INTRODUCTION

Limb salvage surgery is a common treatment for patients who suffer from bone tumors. In the case of pelvic tumors this creates a challenge for the surgeon and the treatment remains controversial because the oncologic complications like local recurrence, dissemination and orthopaedic ones, like infection, haemorrhage, and mechanical problems of reconstructions Tumors affecting the acetabulum are a challenge for the surgeon because of the impact in the function of the extremity. There are many reconstruction techniques described in the literature like prosthesis, allograft systems, arthrodesis, etc…, but still there is not a gold standard due to the poor functional results at long term follow up, and the associated complications of all techniques. In this study we show the experience in our center on pelvic reconstructions after tumors affecting the acetabulum area (zone II).

Introduction and purpose: The purpose of our study is to make a critical review of our experience and find a method of systematised, objective therapeutic strategy in the treatment of vertebral metastases.

Materials and methods: We reviewed 38 cases of vertebral metastasis (1995–2004) from primary tumours: lung 21%, breast 21%, prostate 12%, renal 12%, ovary 8%, tongue 4%, cavum 4%, melanoma 4%, unknown primary tumour 17%.

24 cases were treated surgically in terms of the clinical criterion agreed between oncologist and traumatologist.

We reviewed the follow-up of the cases (treatment, complications, mortality) and the subsequent application of the Tokuhashi prognostic index and the Tomita therapy protocol with two objectives: to evaluate our results and assess these two methods as working tools.

Results: 74% of the patients had preoperative radiotherapy. The surgical treatment was corporectomy and dorsal decompression (17%), partial corporectomy and dorsal decompression (29%), decompression and dorsal instrumentation (37%) and non-instrumented decompression laminectomy (17%).

The mean survival was 17 months. The surgical treatment controlled pain in 87%; there was neurological improvement in 21%, control in 54% and progression in 25%.

Conclusions: Our results were not as good as those found in the literature, in which the usefulness of postoperative radiotherapy is emphasised.

Preoperative radiotherapy may have made tumour excision more difficult which, together with the delayed decision-making, influenced the loss of efficacy in our cases.

We need more prospective studies to validate the Tokuhashi index and the Tomita protocol, which we think are very useful in taking therapy decisions.

Introduction: Synovial sarcoma ranks as the fourth most common sarcoma, but it is uncommon in the hand. Most Synovial Sarcomas arise in para-articular soft tissue such as tendon, tendon sheath and bursa adjacent to the large joints capsules. Arround 60–70% of these tumors involve lower extremity and they frequently affect knee, thigh and foot. The reported incidence for Synovial Sarcoma in hand is only 8.5%.

Material and methods: We carried out a retrospective study of 6 hand and forearm sarcomas, of a series of 35 synovial sarcomas surgically treated in our center from 1991 to 1997, with a 6 years follow up (3y.–11y.). 3 patients were male and 3 female, with a mean age of 54 years at the moment of initial diagnosis. Histologically all of them were synovial sarcomas: 4 monophasic and 2 biphasic. The inmunochemistry showed that the neoplasic cells were positive for vimentin, epithelial membrane antigen and cytokeratin. 2 of them were localized in the palmar aspect of the hand (2 ulnar cases and 2 eminence tenar cases), an 2 cases were dorsal. 2 cases were misdiagnosed as benign lesions and treated with tumor excision at another center.

Results: Primary treatment consisted of radical local excision of synovial sarcoma of the hand. 5 patients received adjuvant chemotherapy with CYVADIC and radiotherapy. 2 cases of recurrence received a second surgical treatment with forearm amputation. The mean time to recurrence was 12 months. At the end of the follow-up 3 patients developed metastatic disease and 2 of them died.

Discussion: Synovial Sarcoma in hand is a highly malignant tumor; due to its morphology they can be misdiagnosed as benign lesions such as aggressive fibromatosis or ganglion cysts. If we diagnose a soft tissue tumor in hand we must practice complementary tests to achieve early diagnosis. It is also important the multidisciplinary treatment of Synovial Sarcoma.