Aims: The purpose of this report is to asses the prognostic factors that could influence management and clinical outcome of malignant fibrous histiocytoma (MFH) of soft tissues. Methods: Between 1990 and 2000, 79 patients diagnosed with localized disease by MFH, seen at Santa Creu i Sant Pau Hospital, have been reviewed. 45 were women and 34 were men. The median age at presentation was 62 years (range: 20–85). The median follow-up was 60 months (range: 1–119). Low grade tumors constituted 8% and the remaining 92% were high grade. Several treatment modalities with or without radiotherapy and/or chemotherapy were associated and assessed. We used Kaplan-Meier method for calculating survival rates and Log-Rank test to assess presumed prognostic factors like sex, age, anatomic side, Enneking stage and associated quimio/radiotherapy. Results: Thigh were the most common location (50%). Isolated local recurrence occurred in 19 patients (24%), isolated meta-static disease without local recurrence in 4 patients (5%), and combined local and metastatic disease occurred in 4 patients (5%). The 2- and 5-year relapse-free survival (RFS) rates were 71% and 67%, respectively.

The 2- and 5-year overall survival (OS) rates were 92% and 86% respectively. We found that only Enneking stage was significant prognostic factor (p< 0.05). The best results in SLE were found in surgery + radiotherapy group but it was not statistically significant (p> 0.05). Conclusions: In our opinion, wide complete surgical resection at the time of primary tumor in combination with local radiotherapy is likely to afford the best chance for RFS and OS. Enneking stage seems to be the most important prognostic factor.

The role of adyuvant chemotherapy remains investigational.

Introduction and Objectives: Our aim is to analyze results using an Albizzia® gradual lengthening intramedullary nail in the femur.

Materials and Methods: From October 1997 to November 2000, 7 femoral lengthenings were performed on 5 patients (2 were bilateral) in our unit, using an intramedullary lengthening nail. Average age was 19 years (15–22). Aetiologies included congenital deformity with symmetric shortening (1 case), fibrous cortical defects (1 case), iatrogenic shortening secondary to trauma (1 case), and 2 cases of symmetric dwarfism (idiopathic drawfism, Turner’s syndrome). Distraction was achieved at 15 cycles/day (1 mm/day). Clinical and radiographic results were evaluated using the Paley criteria, considering the indices of consolidation and distraction. Average follow-up time was 48 months (30–60 months).

Results: Average lengthening obtained was 5.7 cm (4–7 cm), with a distraction period of 99 days (45–214 days) and a distraction index of 0.71 mm/day (17 days/1 cm). In bilateral cases, the distraction index was 0.57 mm/day. Consolidation time was 187 days with a consolidation index of 33 days/cm. Complications included 3 mechanical (2 broken screws and one intramedullary saw failure); one involving bone (1 intraoperative fracture), and one case requiring spinal anaesthesia to achieve lengthening in the first few days. No nerve, joint, or infection-related complications were observed. Average duration of surgery was 2 hours 40 minutes.

Discussion and Conclusions: The use of a gradual intramedullary lengthening nail yields good results, since it is a more stable system which minimises complications compared to external fixators. It is also a more comfortable procedure for the patient.

Introduction and Objectives: From January 1983 to December 2000 we treated a total of 542 intermediate to high-grade primary bone tumours. We present our experience in reconstruction following tumour resection from the hip, excluding cases of pelvic reconstruction and cases of localised benign bone tumours of the hip.

Materials and Methods: This study included 49 cases of primary bone tumours localised to the proximal humerus (9% of the total). Of all cases treated by means of massive structural allograft for femoral reconstruction (44), only 11 cases were in the hip region. We performed 28 hip tumour resections for high-grade bone tumors with the following diagnoses: osteosarcoma (7), chondrosarcoma (9), Ewing’s sarcoma (6), malignant fibrous histiocytoma (2), and selected cases of metastasis-myeloma (4). Limb salvage procedures (22) with reconstruction after the first surgery included: modular megaprosthesis (11), megaprosthesis associated with massive structural allograft of the proximal third of the femur (8), and osteoarticular allografts (3). The remaining cases (6) required immediate agressive surgery including coxofemoral disarticulation (4) and hemipelvectomy (2).

Results: Limb salvage cases treated by means of mega-prosthesis associated with a composite allograft presented the following complications: 1 case of deep infection with local recurrence and immediate postoperative dislocation (12.5%), 3 isolated coxofemoral dislocations (37.5%), and one case of homograft osteolysis (12.5%). Mean follow-up time was greater than 5 years, and two patients died due to dissemination of the primary tumour (1 chondrosarcoma and 1 osteosarcoma). Cases of limb salvage treatment using modular mega-prosthesis had the following complications: 2 isolated coxofemoral dislocations (18%) and 2 cases of recurrence or local tumour progression (18%). Mean follow-up time was greater than 3 years, and two patients died due to progression of the primary tumour. Cases of salvage treatment using osteoarticular allografts had a mean follow-up time of 2 years and showed no significant complications.

Discussion and Conclusions: 1) In cases of disease up to 12 years of age (primarily Ewing’s sarcomas) we prefer osteoarticular reconstruction. 2) In cases of young adults (from 12 to 60 years of age) we prefer reconstruction using a megaprosthesis (Wagner type) with massive structural allograft. 3) In cases of older adults (greater than 60 years of age) we perform reconstruction using a modular megaprosthesis for tumour treatment.

Introduction and Objectives: This study analyses the results of our experience in reconstruction of high-grade sarcomas of the proximal humerus.

Materials and Methods: A total of 37 patients were treated from March 1983 to December 2001. Average age was 24 years (19–38), with 21 males and 16 females, all presenting with high-grade sarcomas of the proximal humerus. The primary tumour was osteosarcoma in 49% (n=18) of cases, chondrosarcoma in 22% (n=8), Ewing’s sarcoma in 13% (n=5), parosteal sarcoma in 8% (n=3), malignant fibrous histiocytoma in 5% (n=2), and adamantinoma in 3% (n=1). All cases were classified as Type 1 Malawer resections (intraarticular resections of the proximal humerus).

Results: During this period, scapulohumeral or scapulothoracic disarticulation was performed in 32% of cases (12 patients). In the remaining 68% (25 cases), limb salvage surgery was performed (relative limb salvage rate: 67.5%). In terms of reconstruction type, 6 cases received megaprotheses, and the remaining 19 cases received osteoarticular allografts of the humerus. Four of the 25 patients had reconstructions with sufficient follow-up time to be considered survivors without recurrence. Results were “acceptable” based on the Enneking-MTS functional scale (overall movement arcs in all directions between 60–120° with tolerable subluxations.) From a subjective point of view, all the patients obtained good results in terms of physical health and mobility of distal joints. No analysis was done of survival due to the varied nature of the neoplasias and adjuvant therapies. The main complication was fracture of the osteoarticular allograft, which occurred in 4 of 19 cases (21%). Subluxation was practically constant throughout our series but was of relatively minor clinical significance.

Discussion and Conclusions: The results obtained in this study in terms of local and functional control are similar to those reported in the literature. In spite of the poor functional results for the shoulder joint, the functional results for distal joints and the cosmetic appearance of the extremity are satisfactory. However, the high rate of allograft fractures forces us to reconsider our reconstruction technique, placing priority on a mixed reconstruction using both allograft and mega-prosthesis.

Introduction and Objectives: Half of primary tumors tend to disseminate to bones, and metastasis to bone is the third most common localisation for disseminated disease, after the lungs and liver. It is also the most common form of neoplasia in the skeleton. Treatment of bone metastasis is essentially palliative, and in select cases improves patient survival. We present results from the last 15 years in our centre.

Materials and Methods: Between the years 1988–2003, our surgical oncology unit has treated 451 patients with bone metastasis. Of these, 49% were male, and 51% were female. Average age was 64 years (19–98). The most common causes were metastatic breast cancer (34%), unknown tumours (17%), multiple myeloma (9%), prostate cancer (9%), lung cancer (7%), bladder cancer (6%), and others (18%). Tumours localised to the following locations: femur (31%), spine (27%), multiple locations (13%), pelvis (11.5%), humerus (9%), and other locations (8.5%). In 69% of cases the first symptom was pain, in 28% pathologic fracture, and in the remaining 3% medullary compression. Of the 125 pathologic fractures, 71% were on the femur, 18% on the humerus, and the remaining 11% in other locations.

Results: In 60% of cases (271 patients) conservative treatment was used, and in the remaining 40% (180 patients) surgical treatment was used. Of the 180 surgeries, 50.5% were for pathologic fractures, and 49.5% were prophylactic surgeries. Of the 125 pathologic fractures, 91 (73%) received surgical treatment, and the other 34 (27%) were treated conservatively. Intramedullary nailing was the most commonly used form of osteosynthesis (47%). Total resolution of pain was achieved in 86.5% of cases, and partial resolution in 13.5%. Mean time in bed from prophylactic surgery was 3 days. Mean time for recovery of function was 7 days for the arms and 11 days for the legs.

Discussion and Conclusions: The fundamental goal is to offer short-term individualized treatment to control pain and avoid bedrest and hospitalization of these patients. Prophylactic surgery does not increase life expectancy of these patients. However, it does alleviate pain, avoids bedrest, and improves functionality. It should be kept in mind that the least aggressive surgical technique possible should be used.