Introduction: Most of the bone metastases have origin in breast, lung, prostate, thyroid and kidney neoplasms. The commonest locations are the axial skeleton and the proximal region of the long bones, being the femur the most affected one. The main objectives of the surgical treatment are a quick functional recuperation and immediate pain relief.

Objectives: The aim of this work was to define a strategy for the surgical treatment of the bone methastasis located in the femur.

Material: The study includes 94 patients with femoral methastasis (100 metastasis) surgicaly treated in the last 10 years in our department.

Methods: Retrospective descriptive study based on medical records evaluation.

Results: The proximal third of the femur was involved in 80 % of the cases. Pathological fracture was identified in 72 cases and impending fracture in 28. Half of the primitive neoplasms was originated in the breast. It was identified as solitary metastatic lesion only in 33 % of the situations. The mean patient survival time was 9,2 months. They were treated with a cemented calcar-replacing prosthesis in 40 patients, 10 patients submited to conventional arthroplasty and 36 with intramedullary fixation (usually a cephalomedullary nail). The remainder 14 were treated with other surgical techniques.

Discussion: The surgery is indicated in case of painful lytic injury or unresponsive to radiotherapy, pathological or impending fracture. The surgical technique depends on the location and size of the lesion and if it is a solitary or multiple bone lesion, choosing between arthroplasties, of preference with long femoral stem, and intramedullary fixation. As we have performed a retrospective study, a functional rigorous evaluation was not possible.

Conclusion: The treatment of metastatic femoral disease is not performed with the intention of cure but to improve significantly the patient’s life quality. The proximal third of the femur is the most reached place. Breast cancer was responsible for around 50 % of the cases. In 50% of the patients the surgical option was an arthroplasty and techniques of femoral nailing were performed in 36%. The cemented replacement prosthesis is used in proximal large injuries with periarticular involvement: The intramedullary fixation is reserved for situations in which the femoral head and neck are not involved. The length of patient survival must exceed the predictable surgical recovery period.

Introduction: Soft tissue sarcomas (STS) are rare tumors. A multidisciplinary approach including surgery, chemotherapy and radiation therapy is recommended.

Materials and Methods: In the last 12 years, 249 patients with STS were teated in our Institution. All of them were treted with a multidisciplinary approach using all or some of the previous refered treatments.

Results: The overall local recurrence rate in the group of patients submited to surgery was 25% and this factor was related mostly with contaminated margins. Surgical resections were associted with soft tissue reconstructions when needed.

Radiation therapy was used in both regimens pre and post operativly, chemotherapy was also used in 85% of the patients, and was not dependent of tumor histotype.

23 patients were submited to surgery of lung metastasis.

Survival rates were determined and compared with stage (AJCC), tumor histotype and surgical margins.

Conclusions: Multidisciplinary approach is the recommended treatment for STS.

Background: A variety of molecular markers related to survival, have been studied in a variety of human neoplasms, particularly in carcinomas, but their significance in osteosarcoma patients is largely unknown. The purpose of this archival study was to determine if there is a correlation between their expression and disease-free and overall survival for patients with osteosarcoma.

Materials and Methods: 93 patients with stage IIB osteosarcomas originating around the knee (distal femur and proximal tibia)were studied. Tumors were evaluated with antibodies to Bcl-2, p53, Fas, Fas L, CD44s, CD44v6, and P-glycoprotein using standard avidinbiotin complex methods. Expression of the various antigens was statisticaly compared to disease-free and overall survival.

Results: Fas (p< 0.05) and Cd44v6 (p< 0.03), were significant and related with the purpose of study; P-glycoprotein was near and the others with no significance.

Conclusions: Fas appears to have a “protective” function in osteosarcoma, probably by allowing tumor cells to proceed through apoptosis pathway to cell death. Although CD44v6, a vascular adhesion molecule, was identified in only 14% of the total cases, its expression correlated with subsequent development of metastases and death (11 of the 13 patients developed pulmonary metastases dying of disease). Although P-glycoprotein did not reach significance, there was a trend toward death from disease in patients expressing it.

In the last ten years, 172 bone sarcomas and 126 soft tissue sarcomas, were treated by our Orthopaedic Oncology Unit. From those patients 49 (16.5%) meet criteria for pulmonary metastasis resection. Patient group were 27 males (55%) and 22 females (45%); median age 28.8 years (range 12–71); histology of the primary tumours were in 33 cases bone lesions (67%): 17 osteosarcomas, 8 Ewing sarcomas, 3 Malignant Fibrous Histiocytoma (MFH) and 1 Giant Cell Tumor and 16 cases (23%) for soft tissue tumours: 5 synovial sarcoma, 3 schwannoma and MFH, 2 leiomiosarcoma and liposarcoma and 1 rhabdomyosarcoma. From those sarcomas 8 (17.8%) were metastatic at presentation. Treatment included surgical resections of the secondary lesions and chemotherapy. The lung metastasis were bilateral in 20 cases (41%) and unilateral in 29 cases (59%). The number of metastasis range from one to 24 and the surgical sessions for each patient were from one to eight. The median disease free survival in the patients with no metastatic lesions at presentation was 17.8m (range 2–88). From this group of patients 25 (51%) were dead of disease (DOD), and 24 (49%) were survivors (median follow-up 42 month: range 12–120 month), being 14 with no evidence of disease (NED) and 10 alive with disease (AWD).

The authors perform a statistical analysis relating survival with local recurrence and the amount of necrosis in the surgical specimen.