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Thio QCBS, van Wulfften Palthe ODR, Bramer JAM, DeLaney TF, Bredella MA, Dempster DW, Zhou H, Hornicek FJ, Chen YLE, Schwab JH. Pilot Study: Short Term Impact of Radiation Therapy on Bone Mineral Density and Bone Metabolism. Calcif Tissue Int 2023; 113:640-650. [PMID: 37910222 PMCID: PMC10673955 DOI: 10.1007/s00223-023-01149-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 10/04/2023] [Indexed: 11/03/2023]
Abstract
Despite the risk of complications, high dose radiation therapy is increasingly utilized in the management of selected bone malignancies. In this study, we investigate the impact of moderate to high dose radiation (over 50 Gy) on bone metabolism and structure. Between 2015 and 2018, patients with a primary malignant bone tumor of the sacrum that were either treated with high dose definitive radiation only or a combination of moderate to high dose radiation and surgery were prospectively enrolled at a single institution. Quantitative CTs were performed before and after radiation to determine changes in volumetric bone mineral density (BMD) of the irradiated and non-irradiated spine. Bone histomorphometry was performed on biopsies of the irradiated sacrum and the non-irradiated iliac crest of surgical patients using a quadruple tetracycline labeling protocol. In total, 9 patients were enrolled. Two patients received radiation only (median dose 78.3 Gy) and 7 patients received a combination of preoperative radiation (median dose 50.4 Gy), followed by surgery. Volumetric BMD of the non-irradiated lumbar spine did not change significantly after radiation, while the BMD of the irradiated sacrum did (pre-radiation median: 108.0 mg/cm3 (IQR 91.8-167.1); post-radiation median: 75.3 mg/cm3 (IQR 57.1-110.2); p = 0.010). The cancellous bone of the non-irradiated iliac crest had a stable bone formation rate, while the irradiated sacrum showed a significant decrease in bone formation rate [pre-radiation median: 0.005 mm3/mm2/year (IQR 0.003-0.009), post-radiation median: 0.001 mm3/mm2/year (IQR 0.001-0.001); p = 0.043]. Similar effects were seen in the cancellous and endocortical envelopes. This pilot study shows a decrease of volumetric BMD and bone formation rate after high-dose radiation therapy. Further studies with larger cohorts and other endpoints are needed to get more insight into the effect of radiation on bone. Level of evidence: IV.
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Affiliation(s)
- Quirina C B S Thio
- Department of Orthopedic Surgery, Academic University Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
- Department of Orthopedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
- Massachusetts General Hospital, Room 3.946, Yawkey Building, 55 Fruit Street, Boston, MA, 02114, USA.
| | - Olivier D R van Wulfften Palthe
- Department of Orthopedic Surgery, Academic University Medical Center, University of Amsterdam, Amsterdam, The Netherlands
- Department of Orthopedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Jos A M Bramer
- Department of Orthopedic Surgery, Academic University Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Thomas F DeLaney
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Miriam A Bredella
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - David W Dempster
- Department of Pathology and Cell Biology, Columbia University, New York, NY, USA
- Regional Bone Center, Helen Hayes Hospital, West Haverstraw, New York, USA
| | - Hua Zhou
- Regional Bone Center, Helen Hayes Hospital, West Haverstraw, New York, USA
| | | | - Yen-Lin E Chen
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Joseph H Schwab
- Department of Orthopedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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Krebbekx GGJ, Fris FJ, Schaap GR, Bramer JAM, Verspoor FGM, Janssen SJ. Fracture risk after intralesional curettage of atypical cartilaginous tumors. J Orthop Surg Res 2023; 18:851. [PMID: 37946306 PMCID: PMC10634173 DOI: 10.1186/s13018-023-04215-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 09/17/2023] [Indexed: 11/12/2023] Open
Abstract
INTRODUCTION The need for curettage of atypical cartilaginous tumors (ACT) is under debate. Curretage results in defects that weaken the bone potentially leading to fractures. The purpose of this study was to retrospectively determine postoperative fracture risk after curettage of chondroid tumors, including patient-specific characteristics that could influence fracture risk. METHODS A total of 297 adult patients who underwent curettage of an ACT followed by phenolisation and augmentation were retrospectively evaluated. Explanatory variables were, sex, age, tumor size, location, augmentation type, and plate fixation. The presence of a postoperative fracture was radiologically diagnosed. Included patients had at least 90 days of follow-up. RESULTS A total of 183 females (62%) were included and 114 males (38%), with an overall median follow-up of 3.2 years (IQR 1.6-5.2). Mean diameter of the lesions was 4.5 (SD 2.8) cm. Patients received augmentation with allograft bone (n = 259, 87%), PMMA (n = 11, 3.7%), or did not receive augmentation (n = 27, 9.1%). Overall fracture risk was 6%. Male sex (p = 0.021) and lesion size larger than 3.8 cm (p < 0.010) were risk factors for postoperative fracture. INTERPRETATION Curettage of ACT results in an overall fracture risk of 6%, which is increased for males with larger lesions.
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Affiliation(s)
- Gitte G J Krebbekx
- Department of Orthopaedic Surgery and Sports Medicine, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands.
- Amsterdam Movement Sciences, Musculoskeletal Health, Amsterdam, The Netherlands.
| | - Felix J Fris
- Department of Orthopaedic Surgery and Sports Medicine, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Musculoskeletal Health, Amsterdam, The Netherlands
| | - G R Schaap
- Department of Orthopaedic Surgery and Sports Medicine, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Musculoskeletal Health, Amsterdam, The Netherlands
| | - J A M Bramer
- Department of Orthopaedic Surgery and Sports Medicine, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Musculoskeletal Health, Amsterdam, The Netherlands
| | - F G M Verspoor
- Department of Orthopaedic Surgery and Sports Medicine, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Musculoskeletal Health, Amsterdam, The Netherlands
| | - Stein J Janssen
- Department of Orthopaedic Surgery and Sports Medicine, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Musculoskeletal Health, Amsterdam, The Netherlands
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Acosta-Medina AA, Kemps PG, Zondag TCE, Abeykoon JP, Forma-Borst J, Steenwijk EC, Feijen EAM, Teepen JC, Bennani NN, Schram SM, Shah MV, Davidge-Pitts C, Koster MJ, Ryu JH, Vassallo R, Tobin WO, Young JR, Dasari S, Rech K, Ravindran A, Cleven AHG, Verdijk RM, van Noesel CJM, Balgobind BV, Bouma GJ, Saeed P, Bramer JAM, de Groen RAL, Vermaat JSP, van de Sande MAJ, Smit EF, Langerak AW, van Wezel T, Tonino SH, van den Bos C, van Laar JAM, Go RS, Goyal G, van Halteren AGS. BRAF V600E is associated with higher incidence of second cancers in adults with Langerhans cell histiocytosis. Blood 2023; 142:1570-1575. [PMID: 37595284 PMCID: PMC10797504 DOI: 10.1182/blood.2023021212] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 07/05/2023] [Accepted: 07/27/2023] [Indexed: 08/20/2023] Open
Abstract
In this retrospective study, BRAF mutation status did not correlate with disease extent or (event-free) survival in 156 adults with Langerhans cell histiocytosis. BRAFV600E was associated with an increased incidence of second malignancies, often comprising hematological cancers, which may be clonally related.
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Affiliation(s)
- Aldo A. Acosta-Medina
- Department of Internal Medicine, Mayo Clinic, Rochester, MN
- Division of Hematology, Mayo Clinic, Rochester, MN
| | - Paul G. Kemps
- Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands
| | - Timo C. E. Zondag
- Section Clinical Immunology, Department of Internal Medicine, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
| | | | - Jelske Forma-Borst
- Department of Pediatrics, Leiden University Medical Center, Leiden, The Netherlands
| | - Eline C. Steenwijk
- Department of Pediatrics, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Jop C. Teepen
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | | | | | | | | | | | - Jay H. Ryu
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN
| | - Robert Vassallo
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN
| | | | | | - Surendra Dasari
- Division of Biomedical Statistics and Informatics, Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN
| | - Karen Rech
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | - Aishwarya Ravindran
- Department of Pathology, University of Alabama at Birmingham, Birmingham, AL
| | - Arjen H. G. Cleven
- Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands
- Department of Pathology, University Medical Center Groningen, Groningen, The Netherlands
| | - Robert M. Verdijk
- Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands
- Department of Pathology, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Carel J. M. van Noesel
- Department of Pathology, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Brian V. Balgobind
- Department of Radiation Oncology, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Gerrit Joan Bouma
- Department of Neurosurgery, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Peerooz Saeed
- Department of Ophthalmology, Orbital Center, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Jos A. M. Bramer
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
- Department of Orthopedic Surgery and Sports Medicine, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Ruben A. L. de Groen
- Department of Hematology, Leiden University Medical Center, Leiden, The Netherlands
| | - Joost S. P. Vermaat
- Department of Hematology, Leiden University Medical Center, Leiden, The Netherlands
| | - Michiel A. J. van de Sande
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
- Department of Orthopedic Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Egbert F. Smit
- Department of Pulmonology, Leiden University Medical Center, Leiden, The Netherlands
| | - Anton W. Langerak
- Department of Immunology, Laboratory Medical Immunology, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Tom van Wezel
- Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands
| | - Sanne H. Tonino
- Department of Hematology, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Cor van den Bos
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
- Department of Pediatric Oncology, Emma Children’s Hospital, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Jan A. M. van Laar
- Section Clinical Immunology, Department of Internal Medicine, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
- Section Clinical Immunology, Department of Immunology, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Ronald S. Go
- Division of Hematology, Mayo Clinic, Rochester, MN
| | - Gaurav Goyal
- Division of Hematology, Mayo Clinic, Rochester, MN
- Division of Hematology-Oncology, University of Alabama at Birmingham, Birmingham, AL
| | - Astrid G. S. van Halteren
- Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands
- Section Clinical Immunology, Department of Internal Medicine, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
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Paulino Pereira NR, Groot OQ, Verlaan JJ, Bongers MER, Twining PK, Kapoor ND, van Dijk CN, Schwab JH, Bramer JAM. Quality of Life Changes After Surgery for Metastatic Spinal Disease: A Systematic Review and Meta-analysis. Clin Spine Surg 2022; 35:38-48. [PMID: 34108371 DOI: 10.1097/bsd.0000000000001213] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 04/14/2021] [Indexed: 11/25/2022]
Abstract
STUDY DESIGN This was a systematic review and meta-analysis. OBJECTIVE A systematic review and meta-analysis was conducted to assess the quality of life (QoL) after open surgery for spinal metastases, and how surgery affects physical, social/family, emotional, and functional well-being. SUMMARY OF BACKGROUND DATA It remains questionable to what extent open surgery improves QoL for metastatic spinal disease, it would be interesting to quantify the magnitude and duration of QoL benefits-if any-after surgery for spinal metastases. MATERIALS AND METHODS Included were studies measuring QoL before and after nonpercutaneous, open surgery for spinal metastases for various indications including pain, spinal cord compression, instability, or tumor control. A random-effect model assessed standardized mean differences (SMDs) of summary QoL scores between baseline and 1, 3, 6, or 9-12 months after surgery. RESULTS The review yielded 10 studies for data extraction. The pooled QoL summary score improved from baseline to 1 month (SMD=1.09, P<0.001), to 3 months (SMD=1.28, P<0.001), to 6 months (SMD=1.21, P<0.001), and to 9-12 months (SMD=1.08, P=0.001). The surgery improved physical well-being during the first 3 months (SMD=0.94, P=0.022), improved emotional (SMD=1.19, P=0.004), and functional well-being (SMD=1.08, P=0.005) during the first 6 months, and only improved social/family well-being at month 6 (SMD=0.28, P=0.001). CONCLUSIONS The surgery improved QoL for patients with spinal metastases, and rapidly improved physical, emotional, and functional well-being; it had minimal effect on social/family well-being. However, choosing the optimal candidate for surgical intervention in the setting of spinal metastases remains paramount: otherwise postoperative morbidity and complications may outbalance the intended benefits of surgery. Future research should report clear definitions of selection criteria and surgical indication and provide stratified QoL results by indication and clinical characteristics such as primary tumor type, preoperative Karnofsky, and Bilsky scores to elucidate the optimal candidate for surgical intervention.
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Affiliation(s)
- Nuno R Paulino Pereira
- Department of Orthopaedic Surgery, Orthopaedic Oncology Service, Massachusetts General Hospital, Harvard Medical School, Boston, MA
- Department of Orthopaedic Surgery, Academic Medical Center, University of Amsterdam, Amsterdam-Zuidoost
| | - Olivier Q Groot
- Department of Orthopaedic Surgery, Orthopaedic Oncology Service, Massachusetts General Hospital, Harvard Medical School, Boston, MA
- Department of Orthopaedic Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Jorrit-Jan Verlaan
- Department of Orthopaedic Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Michiel E R Bongers
- Department of Orthopaedic Surgery, Orthopaedic Oncology Service, Massachusetts General Hospital, Harvard Medical School, Boston, MA
- Department of Orthopaedic Surgery, Academic Medical Center, University of Amsterdam, Amsterdam-Zuidoost
| | - Peter K Twining
- Department of Orthopaedic Surgery, Orthopaedic Oncology Service, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Neal D Kapoor
- Department of Orthopaedic Surgery, Orthopaedic Oncology Service, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Cornelis N van Dijk
- Department of Orthopaedic Surgery, Academic Medical Center, University of Amsterdam, Amsterdam-Zuidoost
| | - Joseph H Schwab
- Department of Orthopaedic Surgery, Orthopaedic Oncology Service, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Jos A M Bramer
- Department of Orthopaedic Surgery, Academic Medical Center, University of Amsterdam, Amsterdam-Zuidoost
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Thio QCBS, Paulino Pereira NR, van Wulfften Palthe O, Sciubba DM, Bramer JAM, Schwab JH. Estimating survival and choosing treatment for spinal metastases: Do spine surgeons agree with each other? J Orthop 2021; 28:134-139. [PMID: 34924728 PMCID: PMC8665269 DOI: 10.1016/j.jor.2021.11.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 09/05/2021] [Accepted: 11/17/2021] [Indexed: 02/08/2023] Open
Abstract
Purpose This study aimed to investigate spine surgeons’ ability to estimate survival in patients with spinal metastases and whether survival estimates influence treatment recommendations. Methods 60 Spine surgeons were asked a survival estimate and treatment recommendation in 12 cases. Intraclass correlation coefficients and descriptive statistics were used to evaluate variability, accuracy and association of survival estimates with treatment recommendation. Results There was substantial variability in survival estimates amongst the spine surgeons. Survival was generally overestimated, and longer estimated survival seemed to lead to more invasive procedures. Conclusions Prognostic models to estimate survival may aid surgeons treating patients with spinal metastases.
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Affiliation(s)
- Quirina C B S Thio
- Department of Orthopaedic Surgery, Amsterdam University Medical Center Amsterdam, Meibergdreef 9, 1105AZ, Amsterdam, the Netherlands.,Division of Orthopaedic Oncology, Department of Orthopaedics Massachusetts General Hospital - Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA
| | - Nuno Rui Paulino Pereira
- Division of Orthopaedic Oncology, Department of Orthopaedics Massachusetts General Hospital - Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA
| | - Olivier van Wulfften Palthe
- Division of Orthopaedic Oncology, Department of Orthopaedics Massachusetts General Hospital - Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA
| | - Daniel M Sciubba
- Department of Neurosurgery, The Johns Hopkins Hospital - the John Hopkins University School of Medicine, 1800 Orleans St, Baltimore, MD, 21287, USA
| | - Jos A M Bramer
- Department of Orthopaedic Surgery, Amsterdam University Medical Center Amsterdam, Meibergdreef 9, 1105AZ, Amsterdam, the Netherlands
| | - Joseph H Schwab
- Division of Orthopaedic Oncology, Department of Orthopaedics Massachusetts General Hospital - Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA
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Thio QCBS, Karhade AV, Bindels B, Ogink PT, Bramer JAM, Ferrone ML, Calderón SL, Raskin KA, Schwab JH. Erratum to: Development and Internal Validation of Machine Learning Algorithms for Preoperative Survival Prediction of Extremity Metastatic Disease. Clin Orthop Relat Res 2021; 479:862. [PMID: 33704109 PMCID: PMC8083934 DOI: 10.1097/corr.0000000000001678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 01/21/2021] [Indexed: 01/31/2023]
Affiliation(s)
- Quirina C B S Thio
- Q. C. B. S. Thio, A. V. Karhade, B. Bindels, P. T. Ogink, S. A. Lozano Calderón, K. A. Raskin, J. H. Schwab, Department of Orthopedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- J. A. M. Bramer, Department of Orthopedic Surgery, Academic University Medical Center, University of Amsterdam, Amsterdam, the Netherlands
- M. L. Ferrone, Department of Orthopedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Aditya V Karhade
- Q. C. B. S. Thio, A. V. Karhade, B. Bindels, P. T. Ogink, S. A. Lozano Calderón, K. A. Raskin, J. H. Schwab, Department of Orthopedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- J. A. M. Bramer, Department of Orthopedic Surgery, Academic University Medical Center, University of Amsterdam, Amsterdam, the Netherlands
- M. L. Ferrone, Department of Orthopedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Bas Bindels
- Q. C. B. S. Thio, A. V. Karhade, B. Bindels, P. T. Ogink, S. A. Lozano Calderón, K. A. Raskin, J. H. Schwab, Department of Orthopedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- J. A. M. Bramer, Department of Orthopedic Surgery, Academic University Medical Center, University of Amsterdam, Amsterdam, the Netherlands
- M. L. Ferrone, Department of Orthopedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Paul T Ogink
- Q. C. B. S. Thio, A. V. Karhade, B. Bindels, P. T. Ogink, S. A. Lozano Calderón, K. A. Raskin, J. H. Schwab, Department of Orthopedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- J. A. M. Bramer, Department of Orthopedic Surgery, Academic University Medical Center, University of Amsterdam, Amsterdam, the Netherlands
- M. L. Ferrone, Department of Orthopedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Jos A M Bramer
- Q. C. B. S. Thio, A. V. Karhade, B. Bindels, P. T. Ogink, S. A. Lozano Calderón, K. A. Raskin, J. H. Schwab, Department of Orthopedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- J. A. M. Bramer, Department of Orthopedic Surgery, Academic University Medical Center, University of Amsterdam, Amsterdam, the Netherlands
- M. L. Ferrone, Department of Orthopedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Marco L Ferrone
- Q. C. B. S. Thio, A. V. Karhade, B. Bindels, P. T. Ogink, S. A. Lozano Calderón, K. A. Raskin, J. H. Schwab, Department of Orthopedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- J. A. M. Bramer, Department of Orthopedic Surgery, Academic University Medical Center, University of Amsterdam, Amsterdam, the Netherlands
- M. L. Ferrone, Department of Orthopedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Santiago Lozano Calderón
- Q. C. B. S. Thio, A. V. Karhade, B. Bindels, P. T. Ogink, S. A. Lozano Calderón, K. A. Raskin, J. H. Schwab, Department of Orthopedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- J. A. M. Bramer, Department of Orthopedic Surgery, Academic University Medical Center, University of Amsterdam, Amsterdam, the Netherlands
- M. L. Ferrone, Department of Orthopedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Kevin A Raskin
- Q. C. B. S. Thio, A. V. Karhade, B. Bindels, P. T. Ogink, S. A. Lozano Calderón, K. A. Raskin, J. H. Schwab, Department of Orthopedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- J. A. M. Bramer, Department of Orthopedic Surgery, Academic University Medical Center, University of Amsterdam, Amsterdam, the Netherlands
- M. L. Ferrone, Department of Orthopedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Joseph H Schwab
- Q. C. B. S. Thio, A. V. Karhade, B. Bindels, P. T. Ogink, S. A. Lozano Calderón, K. A. Raskin, J. H. Schwab, Department of Orthopedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- J. A. M. Bramer, Department of Orthopedic Surgery, Academic University Medical Center, University of Amsterdam, Amsterdam, the Netherlands
- M. L. Ferrone, Department of Orthopedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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Thio QCBS, Karhade AV, Notman E, Raskin KA, Lozano-Calderón SA, Ferrone ML, Bramer JAM, Schwab JH. Serum alkaline phosphatase is a prognostic marker in bone metastatic disease of the extremity. J Orthop 2020; 22:346-351. [PMID: 32921951 DOI: 10.1016/j.jor.2020.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 08/11/2020] [Indexed: 11/16/2022] Open
Abstract
Purpose The purpose of this study was to determine the prognostic value of serum alkaline phosphatase for treatment decision making in metastatic bone disease. Methods 1090 patients who underwent surgery for extremity metastatic disease were retrospectively identified at two tertiary care centers. The association between alkaline phosphatase and mortality was assessed by bivariate and multivariate analyses. Results Three-month and one-year mortality rates were 305 (29%) and 639 (62%), respectively. Alkaline phosphatase was associated with mortality at both three months and one year. Conclusion Serum alkaline phosphatase may be a useful marker in prognostic algorithms for patients with extremity metastatic disease.
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Affiliation(s)
- Quirina C B S Thio
- Department of Orthopedic Surgery, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Aditya V Karhade
- Department of Orthopedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Emily Notman
- Department of Orthopedic Surgery, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Kevin A Raskin
- Department of Orthopedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Santiago A Lozano-Calderón
- Department of Orthopedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Marco L Ferrone
- Department of Orthopedic Surgery, Brigham and Womens Hospital, Harvard Medical School, Boston, MA, USA
| | - Jos A M Bramer
- Department of Orthopedic Surgery, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Joseph H Schwab
- Department of Orthopedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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Janssen SJ, Pereira NRP, Thio QCBS, Raskin KA, Bramer JAM, Lozano-Calderon SA, Schwab JH. Physical function and pain intensity in patients with metastatic bone disease. J Surg Oncol 2019; 120:376-381. [PMID: 31140605 DOI: 10.1002/jso.25510] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2019] [Revised: 04/11/2019] [Accepted: 05/06/2019] [Indexed: 01/11/2023]
Abstract
BACKGROUND Patient reported outcome data in bone metastatic disease are scarce and it would be useful to have normative data and understand what patients are at risk for poor function and more pain. OBJECTIVES We aimed to assess what factors are independently associated with physical function and pain intensity in patients with bone metastasis. METHODS We included data from 211 patients with bone metastasis who completed a survey (2014-2016) including the PROMIS Physical Function Cancer and PROMIS Pain Intensity questionnaires. RESULTS Prostate (P < .001) and thyroid carcinoma (P = .007) were associated with better function and having other disabling conditions (P = 0.035) was associated with worse function. Prostate carcinoma (P = .001) and lymphoma (P = .007) were associated with less pain. There was a moderate correlation between pain and function (P < .001). Function was substantially worse as compared to a US reference population of patients with cancer (P < .001), whereas pain was slightly less compared to the US general population average (P < .001). CONCLUSIONS Patients with bone metastasis have a poor physical function. Physical function and pain intensity depend on tumor histology, but also on potentially modifiable factors such as other disabling conditions. LEVEL OF EVIDENCE Level III, prognostic study.
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Affiliation(s)
- Stein J Janssen
- Department of Orthopaedic Surgery, Amsterdam University Medical Center-University of Amsterdam, Amsterdam, The Netherlands
| | | | - Quirina C B S Thio
- Department of Orthopaedic Surgery, Orthopaedic Oncology Service, Massachusetts General Hospital-Harvard Medical School, Boston, Massachusetts
| | - Kevin A Raskin
- Department of Orthopaedic Surgery, Orthopaedic Oncology Service, Massachusetts General Hospital-Harvard Medical School, Boston, Massachusetts
| | - Jos A M Bramer
- Department of Orthopaedic Surgery, Amsterdam University Medical Center-University of Amsterdam, Amsterdam, The Netherlands
| | - Santiago A Lozano-Calderon
- Department of Orthopaedic Surgery, Orthopaedic Oncology Service, Massachusetts General Hospital-Harvard Medical School, Boston, Massachusetts
| | - Joseph H Schwab
- Department of Orthopaedic Surgery, Orthopaedic Oncology Service, Massachusetts General Hospital-Harvard Medical School, Boston, Massachusetts
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van Wulfften Palthe ODR, Tromp I, Ferreira A, Fiore A, Bramer JAM, van Dijk NC, DeLaney TF, Schwab JH, Hornicek FJ. Sacral chordoma: a clinical review of 101 cases with 30-year experience in a single institution. Spine J 2019; 19:869-879. [PMID: 30445184 DOI: 10.1016/j.spinee.2018.11.002] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Revised: 10/31/2018] [Accepted: 11/01/2018] [Indexed: 02/03/2023]
Abstract
BACKGROUND Local recurrence rates are high in sacral chordoma patients. Adjuvant radiotherapy may play a role in increasing local control. Patients with locally recurrent tumors continue to comprise a significant proportion of the sacral chordoma population and appear to have worse prognosis than those with primary tumors. High-quality studies comparing presentation and treatments for primary and first local recurrent sacral chordoma tumors are sparse. PURPOSE To determine: whether there is a difference in how primary and tumors at first recurrence present; the overall survival, local relapse-free survival, and distant relapse-free survival rates and prognostic factors for patients presenting with a primary tumor; overall survival, local relapse-free survival, and distant relapse-free survival rates and prognostic factors for patients presenting with a first local relapse; if there any differences in overall survival, local relapse-free survival, and distant relapse-free survival rates between patients presenting with a primary tumor and those with a first local relapse. STUDY DESIGN Retrospective case series. PATIENT SAMPLE One hundred one sacral chordoma cases. OUTCOME MEASURE Overall survival, local relapse-free survival, and distant relapse-free survival rates. METHODS Between 1978 and 2013, 131 patients with sacral chordoma were seen. Of them, 17 patients (13%) presented with a history of more than one local recurrence. One patient (1%) presented with multiple distant metastases. Ten patients (8%) had less than 36 months of follow-up and had no event (eg, death, local recurrence, or distant metastasis). A total of 102 patients met our inclusion criteria: patients with primary or first recurrent tumors, without metastatic disease, who underwent surgery and with at least 36 months of follow-up. One patient (1%) died intraoperatively; therefore, 101 patients were included in the present analysis. Cox proportional hazards regression analysis was performed for primary and local recurrent tumor separately and to compare primary and local recurrent tumors. RESULTS We analyzed 73 primary and 28 first time recurrent sacral chordomas. Tumor size at presentation was different for primary and recurrent tumors (primary median size: 158 cm3, interquartile range [IQR]: 46-634; recurrent median size: 39 cm3, IQR: 14-175; p=.001). Overall survival at 5 and 10years for the primary tumors was 79% and 59%, respectively. Local relapse-free survival at 5years was 86%. For primary tumors, not receiving radiation was an independent predictor for worse local relapse-free survival (hazard ratio [HR]: 0.20; 95% confidence interval [CI]: 0.0043-0.90; p=.004) and increased tumor size was an independent predictor for both worse overall survival (HR: 1.68; 95% CI: 1.38-2.42; p=.004) and worse distant relapse-free survival (HR: 2.25; 95% CI: 1.47-3.44; p<.001). For recurrent tumors, the 5- and 10-year overall survival was 65% and 40%, respectively. Local relapse-free survival at 5years was 79% for recurrent tumors. On bivariate analysis, increased tumor size was a significant predictor for worse survival (LR median: 338 mL; IQR: 218-503 mL; no LR median: 26 mL; IQR: 9-71 mL). A trend was seen toward better distant relapse survival for tumors presenting as a primary tumor (HR: 0.51; 95% CI: 0.25-1.06; p=.072). CONCLUSION Using a combination of surgical resection and adjuvant radiotherapy allowed us to obtain a good overall survival, local relapse-free survival, and distant relapse-free survival in patients presenting with either a primary tumor or with a first time local recurrent tumor.
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Affiliation(s)
- Olivier D R van Wulfften Palthe
- Department of Orthopaedic Surgery, Orthopaedic Oncology Service, Massachusetts General Hospital - Harvard Medical School, 55 Fruit St, Boston, MA 02114, USA.
| | - Isabel Tromp
- Department of Orthopaedic Surgery, Orthopaedic Oncology Service, Massachusetts General Hospital - Harvard Medical School, 55 Fruit St, Boston, MA 02114, USA
| | - Al Ferreira
- Department of Orthopaedic Surgery, Orthopaedic Oncology Service, Massachusetts General Hospital - Harvard Medical School, 55 Fruit St, Boston, MA 02114, USA
| | - Anne Fiore
- Department of Orthopaedic Surgery, Orthopaedic Oncology Service, Massachusetts General Hospital - Harvard Medical School, 55 Fruit St, Boston, MA 02114, USA
| | - Jos A M Bramer
- Department of Orthopaedic Surgery, Amsterdam Medical Center - University Of Amsterdam, Meidreef 9, 1105 AZ, Amsterdam-Zuidoost, The Netherlands
| | - Niek C van Dijk
- Department of Orthopaedic Surgery, Amsterdam Medical Center - University Of Amsterdam, Meidreef 9, 1105 AZ, Amsterdam-Zuidoost, The Netherlands
| | - Thomas F DeLaney
- Department of Radiation Oncology, Massachusetts General Hospital - Harvard Medical School, 55 Fruit St, Boston, MA 02114, USA
| | - Joseph H Schwab
- Department of Orthopaedic Surgery, Orthopaedic Oncology Service, Massachusetts General Hospital - Harvard Medical School, 55 Fruit St, Boston, MA 02114, USA
| | - Francis J Hornicek
- Department of Orthopaedic Surgery, Orthopaedic Oncology Service, Massachusetts General Hospital - Harvard Medical School, 55 Fruit St, Boston, MA 02114, USA
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10
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Sanders PTJ, Bus MPA, Scheper H, van der Wal RJP, van de Sande MAJ, Bramer JAM, Schaap GR, de Boer MGJ, Dijkstra PDS. Multiflora and Gram-Negative Microorganisms Predominate in Infections Affecting Pelvic Endoprostheses Following Tumor Resection. J Bone Joint Surg Am 2019; 101:797-803. [PMID: 31045667 DOI: 10.2106/jbjs.18.00836] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Periprosthetic infections after pelvic reconstruction are common, with reported rates ranging from 11% to 53%. Management of these infections is troublesome, as they commonly necessitate multiple surgical interventions and implant removal. The epidemiology and outcomes of these infections are largely unknown. The aim of this study was to analyze the causative microorganisms and the clinical outcome of treatment in a series of patients with pelvic endoprostheses affected by infection following tumor resection. METHODS In this retrospective, multicenter cohort study, we identified all patients who developed an infection after endoprosthetic reconstruction in periacetabular tumor resection, between 2003 and 2017. The microorganisms that were isolated during the first debridement were recorded, as were the number of reoperations for ongoing infection, the antimicrobial treatment strategy, and the outcome of treatment. RESULTS In a series of 70 patients who underwent pelvic endoprosthetic reconstruction, 18 (26%) developed an infection. The type of pelvic resection according to the Enneking-Dunham classification was type P2-3 in 14 (78%) of these patients and type P2 in 4 (22%). Median follow-up was 66 months. Fourteen (78%) of the 18 patients with infection had a polymicrobial infection. Enterobacteriaceae were identified on culture for 12 (67%). Of a total 42 times that a microorganism was isolated, the identified pathogen was gram-negative in 26 instances (62%). Microorganisms associated with intestinal flora were identified 32 times (76%). At the time of latest follow-up, 9 (50%) of the patients had the original implant in situ. Of these, 2 had a fistula and another 2 were receiving suppressive antibiotic therapy. In the remaining 9 (50%) of the patients, the original implant had been removed. At the time of final follow-up, 3 of these had a second implant in situ. The remaining 6 patients had undergone no secondary reconstruction. CONCLUSIONS Infections that affect pelvic endoprostheses are predominantly polymicrobial and caused by gram-negative microorganisms, and may be associated with intestinal flora. This differs fundamentally from mono-bacterial gram-positive causes of conventional periprosthetic joint infections and may indicate a different pathogenesis. Our results suggest that prophylaxis and empiric treatment may need to be re-evaluated. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- P T J Sanders
- Departments of Orthopedic Surgery (P.T.J.S., M.P.A.B., R.J.P.v.d.W., M.A.J.v.d.S., and P.D.S.D.) and Infectious Diseases (H.S. and M.G.J.d.B.), Leiden University Medical Center, Leiden, the Netherlands
| | - M P A Bus
- Departments of Orthopedic Surgery (P.T.J.S., M.P.A.B., R.J.P.v.d.W., M.A.J.v.d.S., and P.D.S.D.) and Infectious Diseases (H.S. and M.G.J.d.B.), Leiden University Medical Center, Leiden, the Netherlands
| | - H Scheper
- Departments of Orthopedic Surgery (P.T.J.S., M.P.A.B., R.J.P.v.d.W., M.A.J.v.d.S., and P.D.S.D.) and Infectious Diseases (H.S. and M.G.J.d.B.), Leiden University Medical Center, Leiden, the Netherlands
| | - R J P van der Wal
- Departments of Orthopedic Surgery (P.T.J.S., M.P.A.B., R.J.P.v.d.W., M.A.J.v.d.S., and P.D.S.D.) and Infectious Diseases (H.S. and M.G.J.d.B.), Leiden University Medical Center, Leiden, the Netherlands
| | - M A J van de Sande
- Departments of Orthopedic Surgery (P.T.J.S., M.P.A.B., R.J.P.v.d.W., M.A.J.v.d.S., and P.D.S.D.) and Infectious Diseases (H.S. and M.G.J.d.B.), Leiden University Medical Center, Leiden, the Netherlands
| | - J A M Bramer
- Department of Orthopedic Surgery, Academic Medical Center, Amsterdam, the Netherlands
| | - G R Schaap
- Department of Orthopedic Surgery, Academic Medical Center, Amsterdam, the Netherlands
| | - M G J de Boer
- Departments of Orthopedic Surgery (P.T.J.S., M.P.A.B., R.J.P.v.d.W., M.A.J.v.d.S., and P.D.S.D.) and Infectious Diseases (H.S. and M.G.J.d.B.), Leiden University Medical Center, Leiden, the Netherlands
| | - P D S Dijkstra
- Departments of Orthopedic Surgery (P.T.J.S., M.P.A.B., R.J.P.v.d.W., M.A.J.v.d.S., and P.D.S.D.) and Infectious Diseases (H.S. and M.G.J.d.B.), Leiden University Medical Center, Leiden, the Netherlands
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11
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Paulino Pereira NR, Ogink PT, Groot OQ, Ferrone ML, Hornicek FJ, van Dijk CN, Bramer JAM, Schwab JH. Complications and reoperations after surgery for 647 patients with spine metastatic disease. Spine J 2019; 19:144-156. [PMID: 29864546 DOI: 10.1016/j.spinee.2018.05.037] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Revised: 04/29/2018] [Accepted: 05/24/2018] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Postoperative morbidity may offset the potential benefits of surgical treatment for spine metastatic disease; hence, risk factors for postoperative complications and reoperations should be taken into considerations during surgical decision-making. In addition, it remains unknown whether complications and reoperations shorten these patients' survival. PURPOSE We aimed to describe and identify factors associated with having a complication within 30 days of index surgery as well as factors associated with having a subsequent reoperation. Furthermore, we assessed the effect of 30-day complications and reoperations on the patients' postoperative survival, as well as described neurologic changes after surgery. STUDY DESIGN Retrospective cohort study. PATIENT SAMPLE We included 647 patients 18 years and older who had surgery for metastatic disease in the spine between January 2002 and January 2014 in one of two affiliated tertiary care centers. OUTCOME MEASURES Our primary outcomes were complications within 30 days after surgery and reoperations until final follow-up or death. METHODS We used multivariate logistic regression to identify risk factors for 30-day complications and reoperations. We used the Cox regression analysis to assess the effect of postoperative complications and reoperations on survival. RESULTS From 647 included patients, 205 (32%) had a complication within 30 days. The following variables were independently associated with 30-day complications: lower albumin levels (odds ratio [OR]: 0.69, 95% confidence interval [CI]=0.49-0.96, p=.021), additional comorbidities (OR=1.42, 95% CI=1.00-2.01, p=.048), pathologic fracture (OR=1.41, 95% CI=0.97-2.05, p=.031), three or more spine levels operated upon (OR=1.64, 95% CI=1.02-2.64, p=.027), and combined surgical approach (OR=2.44, 95% CI=1.06-5.60, p=.036). One hundred and fifteen patients (18%) had at least one reoperation after the initial surgery; prior radiotherapy (OR=1.56, 95% CI=1.07-2.29, p=.021) to the spinal tumor was independently associated with reoperation. 30-day complications were associated with worse survival (hazard ratio [HR]=1.40, 95% CI=1.17-1.68, p<.001), and reoperation was not significantly associated with worse survival (HR=0.80, 95% CI=0.09-1.00, p=.054). Neurologic status worsened in 42 (6.7%), remained stable in 445 (71%), and improved in 140 (22%) patients after surgery. CONCLUSIONS Three or more spine levels operated upon and prior radiotherapy should prompt consideration of a preoperative plastic surgery consultation regarding soft tissue coverage. Furthermore, if time allows, aggressive nutritional supplementation should be considered for patient with low preoperative serum albumin levels. Surgeons should be aware of the increase in complications in patients presenting with pathologic fracture, undergoing a combined approach, and with any additional preoperative comorbidities. Importantly, 30-day complications were associated with worsened survival.
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Affiliation(s)
- Nuno Rui Paulino Pereira
- Department of Orthopaedic Surgery, Orthopaedic Oncology Service, Massachusetts General Hospital-Harvard Medical School, 55 Fruit St, Boston, MA 02114, USA.
| | - Paul T Ogink
- Department of Orthopaedic Surgery, Orthopaedic Oncology Service, Massachusetts General Hospital-Harvard Medical School, 55 Fruit St, Boston, MA 02114, USA.
| | - Olivier Q Groot
- Department of Orthopaedic Surgery, Orthopaedic Oncology Service, Massachusetts General Hospital-Harvard Medical School, 55 Fruit St, Boston, MA 02114, USA.
| | - Marco L Ferrone
- Department of Orthopaedic Surgery, Orthopaedic Oncology Service, Brigham and Women's Hospital-Harvard Medical School, 75 Francis St, Boston, MA 02115, USA.
| | | | - C N van Dijk
- Department of Orthopaedic Surgery, Academisch Medisch Centrum, Meibergdreef 9, Amsterdam, 1105 AZ, USA.
| | - J A M Bramer
- Department of Orthopaedic Surgery, Academisch Medisch Centrum, Meibergdreef 9, Amsterdam, 1105 AZ, USA.
| | - Joseph H Schwab
- Department of Orthopaedic Surgery, Orthopaedic Oncology Service, Massachusetts General Hospital-Harvard Medical School, 55 Fruit St, Boston, MA 02114, USA.
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12
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Janssen SJ, Langerhuizen DWG, Schwab JH, Bramer JAM. Outcome after reconstruction of proximal femoral tumors: A systematic review. J Surg Oncol 2018; 119:120-129. [DOI: 10.1002/jso.25297] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2018] [Accepted: 10/25/2018] [Indexed: 11/11/2022]
Affiliation(s)
- Stein J. Janssen
- Department of Orthopaedic SurgeryAmphia HospitalBreda The Netherlands
| | - David W. G. Langerhuizen
- Department of Orthopaedic SurgeryAcademic Medical Center, University of AmsterdamAmsterdam The Netherlands
| | - Joseph H. Schwab
- Department of Orthopaedic SurgeryOrthopaedic Oncology Service, Massachusetts General Hospital, Harvard Medical SchoolBoston Massachusetts
| | - Jos A. M. Bramer
- Department of Orthopaedic SurgeryAcademic Medical Center, University of AmsterdamAmsterdam The Netherlands
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Janssen SJ, Bramer JAM, Guitton TG, Hornicek FJ, Schwab JH. Management of metastatic humeral fractures: Variations according to orthopedic subspecialty, tumor characteristics. Orthop Traumatol Surg Res 2018; 104:59-65. [PMID: 29248766 DOI: 10.1016/j.otsr.2017.11.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Revised: 10/03/2017] [Accepted: 11/08/2017] [Indexed: 02/02/2023]
Abstract
HYPOTHESIS This study assessed, if there was a difference in surgical decision making for metastatic humeral lesions based on; orthopaedic subspecialty, tumor characteristics. STUDY TYPE Cross sectional survey study. MATERIALS AND METHODS Twenty-four case scenarios were created by combining: tumor type, life expectancy, fracture type, and anatomical location. Participants were asked for every case: what treatment would you recommend? Participants were 78 (48%) orthopaedic oncologists and 83 (52%) orthopaedic surgeons that were not regularly involved in the treatment of bone tumors. RESULTS There was a difference between orthopaedic oncologists and other subspecialty surgeons in recommendation for specific treatments: intramedullary nailing was less often recommended by orthopaedic oncologists (53%, 95%CI: 47-59) compared to other surgeons (62%, 95%CI: 57-67) (p=0.023); while endoprosthetic reconstruction (orthopaedic oncologists: 8.8% [95%CI: 6.6-11], other surgeons: 3.6%[95%CI: 2.3-4.8], p<0.001) and plate-screw fixation (orthopaedic oncologists: 19%[95%CI: 14-25], other surgeons: 9.5%[95%CI: 5.9-13], p=0.003) were more often recommended by orthopaedic oncologists. There was no difference in recommendation for nonoperative management. There were differences in recommendation for specific treatments based on tumor type, life expectancy, and anatomical location, but not fracture type. DISCUSSION Subspecialty training and patient and tumor characteristics influence the decision for operative management and the decision for a specific implant in metastatic humeral fractures. LEVEL OF EVIDENCE Level 3.
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Affiliation(s)
- S J Janssen
- Research fellow othopaedic surgery, Massachusetts general hospital, room 3.946, Yawket building, 55, Fruit street, 02114 Boston, MA, United States of America; Department of orthopaedic surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America.
| | - J A M Bramer
- Department of orthopaedic surgery, Academic medical center, university of Amsterdam, Amsterdam, Netherlands
| | - T G Guitton
- Department of plastic surgery, university medical center Groningen, Groningen, Nerverlands
| | - F J Hornicek
- Department of orthopaedic surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America
| | - J H Schwab
- Department of orthopaedic surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America
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14
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Paulino Pereira NR, Janssen SJ, Raskin KA, Hornicek FJ, Ferrone ML, Shin JH, Bramer JAM, van Dijk CN, Schwab JH. Most efficient questionnaires to measure quality of life, physical function, and pain in patients with metastatic spine disease: a cross-sectional prospective survey study. Spine J 2017; 17:953-961. [PMID: 28242336 DOI: 10.1016/j.spinee.2017.02.006] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Revised: 01/10/2017] [Accepted: 02/22/2017] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Assessing quality of life, functional outcome, and pain has become important in assessing the effectiveness of treatment for metastatic spine disease. Many questionnaires are able to measure these outcomes; few are validated in patients with metastatic spine disease. As a result, there is no consensus on the ideal questionnaire to use in these patients. PURPOSE Our study aim was to assess whether certain questionnaires measuring quality of life, functional outcome, and pain (1) correlated with each other, (2) measured the construct they claim to measure, (3) had good coverage-floor and ceiling effects, (4) were reliable, and (5) whether there were differences in completion time between them. DESIGN This is a prospective cross-sectional survey study from three outpatient clinics (two orthopedic oncology clinics and one neurosurgery clinic) from two affiliated tertiary hospital care centers. PATIENT SAMPLE We included 100 consecutive patients with metastatic spine disease between July 2014 and February 2016. We excluded non-English-speaking patients. OUTCOME MEASURES The following questionnaires were given in random order: Oswestry Disability Index (ODI) or Neck Disability Index (NDI), Patient-Reported Outcomes Measurement Information System (PROMIS) Physical Function, PROMIS Pain Intensity, EuroQol-5 Dimensions (EQ-5D), and the Spine Oncology Study Group Outcome Questionnaire (SOSG-OQ). METHODS We used exploratory factor analysis-correlating questionnaires with an underlying mathematically derived trait-to assess if questionnaires measured the same concept. Coverage was assessed by floor and ceiling effects, and reliability was assessed by standard error of measurement as a function of ability. Differences in completion times were tested using the Friedman test. RESULTS Questionnaires measured the construct they were developed for, as demonstrated with high correlations (>0.7) with the underlying trait. A floor effect was present in the PROMIS Pain Intensity (7.0%), ODI or NDI (4.0%), and the PROMIS Physical Function (1.0%) questionnaires. A ceiling effect was present in the EQ-5D questionnaire (6.0%). The SOSG-OQ had no floor or ceiling effect. The PROMIS Physical Function and PROMIS Pain Intensity proved to be the most reliable, whereas the EQ-5D was the least reliable. Completion time differed among questionnaires (p<.001) and was shortest for the PROMIS Pain Intensity (median 24 seconds) and PROMIS Physical Function (median 42 seconds). CONCLUSIONS In patients with metastatic spine disease, we recommend the SOSG-OQ for measuring quality of life, the PROMIS Physical Function for measuring physical function, and the PROMIS Pain Intensity for measuring pain.
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Affiliation(s)
- Nuno Rui Paulino Pereira
- Department of Orthopaedic Surgery, Orthopaedic Oncology Service, Massachusetts General Hospital-Harvard Medical School, 55 Fruit St, Boston, MA 02114, USA.
| | - Stein J Janssen
- Department of Orthopaedic Surgery, Orthopaedic Oncology Service, Massachusetts General Hospital-Harvard Medical School, 55 Fruit St, Boston, MA 02114, USA
| | - Kevin A Raskin
- Department of Orthopaedic Surgery, Orthopaedic Oncology Service, Massachusetts General Hospital-Harvard Medical School, 55 Fruit St, Boston, MA 02114, USA
| | - Francis J Hornicek
- Department of Orthopaedic Surgery, Orthopaedic Oncology Service, Massachusetts General Hospital-Harvard Medical School, 55 Fruit St, Boston, MA 02114, USA
| | - Marco L Ferrone
- Department of Orthopaedic Surgery, Orthopaedic Oncology Service, Brigham and Women's Hospital-Harvard Medical School, 75 Francis St, Boston, MA 02115, USA
| | - John H Shin
- Department of Neurosurgery, Massachusetts General Hospital-Harvard Medical School, 55 Fruit St, Boston, MA 02114, USA
| | - Jos A M Bramer
- Department of Orthopaedic Surgery, Academic Medical Center-University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Cornelis Nicolaas van Dijk
- Department of Orthopaedic Surgery, Academic Medical Center-University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Joseph H Schwab
- Department of Orthopaedic Surgery, Orthopaedic Oncology Service, Massachusetts General Hospital-Harvard Medical School, 55 Fruit St, Boston, MA 02114, USA
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15
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van Egmond-van Dam JC, Bekkering WP, Bramer JAM, Beishuizen A, Fiocco M, Dijkstra PDS. Functional outcome after surgery in patients with bone sarcoma around the knee; results from a long-term prospective study. J Surg Oncol 2017; 115:1028-1032. [PMID: 28384378 PMCID: PMC5516165 DOI: 10.1002/jso.24618] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Revised: 02/03/2017] [Accepted: 03/01/2017] [Indexed: 11/18/2022]
Abstract
Background and Objectives In a previous conducted study functional outcome of young patients with bone sarcoma located around the knee was longitudinally evaluated during the first 2 years postoperatively. Functional outcome improved significantly over the first 2 years. The purpose of this descriptive study was to evaluate the functional outcome of these patients at long‐term follow‐up of 7 years. Methods Functional outcome was assessed with the TESS, MSTS, Baecke questionnaire, and three functional performance tests: time up and down stairs (TUDS), various walking activities (VWA), and the 6‐min walking test (6MWT). Linear Mixed Model has been employed for the repeated measurements. Results Twenty patients of the original study (n = 44) participated in the current study. Fifteen limb‐salvage and five ablative surgery patients, median follow‐up 7.4 years (6.8‐8.0) (CI 95%), mean age 22.3 years (18.2‐31.6). Between 2 and 7 years after surgery, 8 limb‐salvage patients (53%) encountered surgery related complications. Questionnaires and functional performance tests showed no significant difference in functional outcome between 2 years and 7 years after surgery (P < 0.05). Conclusions Between 2 years and follow‐up at average 7 years after surgery no further improvements were noticed at young patients with a bone sarcoma located around the knee.
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Affiliation(s)
- Janneke C van Egmond-van Dam
- Department of Orthopedics, Rehabilitation & Physical Therapy, Leiden University Medical Centre, Leiden, Netherlands
| | - W Peter Bekkering
- Department of Orthopedics, Rehabilitation & Physical Therapy, Leiden University Medical Centre, Leiden, Netherlands.,Department of Orthopedic Surgery, Academic Medical Center University of Amsterdam, Amsterdam, Netherlands
| | - Jos A M Bramer
- Department of Orthopedic Surgery, Academic Medical Center University of Amsterdam, Amsterdam, Netherlands
| | - Auke Beishuizen
- Department of Pediatric Oncology/Hematology, Erasmus MC University Medical Center-Sophia Children's Hospital, Rotterdam, Netherlands
| | - Marta Fiocco
- Mathematical Institute Leiden University, Leiden, Netherlands.,Department of Medical Statistics and Bioinformatics, Leiden University Medical Centre, Leiden, Netherlands
| | - P D Sander Dijkstra
- Department of Orthopedics, Rehabilitation & Physical Therapy, Leiden University Medical Centre, Leiden, Netherlands
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Paulino Pereira NR, Mclaughlin L, Janssen SJ, van Dijk CN, Bramer JAM, Laufer I, Bilsky MH, Schwab JH. The SORG nomogram accurately predicts 3- and 12-months survival for operable spine metastatic disease: External validation. J Surg Oncol 2017; 115:1019-1027. [DOI: 10.1002/jso.24620] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2016] [Accepted: 02/28/2017] [Indexed: 11/11/2022]
Affiliation(s)
- Nuno Rui Paulino Pereira
- Department of Orthopaedic Surgery, Orthopaedic Oncology Service; Massachusetts General Hospital-Harvard Medical School; Boston Massachusetts
| | - Lily Mclaughlin
- Department of Neurosurgery; Memorial Sloan Kettering Cancer Center; New York New York
| | - Stein J. Janssen
- Department of General Surgery; Onze Lieve Vrouwe Gasthuis; Amsterdam The Netherlands
| | - Cornelis N. van Dijk
- Department of Orthopaedic Surgery; Academic Medical Center-University of Amsterdam; Amsterdam The Netherlands
| | - Jos A. M. Bramer
- Department of Orthopaedic Surgery; Academic Medical Center-University of Amsterdam; Amsterdam The Netherlands
| | - Ilya Laufer
- Department of Neurosurgery; Memorial Sloan Kettering Cancer Center; New York New York
| | - Mark H. Bilsky
- Department of Neurosurgery; Memorial Sloan Kettering Cancer Center; New York New York
| | - Joseph H. Schwab
- Department of Orthopaedic Surgery, Orthopaedic Oncology Service; Massachusetts General Hospital-Harvard Medical School; Boston Massachusetts
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Bus MPA, van de Sande MAJ, Fiocco M, Schaap GR, Bramer JAM, Dijkstra PDS. Erratum to: What Are the Long-term Results of MUTARS ® Modular Endoprostheses for Reconstruction of Tumor Resection of the Distal Femur and Proximal Tibia? Clin Orthop Relat Res 2017; 475:922. [PMID: 26743621 PMCID: PMC5289152 DOI: 10.1007/s11999-015-4684-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Affiliation(s)
- Michaël P A Bus
- Department of Orthopaedic Surgery, Leiden University Medical Center, Albinusdreef 2, 2300 RC, Leiden, The Netherlands.
| | - Michiel A J van de Sande
- Department of Orthopaedic Surgery, Leiden University Medical Center, Albinusdreef 2, 2300 RC, Leiden, The Netherlands
| | - Marta Fiocco
- Department of Medical Statistics and Bioinformatics, Leiden University Medical Center, Leiden, The Netherlands
- The Mathematical Institute, Leiden University, Leiden, The Netherlands
| | - Gerard R Schaap
- Department of Orthopaedic Surgery, Academic Medical Center, Amsterdam, The Netherlands
| | - Jos A M Bramer
- Department of Orthopaedic Surgery, Academic Medical Center, Amsterdam, The Netherlands
| | - P D Sander Dijkstra
- Department of Orthopaedic Surgery, Leiden University Medical Center, Albinusdreef 2, 2300 RC, Leiden, The Netherlands
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Bus MPA, Szafranski A, Sellevold S, Goryn T, Jutte PC, Bramer JAM, Fiocco M, Streitbürger A, Kotrych D, van de Sande MAJ, Dijkstra PDS. LUMiC ® Endoprosthetic Reconstruction After Periacetabular Tumor Resection: Short-term Results. Clin Orthop Relat Res 2017; 475:686-695. [PMID: 27020434 PMCID: PMC5289170 DOI: 10.1007/s11999-016-4805-4] [Citation(s) in RCA: 65] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Reconstruction of periacetabular defects after pelvic tumor resection ranks among the most challenging procedures in orthopaedic oncology, and reconstructive techniques are generally associated with dissatisfying mechanical and nonmechanical complication rates. In an attempt to reduce the risk of dislocation, aseptic loosening, and infection, we introduced the LUMiC® prosthesis (implantcast, Buxtehude, Germany) in 2008. The LUMiC® prosthesis is a modular device, built of a separate stem (hydroxyapatite-coated uncemented or cemented) and acetabular cup. The stem and cup are available in different sizes (the latter of which is also available with silver coating for infection prevention) and are equipped with sawteeth at the junction to allow for rotational adjustment of cup position after implantation of the stem. Whether this implant indeed is durable at short-term followup has not been evaluated. QUESTIONS/PURPOSES (1) What proportion of patients experience mechanical complications and what are the associated risk factors of periacetabular reconstruction with the LUMiC® after pelvic tumor resection? (2) What proportion of patients experience nonmechanical complications and what are the associated risk factors of periacetabular reconstruction with the LUMiC® after pelvic tumor resection? (3) What is the cumulative incidence of implant failure at 2 and 5 years and what are the mechanisms of reconstruction failure? (4) What is the functional outcome as assessed by Musculoskeletal Tumor Society (MSTS) score at final followup? METHODS We performed a retrospective chart review of every patient in whom a LUMiC® prosthesis was used to reconstruct a periacetabular defect after internal hemipelvectomy for a pelvic tumor from July 2008 to June 2014 in eight centers of orthopaedic oncology with a minimum followup of 24 months. Forty-seven patients (26 men [55%]) with a mean age of 50 years (range, 12-78 years) were included. At review, 32 patients (68%) were alive. The reverse Kaplan-Meier method was used to calculate median followup, which was equal to 3.9 years (95% confidence interval [CI], 3.4-4.3). During the period under study, our general indications for using this implant were reconstruction of periacetabular defects after pelvic tumor resections in which the medial ilium adjacent to the sacroiliac joint was preserved; alternative treatments included hip transposition and saddle or custom-made prostheses in some of the contributing centers; these were generally used when the medial ilium was involved in the tumorous process or if the LUMiC® was not yet available in the specific country at that time. Conventional chondrosarcoma was the predominant diagnosis (n = 22 [47%]); five patients (11%) had osseous metastases of a distant carcinoma and three (6%) had multiple myeloma. Uncemented fixation (n = 43 [91%]) was preferred. Dual-mobility cups (n = 24 [51%]) were mainly used in case of a higher presumed risk of dislocation in the early period of our study; later, dual-mobility cups became the standard for the majority of the reconstructions. Silver-coated acetabular cups were used in 29 reconstructions (62%); because only the largest cup size was available with silver coating, its use depended on the cup size that was chosen. We used a competing risk model to estimate the cumulative incidence of implant failure. RESULTS Six patients (13%) had a single dislocation; four (9%) had recurrent dislocations. The risk of dislocation was lower in reconstructions with a dual-mobility cup (one of 24 [4%]) than in those without (nine of 23 [39%]) (hazard ratio, 0.11; 95% CI, 0.01-0.89; p = 0.038). Three patients (6%; one with a preceding structural allograft reconstruction, one with poor initial fixation as a result of an intraoperative fracture, and one with a cemented stem) had loosening and underwent revision. Infections occurred in 13 reconstructions (28%). Median duration of surgery was 6.5 hours (range, 4.0-13.6 hours) for patients with an infection and 5.3 hours (range, 2.8-9.9 hours) for those without (p = 0.060); blood loss was 2.3 L (range, 0.8-8.2 L) for patients with an infection and 1.5 L (range, 0.4-3.8 L) for those without (p = 0.039). The cumulative incidences of implant failure at 2 and 5 years were 2.1% (95% CI, 0-6.3) and 17.3% (95% CI, 0.7-33.9) for mechanical reasons and 6.4% (95% CI, 0-13.4) and 9.2% (95% CI, 0.5-17.9) for infection, respectively. Reasons for reconstruction failure were instability (n = 1 [2%]), loosening (n = 3 [6%]), and infection (n = 4 [9%]). Mean MSTS functional outcome score at followup was 70% (range, 33%-93%). CONCLUSIONS At short-term followup, the LUMiC® prosthesis demonstrated a low frequency of mechanical complications and failure when used to reconstruct the acetabulum in patients who underwent major pelvic tumor resections, and we believe this is a useful reconstruction for periacetabular resections for tumor or failed prior reconstructions. Still, infection and dislocation are relatively common after these complex reconstructions. Dual-mobility articulation in our experience is associated with a lower risk of dislocation. Future, larger studies will need to further control for factors such as dual-mobility articulation and silver coating. We will continue to follow our patients over the longer term to ascertain the role of this implant in this setting. LEVEL OF EVIDENCE Level IV, therapeutic study.
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Affiliation(s)
- Michaël P. A. Bus
- Department of Orthopaedic Surgery, Leiden University Medical Center, Albinusdreef 2, 2300 RC Leiden, The Netherlands
| | | | | | - Tomasz Goryn
- Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Warsaw, Poland
| | - Paul C. Jutte
- University Medical Center Groningen, Groningen, The Netherlands
| | | | - M. Fiocco
- Department of Medical Statistics and Bioinformatics, Leiden University Medical Center, Leiden, The Netherlands ,Mathematical Institute, Leiden University, Leiden, The Netherlands
| | | | | | - Michiel A. J. van de Sande
- Department of Orthopaedic Surgery, Leiden University Medical Center, Albinusdreef 2, 2300 RC Leiden, The Netherlands
| | - P. D. Sander Dijkstra
- Department of Orthopaedic Surgery, Leiden University Medical Center, Albinusdreef 2, 2300 RC Leiden, The Netherlands
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van der Vliet QMJ, Paulino Pereira NR, Janssen SJ, Hornicek FJ, Ferrone ML, Bramer JAM, van Dijk CN, Schwab JH. What Factors are Associated With Quality Of Life, Pain Interference, Anxiety, and Depression in Patients With Metastatic Bone Disease? Clin Orthop Relat Res 2017; 475:498-507. [PMID: 27752988 PMCID: PMC5213947 DOI: 10.1007/s11999-016-5118-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Accepted: 10/04/2016] [Indexed: 01/31/2023]
Abstract
BACKGROUND It would be helpful for the decision-making process of patients with metastatic bone disease to understand which patients are at risk for worse quality of life (QOL), pain, anxiety, and depression. Normative data, and where these stand compared with general population scores, can be useful to compare and interpret results of similar patients or patient groups, but to our knowledge, there are no such robust data. QUESTIONS/PURPOSES We wished (1) to assess what factors are independently associated with QOL, pain interference, anxiety, and depression in patients with metastatic bone disease, and (2) to compare these outcomes with general US population values. METHODS Between November 2011 and February 2015, 859 patients with metastatic bone disease presented to our orthopaedic oncology clinic; 202 (24%) were included as they completed the EuroQOL-5 Dimension (EQ-5DTM), PROMIS® Pain Interference, PROMIS® Anxiety, and PROMIS® Depression questionnaires as part of a quality improvement program. We did not record reasons for not responding and found no differences between survey respondents and nonrespondents in terms of age (63 versus 64 years; p = 0.916), gender (51% men versus 47% men; p = 0.228), and race (91% white versus 88% white; p = 0.306), but survey responders were more likely to be married or living with a partner (72%, versus 62%; p = 0.001). We assessed risk factors for QOL, pain interference, anxiety, and depression using multivariable linear regression analysis. We used the one-sample signed rank test to assess whether scores differed from US population averages drawn from earlier large epidemiologic studies. RESULTS Younger age (β regression coefficient [β], < 0.01; 95% CI, 0.00-0.01; p = 0.041), smoking (β, -0.12; 95% CI, -0.22 to -0.01; p = 0.026), pathologic fracture (β, -0.10; 95% CI, -0.18 to -0.02; p = 0.012), and being unemployed (β, -0.09; 95% CI, -0.17 to -0.02; p = 0.017) were associated with worse QOL. Current smoking status was associated with more pain interference (β, 6.0; 95% CI, 1.6-11; p = 0.008). Poor-prognosis cancers (β, 3.8; 95% CI, 0.37-7.2; p = 0.030), and pathologic fracture (β, 6.3; 95% CI, 2.5-7.2; p = 0.001) were associated with more anxiety. Being single (β, 5.9; 95% CI, 0.83-11; p = 0.023), and pathologic fracture (β, 4.4; 95% CI, 0.8-8.0; p = 0.017) were associated with depression. QOL scores (0.68 versus 0.85; p < 0.001), pain interference scores (65 versus 50; p < 0.001), and anxiety scores (53 versus 50; p = 0.011) were worse for patients with bone metastases compared with general US population values, whereas depression scores were comparable (48 versus 50; p = 0.171). CONCLUSIONS Impending pathologic fractures should be treated promptly to prevent deterioration in QOL, anxiety, and depression. Our normative data can be used to compare and interpret results of similar patients or patient groups. Future studies could focus on specific cancers metastasizing to the bone, to further understand which patients are at risk for worse patient-reported outcomes. LEVEL OF EVIDENCE Level III, prognostic study.
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Affiliation(s)
- Q M J van der Vliet
- Department of Orthopaedic Surgery, Orthopaedic Oncology Service, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - N R Paulino Pereira
- Department of Orthopaedic Surgery, Orthopaedic Oncology Service, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
- Massachusetts General Hospital, Room 3.946, Yawkey Building, 55 Fruit Street, Boston, MA, 02114, USA.
| | - S J Janssen
- Department of Orthopaedic Surgery, Orthopaedic Oncology Service, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - F J Hornicek
- Department of Orthopaedic Surgery, Orthopaedic Oncology Service, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - M L Ferrone
- Department of Orthopaedic Surgery, Orthopaedic Oncology Service, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - J A M Bramer
- Department of Orthopaedic Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - C N van Dijk
- Department of Orthopaedic Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - J H Schwab
- Department of Orthopaedic Surgery, Orthopaedic Oncology Service, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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Janssen SJ, Teunis T, Hornicek FJ, van Dijk CN, Bramer JAM, Schwab JH. Outcome after fixation of metastatic proximal femoral fractures: A systematic review of 40 studies. J Surg Oncol 2016; 114:507-19. [PMID: 27374478 DOI: 10.1002/jso.24345] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Accepted: 06/13/2016] [Indexed: 12/17/2022]
Abstract
Endoprosthetic reconstruction, intramedullary nailing, and open reduction internal fixation (ORIF) are the most commonly practiced surgical strategies for treatment of metastatic proximal femoral fractures. This review describes functional outcome, local, and systemic complications. All three surgical strategies result in reasonable function on average; however, wide ranges indicate that both poor and good functional levels are obtained. We found that the overall reoperation rate was comparable for endoprosthesis and intramedullary nailing, but was higher for ORIF. J. Surg. Oncol. 2016;114:507-519. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Stein J Janssen
- Department of Orthopaedic Surgery, Orthopaedic Oncology Service Boston, Massachusetts General Hospital-Harvard Medical School, Boston, Massachusetts
| | - Teun Teunis
- Department of Orthopaedic Surgery, Orthopaedic Oncology Service Boston, Massachusetts General Hospital-Harvard Medical School, Boston, Massachusetts
| | - Francis J Hornicek
- Department of Orthopaedic Surgery, Orthopaedic Oncology Service Boston, Massachusetts General Hospital-Harvard Medical School, Boston, Massachusetts
| | - C Niek van Dijk
- Department of Orthopaedic Surgery, Academic Medical Center-University of Amsterdam, Amsterdam, The Netherlands
| | - Jos A M Bramer
- Department of Orthopaedic Surgery, Academic Medical Center-University of Amsterdam, Amsterdam, The Netherlands
| | - Joseph H Schwab
- Department of Orthopaedic Surgery, Orthopaedic Oncology Service Boston, Massachusetts General Hospital-Harvard Medical School, Boston, Massachusetts
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Bus MPA, Bramer JAM, Schaap GR, Schreuder HWB, Jutte PC, van der Geest ICM, van de Sande MAJ, Dijkstra PDS. Hemicortical resection and inlay allograft reconstruction for primary bone tumors: a retrospective evaluation in the Netherlands and review of the literature. J Bone Joint Surg Am 2015; 97:738-50. [PMID: 25948521 DOI: 10.2106/jbjs.n.00948] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Selected primary tumors of the long bones can be adequately treated with hemicortical resection, allowing for optimal function without compromising the oncological outcome. Allografts can be used to reconstruct the defect. As there is a lack of studies of larger populations with sufficient follow-up, little is known about the outcomes of these procedures. METHODS In this nationwide retrospective study, all patients treated with hemicortical resection and allograft reconstruction for a primary bone tumor from 1989 to 2012 were evaluated for (1) mechanical complications and infection, (2) oncological outcome, and (3) failure or allograft survival. The minimum duration of follow-up was twenty-four months. RESULTS The study included 111 patients with a median age of twenty-eight years (range, seven to seventy-three years). The predominant diagnoses were adamantinoma (n = 37; 33%) and parosteal osteosarcoma (n = 18; 16%). At the time of review, 104 patients (94%) were alive (median duration of follow-up, 6.7 years). Seven patients (6%) died, after a median of twenty-six months. Thirty-seven patients (33%) had non-oncological complications, with host bone fracture being the most common (n = 20, 18%); all healed uneventfully. Other complications included nonunion (n = 8; 7%), infection (n = 8; 7%), and allograft fracture (n = 3; 3%). Of ninety-seven patients with a malignant tumor, fifteen (15%) had residual or recurrent tumor and six (6%) had metastasis. The risk of complications and fractures increased with the extent of cortical resection. CONCLUSIONS Survival of hemicortical allografts is excellent. Host bone fracture is the predominant complication; however, none of these fractures necessitated allograft removal in our series. The extent of resection is the most important risk factor for complications. Hemicortical resection is not recommended for high-grade lesions; however, it may be superior to segmental resection for treatment of carefully selected tumors, provided that it is possible to obtain adequate margins. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- M P A Bus
- Department of Orthopaedic Surgery, Leiden University Medical Center, Postzone J11-R70, P.O. Box 9600, 2300 RC Leiden, the Netherlands. E-mail address for M.P.A. Bus:
| | - J A M Bramer
- Department of Orthopaedic Surgery, Academic Medical Center, P.O. Box 22660, 1100 DD Amsterdam, the Netherlands
| | - G R Schaap
- Department of Orthopaedic Surgery, Academic Medical Center, P.O. Box 22660, 1100 DD Amsterdam, the Netherlands
| | - H W B Schreuder
- Department of Orthopaedic Surgery, Radboud University Medical Center, Nijmegen, Postzone 357, P.O. Box 9101, 6500 HB Nijmegen, the Netherlands
| | - P C Jutte
- Department of Orthopaedic Surgery, University Medical Center Groningen, Groningen, P.O. Box 30.001, 9700 RB Groningen, the Netherlands
| | - I C M van der Geest
- Department of Orthopaedic Surgery, Radboud University Medical Center, Nijmegen, Postzone 357, P.O. Box 9101, 6500 HB Nijmegen, the Netherlands
| | - M A J van de Sande
- Department of Orthopaedic Surgery, Leiden University Medical Center, Postzone J11-R70, P.O. Box 9600, 2300 RC Leiden, the Netherlands. E-mail address for M.P.A. Bus:
| | - P D S Dijkstra
- Department of Orthopaedic Surgery, Leiden University Medical Center, Postzone J11-R70, P.O. Box 9600, 2300 RC Leiden, the Netherlands. E-mail address for M.P.A. Bus:
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Janssen SJ, Teunis T, Hornicek FJ, Bramer JAM, Schwab JH. Outcome of operative treatment of metastatic fractures of the humerus: a systematic review of twenty three clinical studies. Int Orthop 2014; 39:735-46. [PMID: 25398471 DOI: 10.1007/s00264-014-2584-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/24/2014] [Accepted: 10/24/2014] [Indexed: 12/19/2022]
Abstract
PURPOSE This systematic review aims to provide an overview of functional outcome and complications after surgery for metastatic humerus fractures. METHODS A literature search was performed in September 2013 using the Pubmed, Embase and Cochrane database. We included 23 studies reporting on 29 treatment arms: intramedullary nailing (19 studies, 596 cases), plate-screw fixation (five studies, 150 cases), endoprosthetic reconstruction (three studies, 81 cases), and diaphysis prosthesis (two studies, 82 cases), totalling 909 fractures. There were 414 pathological and 56 impending fractures. In 439 cases the type of fracture was not specified. Four studies reported functional outcome. RESULTS Average Musculoskeletal Tumor Society score ranged from 64 to 79 (three studies, 100 patients) after intramedullary nailing, was 90 (one study, 24 patients) after plate-screw fixation, and 73 (one study, 30 patients) after endoprosthetic reconstruction. Re-operation rate varied from 0 to 10 % after intramedullary nailing (overall 4.4 %), 5-14 % after plate-screw fixation (overall 9.3 %), 14-16 % after diaphysis prosthesis (overall 14.6 %), and 0-6 % after endoprosthetic reconstruction (overall 2.5 %). Systemic complication rate varied between 0 and 26 % after intramedullary nailing (overall 2.2 %), between 0 and 6 % after plate-screw fixation (overall 4.8 %), was 0 % after endoprosthetic reconstruction, and varied between 0 and 16 % after diaphysis prosthesis (overall 9.7 %). CONCLUSIONS Reported complication rates help surgeons inform their patients and could aid in surgical decision making. Functional outcome, pain and quality of life were poorly reported. Patient reported outcomes are therefore an important direction for future research.
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Affiliation(s)
- Stein J Janssen
- Department of Orthopaedic Surgery Orthopaedic Oncology Service, Massachusetts General Hospital - Harvard Medical School, Room 3.946, Yawkey building, 55 Fruit Street, Boston, MA, 02114, USA,
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van der Heijden L, van de Sande MAJ, van der Geest ICM, Schreuder HWB, van Royen BJ, Jutte PC, Bramer JAM, Öner FC, van Noort-Suijdendorp AP, Kroon HM, Dijkstra PDS. Giant cell tumors of the sacrum--a nationwide study on midterm results in 26 patients after intralesional excision. Eur Spine J 2014; 23:1949-62. [PMID: 24614982 DOI: 10.1007/s00586-014-3263-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/10/2013] [Revised: 02/20/2014] [Accepted: 02/20/2014] [Indexed: 10/25/2022]
Abstract
PURPOSE Evaluation of recurrences, complications and function at mid-term follow-up after curettage for sacral giant cell tumor (GCT). METHODS We retrospectively studied all 26 patients treated for sacral GCT in the Netherlands (from 1990 to 2010). Median follow-up was 98 (6-229) months. All patients underwent intralesional excision, 21 with local adjuvants, 5 radiotherapy, 3 IFN-α, 1 bisphosphonates. Functional outcome was assessed using Musculoskeletal Tumor Society (MSTS) score. Statistics were performed with Kaplan-Meier, Cox regression, log rank and Mann-Whitney U. RESULTS Recurrence rate was 14/26 after median 13 (3-139) months and was highest after isolated curettage (4/5). Soft tissue masses >10 cm increased recurrence risk (HR = 3.3, 95 % CI = 0.81-13, p = 0.09). Complications were reported in 12/26 patients. MSTS was superior in patients without complications (27 vs. 21; p = 0.024). CONCLUSION Recurrence rate for sacral GCT was highest after isolated curettage, indicating that (local) adjuvant treatment is desired to obtain immediate local control. Complications were common and impaired function.
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Affiliation(s)
- L van der Heijden
- Department of Orthopedic Surgery, Leiden University Medical Center (LUMC), Postzone J11-70, PO Box 9600, 2300 RC, Leiden, The Netherlands,
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Bus MPA, Dijkstra PDS, van de Sande MAJ, Taminiau AHM, Schreuder HWB, Jutte PC, van der Geest ICM, Schaap GR, Bramer JAM. Intercalary allograft reconstructions following resection of primary bone tumors: a nationwide multicenter study. J Bone Joint Surg Am 2014; 96:e26. [PMID: 24553895 DOI: 10.2106/jbjs.m.00655] [Citation(s) in RCA: 95] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Favorable reports on the use of massive allografts to reconstruct intercalary defects underline their place in limb-salvage surgery. However, little is known about optimal indications as reports on failure and complication rates in larger populations remain scarce. We evaluated the incidence of and risk factors for failure and complications, time to full weight-bearing, and optimal fixation methods for intercalary allografts after tumor resection. METHODS A retrospective study was performed in all four centers of orthopaedic oncology in the Netherlands. All consecutive patients reconstructed with intercalary (whole-circumference) allografts after tumor resection in the long bones during 1989 to 2009 were evaluated. The minimum follow-up was twenty-four months. Eighty-seven patients with a median age of seventeen years (range, 1.5 to 77.5 years) matched inclusion criteria. The most common diagnoses were osteosarcoma, Ewing sarcoma, adamantinoma, and chondrosarcoma. The median follow-up period was eighty-four months (range, twenty-five to 262 months). Ninety percent of tumors were localized in the femur or the tibia. RESULTS Fifteen percent of our patients experienced a graft-related failure. The major complications were nonunion (40%), fracture (29%), and infection (14%). Complications occurred in 76% of patients and reoperations were necessary in 70% of patients. The median time to the latest complication was thirty-two months (range, zero to 200 months). The median time to full weight-bearing was nine months (range, one to eighty months). Fifteen grafts failed, twelve of which failed in the first four years. None of the thirty-four tibial reconstructions failed. Reconstruction site, patient age, allograft length, nail-only fixation, and non-bridging osteosynthesis were the most important risk factors for complications. Adjuvant chemotherapy and irradiation had no effects on complication rates. CONCLUSIONS We report high complication rates and considerable failure rates for the use of intercalary allografts; complications primarily occurred in the first years after surgery, but some occurred much later after surgery. To reduce the number of failures, we recommend reconsidering the use of allografts for reconstructions of defects that are ≥15 cm, especially in older patients, and applying bridging osteosynthesis with use of plate fixation.
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Affiliation(s)
- M P A Bus
- Department of Orthopaedic Surgery, Academic Medical Center, P.O. Box 22660, 1100 DD Amsterdam, The Netherlands. E-mail address for J.A.M. Bramer:
| | - P D S Dijkstra
- Department of Orthopaedic Surgery, Leiden University Medical Center, Postzone J11-R70, P.O. Box 9600, 2300 RC Leiden, The Netherlands
| | - M A J van de Sande
- Department of Orthopaedic Surgery, Leiden University Medical Center, Postzone J11-R70, P.O. Box 9600, 2300 RC Leiden, The Netherlands
| | - A H M Taminiau
- Department of Orthopaedic Surgery, Leiden University Medical Center, Postzone J11-R70, P.O. Box 9600, 2300 RC Leiden, The Netherlands
| | - H W B Schreuder
- Department of Orthopaedic Surgery, Radboud University Nijmegen Medical Center, Postzone 357, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
| | - P C Jutte
- Department of Orthopaedic Surgery, University Medical Center Groningen, P.O. Box 30.001, 9700 RB Groningen, The Netherlands
| | - I C M van der Geest
- Department of Orthopaedic Surgery, Radboud University Nijmegen Medical Center, Postzone 357, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
| | - G R Schaap
- Department of Orthopaedic Surgery, Academic Medical Center, P.O. Box 22660, 1100 DD Amsterdam, The Netherlands. E-mail address for J.A.M. Bramer:
| | - J A M Bramer
- Department of Orthopaedic Surgery, Academic Medical Center, P.O. Box 22660, 1100 DD Amsterdam, The Netherlands. E-mail address for J.A.M. Bramer:
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Hoornenborg D, Veltman ES, Oldenburger F, Bramer JAM, Schaap GR. A patient with scapular Ewing sarcoma; 5-year follow-up after extracorporeal irradiation and re-implantation of the scapula, a case report. J Bone Oncol 2013; 2:30-2. [PMID: 26909269 PMCID: PMC4723359 DOI: 10.1016/j.jbo.2012.12.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2012] [Revised: 12/13/2012] [Accepted: 12/17/2012] [Indexed: 12/16/2022] Open
Abstract
In 2007 a 9½-year-old boy was treated with resection, extracorporeal irradiation and re-implantation of the right scapula. He also received chemotherapy. During five year follow-up shoulder function remained largely intact. Subtotal resorption of the scapula occurred, leaving only the glenohumeral joint intact. Sensibility and strength are intact. To date there is no sign of local or metastatic recurrence.
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Affiliation(s)
- Daniel Hoornenborg
- Department of Orthopaedic Surgery, Academic Medical Center Amsterdam, Meibergdreef 9, 1100 DD Amsterdam, the Netherlands
| | - Ewout S Veltman
- Department of Orthopaedic Surgery, Academic Medical Center Amsterdam, Meibergdreef 9, 1100 DD Amsterdam, the Netherlands
| | - Foppe Oldenburger
- Department of Radiotherapy, Academic Medical Center Amsterdam, Meibergdreef 9, 1100 DD Amsterdam, the Netherlands
| | - Jos A M Bramer
- Department of Orthopaedic Surgery, Academic Medical Center Amsterdam, Meibergdreef 9, 1100 DD Amsterdam, the Netherlands
| | - Gerard R Schaap
- Department of Orthopaedic Surgery, Academic Medical Center Amsterdam, Meibergdreef 9, 1100 DD Amsterdam, the Netherlands
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Abstract
Juxta-articular myxoma is a benign lesion usually presenting as a slow-growing, well-circumscribed mass. Occasionally, however, the lesion grows rapidly and is poorly circumscribed, and it is this clinical presentation that arouses suspicion of malignancy. Furthermore, on histology a myxoma can also be confused with a variety of sarcomas. We present a case of juxta-articular myxoma and discuss the possible diagnostic dilemmas involved.
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van Ooij B, Bramer JAM. [A woman with a swelling of her left upper leg]. Ned Tijdschr Geneeskd 2011; 155:A2151. [PMID: 21771375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
A 27-year-old woman came to the clinic with a tumour of her left upper leg: grade I chondrosarcoma, transformed from an osteochondroma. Radical excision with a total hip arthroplasty using a tumour prosthesis was performed.
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Affiliation(s)
- Bas van Ooij
- Academisch Medisch Centrum, Orthopaedic Research Center Amsterdam, Amsterdam, the Netherlands.
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van de Sande MAJ, Bramer JAM, Jutte PC, Schreuder HWB, Dijkstra PDS. [Diagnosis and treatment of bone metastasis]. Ned Tijdschr Geneeskd 2010; 154:A2125. [PMID: 21029490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
The improved prognosis of cancer patients has led to an increased incidence of both bone metastases and (impending) pathological fractures. A solitary bone lesion seen on radiography should never be assumed to be a metastasis. Preoperative biopsy is necessary in patients with a known malignancy and a solitary lytic bone lesion as well as in patients in whom the primary tumor is unknown, in order to prevent an incorrect operation (also known as 'whoops surgery'). If the patient has an (impending) pathological fracture, normal bone healing is not to be expected, not even after stable fixation. Surgical fixation of an impending pathologic fracture is recommended when radiography indicates that a length of more than 3 cm of the cortex of a long bone has been destroyed. If surgical treatment is necessary, it should support the whole long bone in order to enable full weight bearing. When the diagnosis of a bone lesion is uncertain, referral to an experienced treatment centre is recommended.
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Affiliation(s)
- Jos A M Bramer
- Department of Orthopedic Surgery, Leiden University Medical Center, Leiden, the Netherlands
| | - Antonie H M Taminiau
- Department of Orthopedic Surgery, Leiden University Medical Center, Leiden, the Netherlands
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Giele BM, Wiertsema SH, Beelen A, van der Schaaf M, Lucas C, Been HD, Bramer JAM. No evidence for the effectiveness of bracing in patients with thoracolumbar fractures. Acta Orthop 2009; 80:226-32. [PMID: 19404808 PMCID: PMC2823176 DOI: 10.3109/17453670902875245] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND AND PURPOSE The use of braces is widespread in patients with thoracolumbar fractures. The effectiveness of bracing, however, is controversial. We sought evidence for the effect of bracing in patients with traumatic thoracolumbar fractures based on outcome and length of hospital stay (LOS). Furthermore, we evaluated the incidence of complications of bracing. METHODS An electronic search strategy with extensive MeSH headings was used in various databases to identify studies that compared bracing and non-bracing therapies. Two reviewers independently selected systematic reviews, randomized controlled trials (RCTs), controlled clinical trials, and observational studies, and both assessed the methodological quality and extracted the data. RESULTS No systematic reviews or RCTs were found. 7 retrospective studies were included. None of these studies showed an effect of bracing. Because of poor methodological quality, no best-evidence synthesis could be performed. One observational study was selected in which a complication of bracing was reported. INTERPRETATION In the present literature, there is no evidence for the effectiveness of bracing in patients with traumatic thoracolumbar fractures. The lack of high-quality studies prevents relevant conclusions from being drawn.
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Affiliation(s)
| | - Suzanne H Wiertsema
- Department of Rehabilitation Medicine, Section of Physical Therapy, VU University Medical CenterAmsterdamthe Netherlands
| | - Anita Beelen
- Department of RehabilitationAmsterdamthe Netherlands
| | | | - Cees Lucas
- Department of Clinical Epidemiology and BiostatisticsAmsterdam the Netherlands
| | - Henk D Been
- Department of Orthopaedic Surgery, Academic Medical Center, University of AmsterdamAmsterdamthe Netherlands
| | - Jos A M Bramer
- Department of Orthopaedic Surgery, Academic Medical Center, University of AmsterdamAmsterdamthe Netherlands
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Pakos EE, Nearchou AD, Grimer RJ, Koumoullis HD, Abudu A, Bramer JAM, Jeys LM, Franchi A, Scoccianti G, Campanacci D, Capanna R, Aparicio J, Tabone MD, Holzer G, Abdolvahab F, Funovics P, Dominkus M, Ilhan I, Berrak SG, Patino-Garcia A, Sierrasesumaga L, San-Julian M, Garraus M, Petrilli AS, Filho RJG, Macedo CRPD, Alves MTDS, Seiwerth S, Nagarajan R, Cripe TP, Ioannidis JPA. Prognostic factors and outcomes for osteosarcoma: an international collaboration. Eur J Cancer 2009; 45:2367-75. [PMID: 19349163 DOI: 10.1016/j.ejca.2009.03.005] [Citation(s) in RCA: 133] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2009] [Accepted: 03/09/2009] [Indexed: 11/30/2022]
Abstract
We aimed to evaluate the prognostic significance of traditional clinical predictors in osteosarcoma through an international collaboration of 10 teams of investigators (2680 patients) who participated. In multivariate models the mortality risk increased with older age, presence of metastatic disease at diagnosis, development of local recurrence when the patient was first seen, use of amputation instead of limb salvage/wide resection, employment of unusual treatments, use of chemotherapeutic regimens other than anthracycline and platinum and use of methotrexate. It was also influenced by the site of the tumour. The risk of metastasis increased when metastatic disease was present at the time the patient was first seen and also increased with use of amputation or unusual treatment combinations or chemotherapy regimens not including anthracycline and platinum. Local recurrence risk was higher in older patients, in those who had local recurrence when first seen and when no anthracycline and platinum were used in chemotherapy. Results were similar when limited to patients seen after 1990 and treated with surgery plus combination chemotherapy. This large-scale international collaboration identifies strong predictors of major clinical outcomes in osteosarcoma.
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Affiliation(s)
- Emilios E Pakos
- Clinical and Molecular Epidemiology Unit, Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, Ioannina 45110, Greece
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Bramer JAM, van Linge JH, Grimer RJ, Scholten RJPM. Prognostic factors in localized extremity osteosarcoma: a systematic review. Eur J Surg Oncol 2009; 35:1030-6. [PMID: 19232880 DOI: 10.1016/j.ejso.2009.01.011] [Citation(s) in RCA: 117] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2008] [Revised: 01/14/2009] [Accepted: 01/20/2009] [Indexed: 10/21/2022] Open
Abstract
AIM Finding reliable prognostic factors for osteosarcoma remains problematic. A systematic review [Davis AM, Bell RS, Goodwin PJ. Prognostic factors in osteosarcoma: a critical review. Journal of Clinical Oncology 1994; 12(2): 423-431.] showed chemotherapy response as only independent factor. We tried to identify evidence-based prognostic factors in the literature since 1992 and to establish pooled relative risks of factors. METHODS MEDLINE and Embase search (1992-August 2006). Two reviewers independently selected papers addressing prognostic factors in localized extremity osteosarcoma, which were studied for methodological quality, and valuable new factors. An attempt was made to pool results. RESULTS Of 1777 "hits", 93 papers were studied in depth. Several "new" prognostic factors were found. Only 7 papers were of sufficient quality to analyze. Chemotherapy response, tumor size and site, alkaline phosphatase level and p-glycoprotein expression seemed to be independent factors. Some new factors looked promising. CONCLUSIONS Although the literature is abundant, it is disappointing that only few papers are of sufficient quality to allow hard conclusions. Because of heterogeneity of the studies pooling results is hardly possible. There is a need for standardization of studies and reports.
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Affiliation(s)
- J A M Bramer
- Department of Orthopedic Surgery (G4 221), Academic Medical Center, Meibergdreef 9, P.O. Box 22660, 1100 DD Amsterdam, The Netherlands.
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Bramer JAM, Abudu AA, Grimer RJ, Carter SR, Tillman RM. Do pathological fractures influence survival and local recurrence rate in bony sarcomas? Eur J Cancer 2007; 43:1944-51. [PMID: 17698347 DOI: 10.1016/j.ejca.2007.07.004] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2007] [Revised: 06/28/2007] [Accepted: 07/04/2007] [Indexed: 10/23/2022]
Abstract
The influence of pathological fracture on surgical management, local recurrence and survival was established in patients with high grade, localised, extremity osteosarcoma (n=484), chondrosarcoma (n=130) and Ewing's sarcoma (n=156). Limb salvage was possible in 79% of patients with a fracture compared to 84% of patients without a fracture (p=0.17). No difference in local recurrence was found between fracture and control groups. In univariate analysis, survival in the fracture group was lower than in the control group for osteosarcoma (34% versus 58%, p<0.01) and chondrosarcoma (35% versus 63%, p=0.04), but not for Ewing's sarcoma (75% versus 64%, p=0.80). In multivariate analysis, fracture remained a significant predictor of survival for osteosarcoma, but not for chondrosarcoma, where dedifferentiated subtype appeared to be decisive. Pathological fracture independently predicts worse survival in osteosarcoma, but not chondrosarcoma and Ewing's sarcoma. Limb saving surgery seems safe, if adequate resection margins are achieved.
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MESH Headings
- Adolescent
- Adult
- Aged
- Aged, 80 and over
- Arm Bones/injuries
- Bone Neoplasms/mortality
- Bone Neoplasms/pathology
- Bone Neoplasms/surgery
- Child
- Child, Preschool
- Chondrosarcoma/mortality
- Chondrosarcoma/pathology
- Chondrosarcoma/surgery
- Female
- Fractures, Spontaneous/mortality
- Fractures, Spontaneous/pathology
- Fractures, Spontaneous/surgery
- Humans
- Leg Bones/injuries
- Limb Salvage
- Male
- Middle Aged
- Multivariate Analysis
- Neoplasm Recurrence, Local/etiology
- Neoplasm Recurrence, Local/mortality
- Osteosarcoma/mortality
- Osteosarcoma/pathology
- Osteosarcoma/surgery
- Prognosis
- Retrospective Studies
- Sarcoma, Ewing/mortality
- Sarcoma, Ewing/pathology
- Sarcoma, Ewing/surgery
- Survival Analysis
- Treatment Outcome
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Affiliation(s)
- J A M Bramer
- Department of Orthopaedic Surgery G4-244, Academic Medical Center, Meibergdreef 9, PO Box 22660, 1100 DD Amsterdam, The Netherlands.
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Bramer JAM, Abudu AA, Tillman RM, Carter SR, Sumathi VP, Grimer RJ. Pre- and post-chemotherapy alkaline phosphatase levels as prognostic indicators in adults with localised osteosarcoma. Eur J Cancer 2005; 41:2846-52. [PMID: 16274987 DOI: 10.1016/j.ejca.2005.07.024] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2005] [Revised: 07/12/2005] [Accepted: 07/27/2005] [Indexed: 11/18/2022]
Abstract
The prognostic value of alkaline phosphatase (AP) measured before and after chemotherapy, but before surgery was established in a retrospective survey of patients. The patients were 18 years or older, with non-metastatic high-grade osteosarcoma. Pre-chemotherapy AP was available in 89 cases, post-chemotherapy AP in 86 patients, and both in 71 cases. AP was classified as Normal (< 100% upper limit), High (100% < or = AP < 200%) or Very High (AP > or = 200%). Osteosarcoma subtype was predominantly conventional. No correlation was found between subtype and chemotherapy response, local recurrence or survival. Pre-chemotherapy AP was raised more in the osteoblastic subtype. Post-chemotherapy AP and normalisation were the same among different subtypes. AP was not correlated with local recurrence. Normal or High pre-chemotherapy AP correlated with better survival at 10 years (64% and 70%) than Very High pre-chemotherapy AP (37%, P = 0.005). Post-chemotherapy AP correlated with survival (68%, 39% and 25% in the Normal, High and Very High group, P = 0.0007) and response to chemotherapy (P = 0.049). A pre-chemotherapy AP above twice Normal correlated with worse survival. If AP decreased after chemotherapy, but was still raised, survival was better, but still worse than if AP normalised. A raised post-chemotherapy AP predicts poor chemotherapy response.
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Affiliation(s)
- Jos A M Bramer
- Royal Orthopaedic Hospital, Bristol Road South, Northfield, Birmingham B31 2AP, UK.
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Bramer JAM, Taminiau AHM. Reconstruction of the pelvic ring with an autograft after hindquarter amputation: improvement of sitting stability and prosthesis support. Acta Orthop 2005; 76:453-4. [PMID: 16156478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Affiliation(s)
- Jos A M Bramer
- Department of Orthopedic Surgery, Leiden University Medical Center, Leiden, The Netherlands
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Bramer JAM, Gubler FM, Maas M, Bras H, de Kraker J, van der Eijken JW, Schaap GR. Colour Doppler ultrasound predicts chemotherapy response, but not survival in paediatric osteosarcoma. Pediatr Radiol 2004; 34:614-9. [PMID: 15148555 DOI: 10.1007/s00247-004-1210-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2003] [Revised: 03/31/2004] [Accepted: 04/02/2004] [Indexed: 10/26/2022]
Abstract
BACKGROUND Histological response to chemotherapy is an important prognostic factor in osteosarcoma, influencing therapeutic considerations. It would be advantageous to be able to assess chemotherapy response, and predict survival, prior to tumour resection. Colour Doppler US (CDUS) is non-invasive, non-demanding for the patient, and easy to plan. This makes the method especially suitable for children, who comprise the majority of patients. OBJECTIVE To establish the value of CDUS for pre-operative prediction of chemotherapy response and survival, using widely available US equipment. MATERIALS AND METHODS CDUS was performed in 21 consecutive patients before and after chemotherapy. Peak systolic velocity (PSV) in the soft-tissue component of the tumour and quotient of resistive index (QRI) of the feeding artery and contralateral control were calculated. A pathologist, unaware of CDUS results, assessed the response to chemotherapy after resection. RESULTS QRI change after chemotherapy was significantly higher in histological responders. No correlation of QRI change with survival was found. There was no significant difference in PSV change comparing any subgroup. CDUS appeared useful in predicting chemotherapy response (sensitivity 83%, specificity 86%), especially for negative response (predictive value 92%). Survival could not be predicted accurately. CONCLUSIONS CDUS can predict chemotherapy response, but not survival. The method could be useful in planning treatment prior to definitive surgery.
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Affiliation(s)
- Jos A M Bramer
- Department of Orthopaedic Surgery, Academic Medical Centre, P.O. Box 22660, 1100 DD Amsterdam, The Netherlands.
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Abstract
In the past, osteochondritis dissecans of the knee was associated with increased tibial exotorsion, established with a clinical measuring method. Now the gold standard for determining tibial torsion is computed tomography. The aim of the current study was to establish whether the abovementioned association could be confirmed in the current patients, measured with computed tomography. Confounding aberrations of femoral torsion were ruled out. Twenty-three patients with osteochondritis dissecans in 27 knees were treated between 1991 and 1999. Symptoms and treatment results were comparable with those reported in the literature. Femoral and tibial torsion were measured with a computed tomography scan. The average femoral antetorsion was comparable with that in the literature. The average tibial exotorsion was significantly higher than the control value. Exotorsion was increased more in patients with bilateral osteochondritis, and extremely high in patients with persisting complaints. Increased tibial exotorsion could play a role in development of osteochondritis dissecans of the knee. Extreme exotorsion might be prognostic for persistent complaints.
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Affiliation(s)
- J A M Bramer
- Orthopaedic Research Center Amsterdam, Amsterdam, the Netherlands.
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den Boer FC, Bramer JAM, Blokhuis TJ, Van Soest EJ, Jenner JMGT, Patka P, Bakker FC, Burger EH, Haarman HJTM. Effect of recombinant human osteogenic protein-1 on the healing of a freshly closed diaphyseal fracture. Bone 2002; 31:158-64. [PMID: 12110429 DOI: 10.1016/s8756-3282(02)00816-5] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Osteogenic protein-1 (OP-1), or bone morphogenetic protein-7, is an osteoinductive morphogen that is involved in embryonic skeletogenesis and in bone repair. In bone defect models without spontaneous healing, local administration of recombinant human OP-1 (rhOP-1) induces complete healing. To investigate the ability of rhOP-1 to accelerate normal physiologic fracture healing, an experimental study was performed. In 40 adult female goats a closed tibial fracture was made, stabilized with an external fixator, and treated as follows: (1) no injection; (2) injection of 1 mg rhOP-1 dissolved in aqueous buffer; (3) injection of collagen matrix; and (4) injection of 1 mg rhOP-1 bound to collagen matrix. The test substances were injected in the fracture gap under fluoroscopic control. At 2 and 4 weeks, fracture healing was evaluated with radiographs, three-dimensional computed tomography (CT), dual-energy X-ray absorptiometry, biomechanical tests, and histology. At 2 weeks, callus diameter, callus volume, and bone mineral content at the fracture site were significantly increased in both rhOP-1 groups compared with the no-injection group. As signs of accelerated callus maturation, bending and torsional stiffness were higher and bony bridging of the fracture gap was observed more often in the group with rhOP-1 dissolved in aqueous buffer than in uninjected fractures. Treatment with rhOP-1 plus collagen matrix did not result in improved biomechanical properties or bony bridging of the fracture gap at 2 weeks. At 4 weeks there were no differences between groups, except for a larger callus volume in the rhOP-1 plus collagen matrix group compared with the control groups. All fractures showed an advanced stage of healing at 4 weeks. In conclusion, the healing of a closed fracture in a goat model can be accelerated by a single local administration of rhOP-1. The use of a carrier material does not seem to be crucial in this application of rhOP-1.
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Affiliation(s)
- F C den Boer
- Department of Surgery, VU University Medical Centre, Amsterdam, The Netherlands.
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