To present the oncological outcome of eleven patients with stage-3 GCT of bone.

Thirty-nine cases of GCT who were treated the past nine years at our department were reviewed. Five tumors were classified as stage I, twenty-three tumors as stage II and eleven as stage III tumors.

In stage I or II tumors we proceeded to an intraoperative biopsy (frozen biosy).In cases where the intraoperative pathological findings confirmed our diagnosis of GCT we proceeded to operative management. In cases where the intraoperative pathologist’s findings were not clear as well as in cases of stage III tumors we performed only a traditional open biopsy proceeding surgery in a second stage. In stage III tumors we aimed wide margins. Ten of these patients underwent wide surgical excision and limb salvage, while in one patient curettage with cementation was the treatment of choice in order to obtain a fair functional outcome.

With a minimum follow up of 3 years, we had no case of local recurrence in cases treated with wide excision and limb salvage. One stage III GCT treated with curettage recurred. Two stage III tumors metastized to the lung. The average interval from initial operation to lung metastasis was six months.

Treating GCT with the above management minimizes diagnostic failures. Literature shows local recurrence rate as high as 50% in stage III GCTs. The present study shows that recurrence rate can be significantly reduced and good functional outcome can be achieved by carefully planning approach and wide excision of the tumor.

In the treatment of osteosarcoma, many reports in the literature outline that tumor response to chemotherapy directly correlates with disease-free survival and/or mortality. The aim of this study is to evaluate if the percentage of tumor necrosis is a sole prognostic indicator of overall survival in osteosarcoma patients.

We retrospectively studied 33 osteosarcoma cases treated in our institution from 1997 to 2006. All patients were treated preoperatively with HDMTX chemotherapy. The percent necrosis of the excised specimen were compared with survival rates of the patients.

Sixteen patients were good responders (Huvos III, IV- > 90% necrosis), 16 patients were poor responders (Huvos I, II- < 90% necrosis), and one patient died during preop. chemotherapy. With a mean follow-up of 5,48 years (3–12 years) 22 patients are NOD (not evident disease), in 8 patient disease progressed, 8 patients died. Statistical analysis could not establish a significant correlation between percent necrosis and patient survival.

Outcome of osteosarcoma may be dependent on a variety of factors s.a. tumor size, location, metastasis, surgical therapy, pathologic fracture. Tumor necrosis itself may be dependent on the histological subtype of the tumor and P-glycoprotein expression. In this series we could not establish tumor necrosis as a sole prognostic factor of patient survival.

The use of megaprosthesis presents a major advancement in orthopaedic oncology in the treatment of malignant bone and soft tissue tumours.

In the present study, we retrospectively analyse the complication rate of limb salvage surgery with megaprosthesis due to malignant tumours treated in our unit.

From 1997 until 2006, 64 patients (37 men, 27 women), aged between 16–78 years old (mean 43.3), have been treated with megaprosthesis insertion. The diagnosis was metastatic bone lesions in 26 patients, osteosarcoma in 14, chondrosarcoma in 14, soft tissue sarcoma with osseous involvement in 3 (2 synovial sarcoma and 1 MPNST), malignant giant cell tumour in 3, angiosarcoma in 2, Ewing sarcoma in 1, and revision of a failed reconstruction in 1 patient. Lower extremity reconstruction included proximal femur (30 patients), distal femur (19), proximal tibia (3) and total femur replacement (4). Upper extremity procedures were proximal humerus (7 patients) and distal humerus reconstruction (1).

Sixty patients were available for follow-up (minimum 1 year, mean 4.2 years). The following complications were encountered: periprosthetic fracture (1 patient), deep infection (4), superficial wound infection (6), local recurrences (2), hip dislocation (3), knee extensor apparatus failure (2), skin necrosis, (3) unsuccessful vascular reconstruction (1). The deep infection led to hip disarticulation in 1 patient and Tikhoff-Linberg resection in 1 patient with proximal humerus prosthesis. A rare case of bone leismaniasis was also encountered (treated conservatively).

Limb salvage surgery is the mainstay of treatment in malignant musculoskeletal tumours. Special megaprosthesis has been developed for this purpose. Survival rate is substantially less than common prosthesis; the complication rate is increased, especially regarding wound healing complications and infection. Adverse prognostic factors are:

a) advanced age,

Introduction: Clear cell sarcoma is a very rare tumor of the tissues described also as melanoma of the tissues. It is a low-grade tumor mostly located in the hand.

Aim: To present 3 patients with this rare tumor located in the hand and to describe the therapy, which is wide or radical excision after control of the local lymphnodes

Methods-materials: We present three patients treated in our department the last 3 years. The tumor was located at the ring finger, the little finger and in the thenar. All the patients primary were treated at an other center with insufficient removal of the tumor. At the time they presented in our department they all had local recurrence.

At our hospital after control of the local lymphnodes (with MRI or scanning), which was negative, two patients were treated with ray amputation and the patient with tumor location in the thenar was treated with wide local excision and skin grafting. By the histological examination the surgical margins in all patients were clear and so Ro therapy or chemotherapy were not further needed. All patients returned to their primary work. Until now we have no further recurrence.

Conclusions: Clear cell sarcoma of the hand is a rare tumor of the tissues with low-grade malignancy and good prognosis if treated by wide excision. Ray amputation gives an excellent therapeutic and functional outcome.

Introduction: Limb salvage surgery has all but replaced amputation as the treatment of choice for sarcomas of the extremities. This dramatic change came about as the result of two important developments: effective chemotherapy and precision imaging techniques.In high-grade sarcomas the most significant predictors of survival are the location of the primary lesion, local control of the tumor, and the degree of necrosis in the primary tumor after intravenous neoadjuvant chemotherapy (histologic response).

Aim : To detect the response to preoperative chemotherapy and correlate with the biological characteristic of osteosarcoma

Materials and method:19 Patients wih primary osteo-sarcoma were studied (follow up 9 months to 7 years). Response to preoperative chemotherapy is made histologically according to the HUVOS staging system..Combination chemotherapy was used based on the Rosen T-10 protocol (high dose methotrexate) or the platine and adriamycine protocol.

Conclusions :The best response to preoperative chemotherapy was found in osteoblastic osteosarcomas (12% grade IV, 33% grade III, 33% grade II and 22% grade I tumor necrosis).Chondroplastic osteosarcomas showed less sensitivity to chemotherapy (o% grade IV, 40 % grade III, 20% grade II and 40% grade I tumor necrosis) and paraosteal and periosteal osteosarcomas were resistant to preoperarive chemotherapy.

Our study includes 20 patients with femoral tumors during the years 1997–2002. The primary tumors were 5 sarcomas and 3 myelomas and we had 12 metastatic bone tumors. We used 12 modular prothesis and 8 long stem revision both for primary and for metastatic bone tumors. We applied special surgical techniques for the prevention of hip dislocation, the most common complication of proximal femoral resections.

In our study we describe the various surgical techniques used, the modes of application of the endoprothesis and also the techniques of the soft tissue reconstruction, hi 17 cases we used bipolar hemiarthroplasty and in 3 cases, where acetabular metastasis was evident, we used special endoprothesis which allowed us to reconstruct the acetabulum with the use of a special plexus. The most frequently used approach was the anterolateral. In one case we used an anteromedial approach due to the femoral triangle invasion by the tumor. We put special emphasis in the techniques of the soft tissue reconstruction, like capsuloplasty, with the use of a Dacron plexus under a specific modification. This plexus was also used as an extension to cover the muscular defects created due to wide tumor resection. The follow up period ranged from 6 months up to 5 years. Out of the 20 cases we had only one dislocation. The functional results according to the Ennekin scale were: Excellent – Good: 65%, Fair: 30%, Poor: 5%.

In conclusion, the new reconstruction techniques and the appropriate application of the modular prothesis that also preserve the femoral length, provide very good joint stability with good functional results.