery for RPS.
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Affiliation(s)
- Marco Baia
- Midlands Abdominal and Retroperitoneal Sarcoma Unit (MARSU), Queen Elizabeth Hospital Birmingham, UK
| | - Samuel J Ford
- Midlands Abdominal and Retroperitoneal Sarcoma Unit (MARSU), Queen Elizabeth Hospital Birmingham, UK
| | | | - Laura Samà
- Surgical Oncology Unit, Humanitas Clinical and Research Center-IRCCS, Rozzano, Italy
| | - David N Naumann
- Midlands Abdominal and Retroperitoneal Sarcoma Unit (MARSU), Queen Elizabeth Hospital Birmingham, UK
| | - Gaya Spolverato
- Department of Surgical, Oncological and Gastroenterological Sciences, Section of Surgery, University of Padova, Padova, Italy
| | - Dario Callegaro
- Sarcoma Service, Department of Surgery, IRCCS Fondazione Istituto Nazionale Dei Tumori di Milano, Milan, Italy.
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Surveillance Post Surgery for Retroperitoneal Soft Tissue Sarcoma. Curr Oncol 2023; 30:2781-2791. [PMID: 36975424 PMCID: PMC10047263 DOI: 10.3390/curroncol30030211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 02/17/2023] [Accepted: 02/23/2023] [Indexed: 03/03/2023] Open
Abstract
Complete en bloc surgical resection offers the best opportunity for the cure of primary retroperitoneal sarcomas (RPS). The potential for disease recurrence, in the form of both loco-regional recurrence and distant metastases, underpins the rationale for postoperative surveillance. There is a paucity of high-quality evidence underpinning follow-up for RPS patients, and most practice guidelines draw from expert opinion and evidence from soft tissue sarcomas of the extremities. The available observational retrospective data analysis has failed to demonstrate that high-intensity radiological surveillance improves the overall survival in patients. The lack of a robust evidence base has given rise to variations in approaches to post-operative surveillance strategies adopted by specialist centres managing RPS across the world. More high-quality prospective research is needed and planned to more clearly support surveillance approaches that balance oncologic outcomes, patient-centric care, and health service value. Risk stratification tools exist and are available for use in routine practice. Their use will likely support more individualised post-operative surveillance moving forward. Surveillance will likely be underpinned by serial radiological imaging for the medium term. However, developments in genomics offer hope for biomarkers such as ctDNA to impact patient care positively in the future and further support individualised patient care pathways.
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Kuek T, Schilling CG, Choong PF. The impact of cost on quality of surgical management in non-metastatic extremity sarcoma: A cross-country narrative literature review with a systematic approach. J Orthop Surg (Hong Kong) 2023; 31:10225536231168989. [PMID: 37053184 DOI: 10.1177/10225536231168989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/14/2023] Open
Abstract
BACKGROUND Extremity sarcoma surgery entails significant costs for patients, governments and insurers. Multiple studies have described individual costs, however, the overall impact of cost on the quality of surgical care remains unclear. OBJECTIVES A narrative review with a systematic approach was undertaken to compare the impact of cost on the quality of extremity sarcoma care across low-middle-income and high-income countries. DATA SOURCES MEDLINE, EMBASE, Cochrane, PsycInfo, DARE, NHS-EED, HTA. METHODS A systematic search was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Inclusion criteria were: discussion of costs and the surgical management of primary extremity sarcoma. There were no restrictions on study design, publication type, date, geographic location or publication status. A data extraction table was used to identify study location, type and findings. RESULTS 1012 studies were retrieved and 44 met the inclusion criteria. Four additional studies were identified from the reference lists of included articles. 27 studies were published in high-income countries (HIC) including all four full health economic analyses and 20 studies were published in low-middle income countries (LMC). Within LMC, cost impeded access to diagnosis, resection and options for reconstruction. In HIC, cost varied with choice of management, particularly during the long-term postoperative period. CONCLUSIONS Within LMC, cost impaired the provision of quality, curative care for patients with extremity sarcoma. Within HIC, while costs varied with chosen management, they were not prohibitive to the provision of quality care. Further research is required, specific to both socioeconomic contexts, to further describe the long-term cost-utility of different methods for the surgical management of extremity sarcoma.
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Affiliation(s)
- Timothy Kuek
- Department of Surgery, St Vincent's Hospital, The University of Melbourne, Melbourne, VIC, Australia
| | - Chris G Schilling
- Department of Surgery, St Vincent's Hospital, The University of Melbourne, Melbourne, VIC, Australia
| | - Peter F Choong
- Department of Surgery, St Vincent's Hospital, The University of Melbourne, Melbourne, VIC, Australia
- Department of Orthopaedics, St Vincent's Hospital, Melbourne, VIC, Australia
- Bone and Soft Tissue Sarcoma Unit, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
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Puri A. CORR Insights®: Does Adding Femoral Lengthening at the Time of Rotation Hip Transposition After Periacetabular Tumor Resection Allow for Restoration of Limb Length and Function? Interim Results of a Modified Hip Transposition Procedure. Clin Orthop Relat Res 2021; 479:1531-1533. [PMID: 34128910 PMCID: PMC8208388 DOI: 10.1097/corr.0000000000001702] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 02/05/2021] [Indexed: 01/31/2023]
Affiliation(s)
- Ajay Puri
- Professor & Head, Surgical Oncology, Department or Orthopaedic Oncology, Tata Memorial Centre & Homi Bhabha National Institute, Mumbai, India
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Schneider P, Giglio V, Ghanem D, Wilson D, Turcotte R, Isler M, Mottard S, Miller B, Hayden J, Doung YC, Gundle K, Randall RL, Jones K, Vélez R, Ghert M. Willingness of patients with sarcoma to participate in cancer surveillance research: a cross-sectional patient survey. BMJ Open 2021; 11:e042742. [PMID: 33637543 PMCID: PMC7919570 DOI: 10.1136/bmjopen-2020-042742] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 01/20/2021] [Accepted: 02/08/2021] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVES To determine the proportion of patients with extremity sarcoma who would be willing to participate in a clinical trial in which they would be randomised to one of four different postoperative sarcoma surveillance regimens. Additionally, we assessed patients' perspectives on the burden of cancer care, factors that influence comfort with randomisation and the importance of cancer research. DESIGN Prospective, cross-sectional patient survey. SETTING Outpatient sarcoma clinics in Canada, the USA and Spain between May 2017 and April 2020. Survey data were entered into a study-specific database. PARTICIPANTS Patients with extremity sarcoma who had completed definitive treatment from seven clinics across Canada, the USA and Spain. MAIN OUTCOME MEASURES The proportion of patients with extremity sarcoma who would be willing to participate in a randomised controlled trial (RCT) that evaluates varying postoperative cancer surveillance regimens. RESULTS One hundred thirty complete surveys were obtained. Respondents reported a wide range of burdens related to clinical care and surveillance. The majority of patients (85.5%) responded that they would agree to participate in a cancer surveillance RCT if eligible. The most common reason to participate was that they wanted to help future patients. Those that would decline to participate most commonly reported that participating in research would be too much of a burden for them at a time when they are already feeling overwhelmed. However, most patients agreed that cancer research will help doctors better understand and treat cancer. CONCLUSIONS These results demonstrate that most participants would be willing to participate in an RCT that evaluates varying postoperative cancer surveillance regimens. Participants' motivation for trial participation included altruistic reasons to help future patients and deterrents to trial participation included the overwhelming burden of a cancer diagnosis. These results will help inform the development of patient-centred RCT protocols in sarcoma surveillance research. LEVEL OF EVIDENCE V.
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Affiliation(s)
| | - Victoria Giglio
- Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Dana Ghanem
- Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - David Wilson
- Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Robert Turcotte
- Division of Orthopaedic Surgery, McGill University Health Centre, Montreal, Québec, Canada
| | - Marc Isler
- Department of Orthopaedic Oncology, University of Montreal, Hopital Maisonneuve-Rosemont, Montreal, Québec, Canada
| | - Sophie Mottard
- Department of Orthopaedic Oncology, University of Montreal, Hopital Maisonneuve-Rosemont, Montreal, Québec, Canada
| | - Benjamin Miller
- Department of Orthopaedics and Rehabilitation, University of Iowa, Iowa City, Iowa, USA
| | - James Hayden
- Department of Orthopaedics & Rehabilitation, Oregon Health & Science University, Portland, Oregon, USA
| | - Yee-Cheen Doung
- Department of Orthopaedics & Rehabilitation, Oregon Health & Science University, Portland, Oregon, USA
| | - Kenneth Gundle
- Department of Orthopaedics & Rehabilitation, Oregon Health & Science University, Portland, Oregon, USA
| | - R Lor Randall
- Department of Orthopaedic Surgery, University of California, Davis, California, USA
| | - Kevin Jones
- Department of Orthopaedics, Huntsman Cancer Institute, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Roberto Vélez
- Orthopaedic Surgery Department, Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | - Michelle Ghert
- Department of Surgery, McMaster University, Hamilton, Ontario, Canada
- Juravinski Cancer Centre, Hamilton Health Sciences, Hamilton, Ontario, Canada
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CORR Insights®: Does PET/CT Aid in Detecting Primary Carcinoma in Patients with Skeletal Metastases of Unknown Primary? Clin Orthop Relat Res 2020; 478:2458-2460. [PMID: 32667762 PMCID: PMC7571920 DOI: 10.1097/corr.0000000000001315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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