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Shi L, Hu K, Li X, Zhao J, Jia M. Doxorubicin and SN-38 inhibit the proliferation of osteosarcoma cells by inducing cell cycle arrest. Process Biochem 2022. [DOI: 10.1016/j.procbio.2022.06.028] [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: 10/17/2022]
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Wang Q, Lin F, Huang B, Pan LH. The Effectiveness and Safety of General and Spinal Anesthesia on Systemic Inflammatory Response in Patients with Tumor-Type Total Knee Arthroplasty. Oncol Res Treat 2020; 43:428-434. [PMID: 32674098 DOI: 10.1159/000507892] [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: 07/02/2019] [Accepted: 04/15/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND The anesthesia procedure in tumor-type total knee arthroplasty (TKA) may contribute to systemic inflammatory response. Therefore, we aim to investigate the effectiveness and safety of general and spinal anesthesia in patients with tumor-type TKA. PATIENTS AND METHODS Twenty-five patients with tumors around the knee undergoing primary unilateral TKA were randomly divided into the general anesthesia group (n = 13) and spinal anesthesia group (n = 12). Knee joint HSS scores and Western Ontario and McMaster University osteoarthritis index (WOMAC osteoarthritis) were recorded before surgery and 12 months after surgery. Visual analogue scale, C-reactive protein (CPR), tumor necrosis factor-α (TNF-α), and interleukin-8 (IL-8) concentration were measured preoperatively (T0), on the day of the operation (T1), and on the first day (T2) after the operation. Complications in the two groups were recorded. RESULTS The operative time, intraoperative blood loss, postoperative drainage, tourniquet time, and complication rate were not significantly different between the general anesthesia and spinal anesthesia groups (all p > 0.05). There were no significant differences in CPR (7.6 ± 3.1, 8.1 ± 4.1, 91.3 ± 24.2 vs. 7.1 ± 2.9, 7.6 ± 3.8, 85.1 ± 19.3 pg/mL, respectively), IL-8 (12.2 ± 6.6, 13.4 ± 7.3, 19.2 ± 10.5 vs. 11.9 ± 5.7, 12.9 ± 8.6, 22.2 ± 12.4 pg/mL, respectively), and TNF-α (2.5 ± 1.7, 2.2 ± 1.9, 2.8 ± 2.1 vs. 2.4 ± 1.3, 2.7 ± 2.1, 2.9 ± 1.6 pg/mL, respectively) between the two groups at T0, T1, and T2 (all p > 0.05). There were no statistical differences in pre- and postoperative HSS knee scores (39.78 ± 11.3, 90.24 ± 15.3 vs. 42.68 ± 12.5, 91.21 ± 16.3) and WOMAC indexes (49.89 ± 7.9, 25.12 ± 6.2 vs. 51.3 ± 8.3, 23.15 ± 5.3) between the two groups (p > 0.05). CONCLUSION General anesthesia and spinal anesthesia in patients with tumor-type TKA had the same effectiveness and safety.
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Affiliation(s)
- Qiang Wang
- Department of Anesthesiology, Affiliated Tumor Hospital, Guangxi Medical University, Nanning, China
| | - Fei Lin
- Department of Anesthesiology, Affiliated Tumor Hospital, Guangxi Medical University, Nanning, China
| | - Bin Huang
- Department of Anesthesiology, Affiliated Tumor Hospital, Guangxi Medical University, Nanning, China
| | - Ling Hui Pan
- Department of Anesthesiology, Affiliated Tumor Hospital, Guangxi Medical University, Nanning, China,
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Prabowo Y, Primaputra MRA, Kodrat E. Reconstruction of osteosarcoma of the proximal tibia using bone on polyethylene hemiarthroplasty knee joint system: A case report. Int J Surg Case Rep 2020; 72:188-196. [PMID: 32544827 PMCID: PMC7298547 DOI: 10.1016/j.ijscr.2020.05.013] [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: 02/20/2020] [Revised: 05/12/2020] [Accepted: 05/13/2020] [Indexed: 11/28/2022] Open
Abstract
Limb-sparing surgery remains a challenging procedure in skeletally immature patients. This bone on polyethylene technique would be functional due to high adaptability in paediatric patients in order to decrease the number of surgeries until the final goal of limb equalization. Such techinique enables good and reliable functional outcome while maintaining the knee joint for daily activity.
Introduction Current treatment in treating patient with osteosarcoma is combination of chemotherapy and surgery, either limb-sparing or limb-ablation surgery. One challenge in limb-sparing technique in children is how to deal with the remaining growth of the bone. We created a limb-sparing reconstruction technique that can be fitted in many types of hospital and have a good functional outcome. Case presentation We reported a case of 13-years-old female with left knee pain since 8 months prior hospital admission with previous treatment to a bone setter and open biopsy at previous hospital. Histopathological findings demonstrated osteosarcoma. The patient had a neoadjuvant chemotherapy and followed with limb-sparing surgery. We performed wide excision of proximal tibia and reconstruction using a bone on polyethylene hemiarthroplasty system of the knee joint. Patient then continued on adjuvant chemotherapy. Later on, local recurrence occurred and we performed excision again. Within one year, the patient could walk full weight bearing, perform daily activities with no limitation and no pain, and she had MSTS score of 21. Discussion Limb-sparing surgery remains a challenging procedure in skeletally immature patients. This bone on polyethylene technique would be functional due to high adaptability in paediatric patients in order to decrease the number of surgeries until the final goal of limb equalization. Conclusion Bone on polyethylene hemiarthroplasty system enables good and reliable functional outcome while maintaining the knee joint for daily activity. It can be chosen as one of viable options in treating osteosarcoma around the knee joint in children.
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Affiliation(s)
- Yogi Prabowo
- Department of Orthopaedic & Traumatology, Cipto Mangunkusumo National Central Hospital and Faculty of Medicine, Universitas Indonesia, Jalan Diponegoro No. 71, Central Jakarta, Jakarta 10430, Indonesia
| | - Muhammad Rizqi Adhi Primaputra
- Department of Orthopaedic & Traumatology, Cipto Mangunkusumo National Central Hospital and Faculty of Medicine, Universitas Indonesia, Jalan Diponegoro No. 71, Central Jakarta, Jakarta 10430, Indonesia.
| | - Evelina Kodrat
- Department of Anatomical Pathology, Cipto Mangunkusumo National Central Hospital and Faculty of Medicine, Universitas Indonesia, Jalan Diponegoro No. 71, Central Jakarta, Jakarta 10430, Indonesia
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Huang J, Bi W, Han G, Jia J, Xu M, Wang W. The multidisciplinary treatment of osteosarcoma of the proximal tibia: a retrospective study. BMC Musculoskelet Disord 2018; 19:315. [PMID: 30185176 PMCID: PMC6123999 DOI: 10.1186/s12891-018-2245-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Accepted: 08/24/2018] [Indexed: 11/10/2022] Open
Abstract
Background Survival and reconstruction constitute important challenges in multimodal treatment of osteosarcoma of the proximal tibia. The purpose of this study was to assess the efficacy and prognosis of neoadjuvant chemotherapy and custom-designed endoprosthetic arthroplasty. Methods A total of 69 patients with osteosarcoma of the proximal tibia were evaluated, including 43 males and 26 females, treated with multidisciplinary limb-salvage remedy from October 2003 to December 2013. They were at least 12 years old (mean, 20 years; range, 12–57 years). The gap between tumor and main artery/nerve was showed in MRI. Mean follow up was 69.5 months (range, 9–144 months). Kaplan-Meier survival curves were generated to assess prognosis and relapse rate. The initial symptoms and disease duration for each patient were recorded. Correlation analyses were performed for the association of various parameters with prognosis. Functional outcomes were evaluated using the Musculoskeletal Tumor Society (MSTS) guidelines after 6 months postoperatively, to analyze the relation between bone excision size and function recovery. Results The resection lengths measured intraoperatively ranged from 80 to 230 mm, and contained 3 cm of normal bone around the tumor. A total of 3 courses of preoperative chemotherapy were administered to all cases. At final follow-up, 1 case showed recurrence. Meanwhile, 8 patients (11.6%) died from lung metastasis. Post-operative infection occurred in 3 patients; 1 case was maintained with revision surgery. Two cases underwent amputation. The mean MSTS system score was 21.6. Conclusions The multidisciplinary treatment result in an overall positive outcome, with improved function.
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Affiliation(s)
- Junqi Huang
- Department of Orthopaedics, Mianyang Central Hospital, Mianyang, 621000, Sichuan, China
| | - Wenzhi Bi
- Department of Orthopaedics, PLA General Hospital, Beijing, 100853, China.
| | - Gang Han
- Department of Orthopaedics, PLA General Hospital, Beijing, 100853, China
| | - Jinpeng Jia
- Department of Orthopaedics, PLA General Hospital, Beijing, 100853, China
| | - Meng Xu
- Department of Orthopaedics, PLA General Hospital, Beijing, 100853, China
| | - Wei Wang
- Department of Orthopaedics, PLA General Hospital, Beijing, 100853, China
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Neoadjuvant Bleomycin, Etoposide, and Cisplatin (BEP) Chemotherapy in the Treatment of Extensively Advanced Yolk Sac Tumors: A Single Center Experience. Int J Gynecol Cancer 2018; 28:713-720. [DOI: 10.1097/igc.0000000000001209] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
ObjectiveThis study aimed to investigate the role of neoadjuvant bleomycin, etoposide, and cisplatin (BEP) regimen in patients with extensively advanced yolk sac tumors (YSTs).MethodsBetween July 1982 and December 2015, a total of 58 patients with YST were initially treated at our institution, among which 18 were evaluated to be inoperable and received neoadjuvant BEP regimen. They were either too debilitated by the disease [Eastern Cooperative Oncology Group Performance Status Scale (ECOG ps) ≥2] to undergo a major surgery or were with too extensively disseminated lesions to be optimally debulked. This cohort of patients was retrospectively reviewed.ResultsOne or 2 cycles of BEP regimen were prescribed to the majority of patients preoperatively. At the completion of neoadjuvant chemotherapy, 17 of them had ECOG ps of 1 or less. Seventeen (94.4%) exhibited clinical partial tumor regression, and 1 (5.6%) had clinical stable disease. Pathological complete tumor regression was observed in 2 (11.1%) patients, whereas the remaining 16 (88.9%) had nearly complete pathological regression. Seventeen patients were cytoreduced to no macroscopic residual disease; the remaining 1 was cytoreduced to macroscopic residual disease of 2 cm or less. No major surgical complications occurred. After a median follow-up of 83.5 months, 17 patients were free of recurrence. Five-year disease-free survival and overall survival were both 94.4%. Fertility-sparing surgery was carried out in all the 17 patients with the desire to preserve their fertility, and 5 infants were delivered in 6 patients who attempted conception.ConclusionsOne or 2 cycles of neoadjuvant BEP regimen followed by cytoreductive surgery offer a chance for cure in extensively advanced patients with YSTs and help pave the way for fertility-sparing surgery.
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Zhang C, Hu J, Zhu K, Cai T, Ma X. Survival, complications and functional outcomes of cemented megaprostheses for high-grade osteosarcoma around the knee. INTERNATIONAL ORTHOPAEDICS 2018; 42:927-938. [PMID: 29427125 DOI: 10.1007/s00264-018-3770-9] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Accepted: 01/05/2018] [Indexed: 12/01/2022]
Abstract
PURPOSE We initiated a retrospective study on the long-term survival of cemented endoprostheses for bone tumours around the knee to answer the following questions: (1) What was the survival of these patients? (2) What was the overall survival of cemented prostheses around the knee? (3) What types of failures were observed in these reconstructions? (4) Did the survival and complications vary according to the site of the implant? (5) What was the functional result after cemented prosthesis replacement around the knee? METHODS From January 2006 to December 2013, 108 consecutive patients with an average age of 25 years, who had mature bone development as evidenced by imaging examinations, underwent 108 cemented endoprosthetic knee replacements for osteosarcoma resection. All patients received neoadjuvant chemotherapy using a multi-drug protocol consisting of high dose methotrexate (HDMTX), doxorubicin (ADM), cisplatin (DDP) and high dose ifosfamide (HDIFO). When extensor mechanism reconstruction was required, we ran nonabsorbable sutures through designated holes in the tibial component to fix detached hamstrings and the remaining ligaments in an imbricated fashion as well as reinforced the reconstruction with a medial gastrocnemius flap. Seventy-two (72/108, 66.7%) lesions were located in the distal femur and 36 (36/108, 33.3%) lesions at the proximal tibias. Nineteen patients were staged as IIA and 89 as IIB according to the Enneking staging system. The average follow-up was 53.3 months (range 12-125 months), with a minimum oncological follow-up of one year. Survival, prosthetic failure, complications and functional outcomes were recorded and reassessed at every visit after the primary operation. RESULTS At the final follow-up, the oncologic results showed that 33 patients died from metastases, and local recurrence occurred in ten patients. The estimated overall five-year and eight-year survival rates were 71% (95% CI: 62.4-79.65%) and 67.2% (95% CI: 58-76.4%), respectively. In this study, a total of 51 complications occurred in 45 patients, and at the end of follow-up, 59 patients had prostheses in situ. The estimated overall five-year and eight-year implant survival rates were 77.7% (95% CI: 67.9-87.5%) and 54.5% (95% CI: 31.4-77.6%), respectively, when patients who died with their original prostheses were censored. In total, 21 (21/108, 19.4%) implants failed, five due to infections (5/21), eight due to aseptic loosening (8/21), four due to local recurrence (4/21), three due to structural failure (3/21) and one due to soft tissue failure (1/21). The average Musculoskeletal Tumor Society Score (MSTS) at the most recent follow-up was 22.9 (9-30) points on a 30-point scale, which indicated an excellent or good functional outcome. Analysis of the results based on implant site revealed a slight difference of the estimated five-year prosthesis survival between implants located in the distal femur and those located in the proximal tibia [86.1% (95% CI: 75.5-97%) versus 66.9% (95% CI: 49.8-83.9%); P = 0.09]. However, the functional outcomes and complication rates of prostheses located in the distal femur were both better than those located in the proximal tibia. CONCLUSIONS With effective management strategies for complications, cemented endoprosthetic reconstruction of the proximal tibia and distal femur using an extensor mechanism reconstruction technique provides a reliable method of reconstruction following tumour resection around the knee. Level of Evidence Level IV, therapeutic study.
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Affiliation(s)
- Chunlin Zhang
- Department of Orthopaedic Surgery, Shanghai Tenth People's Hospital, Tongji University School of Medicine, 301 Yanchang Road, Shanghai, 200072, People's Republic of China.
| | - Jianping Hu
- Department of Orthopaedic Surgery, Shanghai Tenth People's Hospital, Tongji University School of Medicine, 301 Yanchang Road, Shanghai, 200072, People's Republic of China.
| | - Kunpeng Zhu
- Department of Orthopaedic Surgery, Shanghai Tenth People's Hospital, Tongji University School of Medicine, 301 Yanchang Road, Shanghai, 200072, People's Republic of China
| | - Tao Cai
- Department of Orthopaedic Surgery, Shanghai Tenth People's Hospital, Tongji University School of Medicine, 301 Yanchang Road, Shanghai, 200072, People's Republic of China
| | - Xiaolong Ma
- Department of Orthopaedic Surgery, Shanghai Tenth People's Hospital, Tongji University School of Medicine, 301 Yanchang Road, Shanghai, 200072, People's Republic of China
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Yao W, Cai Q, Wang J, Gao S. Treatment of osteosarcoma around the knee in skeletally immature patients. Oncol Lett 2017; 14:5241-5248. [PMID: 29113159 PMCID: PMC5656020 DOI: 10.3892/ol.2017.6903] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Accepted: 06/29/2017] [Indexed: 12/18/2022] Open
Abstract
Limb sparing surgery in growing young patients with malignant tumors is difficult as invasion of the physis by the tumor or surgical resection through the metaphysis may cause significant limb discrepancy following surgery. At present, hinged tumor prosthesis or biological reconstructions are the main methods following tumor resection in these patients. The aim of the present study was to assess different procedures for the treatment of osteosarcoma around knee joints in immature patients. A retrospective study of 56 patients (<15 years old, open physis) who had been treated for osteosarcoma around the knee joint between January 2007 and December 2015 was performed. Clinical data collected included patient demographics (age at diagnosis, sex and date of diagnosis), tumor characteristics [location, Enneking stage and subtype on magnetic resonance imaging (MRI)], treatment (response to neoadjuvant chemotherapy and type of primary surgery) and clinical outcomes (limb function, discrepancy and overall survival). The median age at the time of diagnosis was 12.14 years (range, 3–15 years). There were 32 male patients (57.1%). A total of 41 (82%) tumors were located at the distal femur, and 15 (18%) at the proximal tibia. A total of 49 (87.5%) patients were diagnosed with stage IIB tumors, and 7 (12.5%) had stage III, according to the Enneking stage classification. Different surgical methods, including amputation, rotation-plasty, endoprosthesis and biological instructions (e.g., allograft) were performed according to MRI type classification. During follow-up, 21 patients (37.5%) succumbed to disease. The Musculoskeletal Tumor Society score ranged from excellent to fair functional result. Recurrence (2 cases, 16.67%) and infection (2, cases, 16.67%) were the main complications following endoprosthesis replacement, while delayed union (12 cases, 57.14%) and fracture (3 cases, 14.29%) were the main causes for biological reconstructions. Limb-length discrepancy ranged from 0–10 cm in limb-saving surgery. The overall survival rate was 57.66% with different cohorts in Enneking stages IIB and III, with or without involvement of the physis and different cycles of chemotherapy. Results of the present study indicated that different limb saving surgeries, including epiphysis/physis preservation with biological construction in patients with MRI types I to III and endoprosthetic/osteoarticular reconstruction in patients with MRI types IV and V, are useful in the management of osteosarcoma in growing young patients with proper surgery indications, and knee joint function was maintained with acceptable complications including limb discrepancy, delayed union, infection, recurrence and fracture.
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Affiliation(s)
- Weitao Yao
- Bone and Soft Department, The Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, Henan 450000, P.R. China
| | - Qiqing Cai
- Bone and Soft Department, The Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, Henan 450000, P.R. China
| | - Jiaqiang Wang
- Bone and Soft Department, The Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, Henan 450000, P.R. China
| | - Songtao Gao
- Bone and Soft Department, The Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, Henan 450000, P.R. China
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