Aims. Patients with differentiated thyroid carcinomas (DTCs) have a favourable long-term survival. Spinal metastases (SMs) cause a decline in performance status (PS), directly affecting mortality and indirectly preventing the use of systemic therapies.
The aims of this study were to evaluate the long-term outcome
of surgery for bone or soft-tissue metastases from renal cell carcinoma
(RCC) and to determine factors that affect prognosis. Between 1993 and 2014, 58 patients underwent surgery for bone
or soft-tissue metastases from RCC at our hospital. There were 46
men and 12 women with a mean age of 60 years (25 to 84). The mean
follow-up period was 52 months (1 to 257). The surgical sites included
the spine (33 patients), appendicular skeleton (ten patients), pelvis (eight
patients), thorax (four patients), and soft tissue (three patients).
The surgical procedures were Aims
Patients and Methods
Resection of pulmonary metastases has previously been reported to improve outcome in high grade osteosarcoma (OS) patients with pulmonary metastases. In this study factors influencing survival in OS patients with pulmonary metastases were determined. One hundred ninety seven patients with OS treated at our institution between 1990 and 2008 under the age of 40 were included. Excluded were patients with insufficient follow-up data (n=12) and irresectable primary tumour (n=11). Of the 174 remaining patients, 26 patients had pulmonary metastases at diagnosis and 62 developed pulmonary metastases during follow-up. Twenty-two of 88 patients (25%) also had extra-pulmonary metastases. Almost all patients with primary non-metastatic OS who experienced a relapse within 310 days (first tertile) died of disease, whereas patients with a relapse free interval of more than 310 days (second and third tertiles) have a significantly better overall survival at about 20% (p=0.02). In total, 56 (63.6%) of 88 patients with pulmonary metastases were treated by
The June 2013 Oncology Roundup. 360 . looks at: whether allograft composite is superior to megaprosthesis in massive reconstruction; pain from glomus tumours; thromboembolism and orthopaedic malignancy; bone marrow aspirate and cavity lesions;
Current 5-year survival after complete resection of pulmonary metastases is ≈ 30%, and many patients develop pulmonary recurrences. Obviously new treatment options are needed for this indication. Isolated lung perfusion (ILuP) is an experimental technique to deliver high-dose chemotherapy to the lung without systemic exposure. Recently, a phase I trial of ILuP combining 45 mg melphalan followed by pulmonary
We first sought to compare survival for patients treated surgically for solitary and multiple metastases in the appendicular skeleton, and second, to explore the role of complete and incomplete resection (R0 and R1/R2) in patients with a solitary bony metastasis in the appendicular skeleton. We conducted a retrospective study on a population-based cohort of all adult patients treated surgically for bony metastases of the appendicular skeleton between January 2014 and December 2019. We excluded patients in whom the status of bone metastases and resection margin was unknown. Patients were followed until the end of the study or to their death. We had no loss to follow-up. We used Kaplan-Meier analysis (with log-rank test) to evaluate patient survival. We identified 506 operations in 459 patients. A total of 120 operations (in 116 patients) were for solitary metastases and 386 (in 345 patients) for multiple metastases. Of the 120 operations, 70 (in 69 patients) had no/an unknown status of visceral metastases (solitary group) and 50 (in 49 patients) had visceral metastases. In the solitary group, 45 operations (in 44 patients) were R0 (resections for cure or complete remission) and 25 (in 25 patients) were R1/R2 (resections leaving microscopic or macroscopic tumour, respectively). The most common types of cancer in the solitary group were kidney (n = 27), lung (n = 25), and breast (n = 20).Aims
Methods
Purpose: Patients presenting with metastatic soft tissue sarcoma (STS) generally have a poor prognosis. The factors that determine ultimate outcome in this setting are poorly understood. The purpose of this study is to establish factors that affect outcomes in a group of patients with metastatic STS at initial presentation who underwent surgical resection of their primary tumour. Method: A retrospective review of our institutional database from 1986 to present was carried out. We identified all patients with STS who, at presentation, had metastatic disease. Patients who did not undergo surgical resection of their primary tumour were excluded. Factors affecting overall survival were assessed using the methods of Kaplan and Meier and ANOVA. Results: We identified 130 patients with metastatic STS (75 male, 55 female). Of these, 81 patients presented with pulmonary metastases, 20 with lymph node metastases, 13 with both lung and lymph node metastases, and in 16 patients initial resection was of a metastatic lesion. Currently only 17 patients (13%) are free of disease. Factors associated with improved survival were lymph node metastases as opposed to pulmonary metastates (p=0.0006), size less than 5 cm (p=0.02), low grade sarcoma (p=0.05) and 3 or fewer pulmonary metastases (p=0.04). Age, gender, histological subtype, anatomic location, use of chemotherapy, depth, bilaterality of pulmonary metastases and pulmonary
Giant cell tumour of bone (GCTB) treatment changed since the introduction of denosumab from purely surgical towards a multidisciplinary approach, with recent concerns of higher recurrence rates after denosumab. We evaluated oncological, surgical, and functional outcomes for distal radius GCTB, with a critically appraised systematic literature review. We included 76 patients with distal radius GCTB in three sarcoma centres (1990 to 2019). Median follow-up was 8.8 years (2 to 23). Seven patients underwent curettage, 38 curettage with adjuvants, and 31 resection; 20 had denosumab.Aims
Methods
Our purpose was to assess the role of preoperative radio-therapy +/− neoadjuvant chemotherapy in nonmetastatic soft tissue sarcoma of extremities for limb-sparing surgery and identify the role of neoadjuvant therapies on local control and survival rate. Forty-seven patients with soft tissue sarcoma of extremities who were treated at Cerrahpasa Medical Faculty within a limb salvage protocol, including preoperative radiotherapy +/− chemotherapy were retrospectively analized. Median age was 45 years (17–72 years). The tumor size was between 5–33 cm. Seventeen patients were in stage I, 11 in stage II, 19 in stage III. The most common histology was synovial sarcoma. Nine patients were treated for locally recurrent tumour. The tumour and surrounding tissues with probable microscopic tumour involvement observed clinically and radiologically, were irradiated. Thirty-two patients, with a high grade tumour and/or tumours larger than 8 cm, also received neoadjuvant chemotherapy. Neoadjuvant chemotherapy regimen was consisted of doxorubicine and ifosphamide with mesna. Preoperative radiotherapy was applied, usually between the second and third cycles of chemotherapy. Definitive surgery was administered 2–6 weeks after radiotherapy or after the third cycle of chemotherapy. Chemotherapy was completed to 6 courses after the surgery. Postoperative external beam radio-therapy boost of 16 Gy was given who had close or positive surgical margins. Median follow-up time was 67 months (12–217 months). All of the patients had limb-sparing surgery. Patients had; 30 marginal excision, 13 wide local excision, 4 radical resection. Nine patients locally recurred. Limb-sparing surgery was performed for 8 patients. 25 patients had distant metastases.
Parosteal osteosarcoma is an uncommon tumour. Different methods of surgical treatment have been reported. Aim of this study was to investigate differences in outcome after biological and prosthetic reconstruction. Since August 1969, 28 patients have been treated at our institution. Average age was 26 years, range 15 to 59 years. Patient data was retrospectively reviewed within the prospective database of the Vienna Tumour Registry. Average follow-up was 133.9 months, range 8.4 to 382.6 months. Two patients died of disease 8.4 and 81.4 months after operation, respectively, another patient died due to unrelated causes 330.4 months postoperatively. All surviving patients were followed for a minimum of 3.6 months. Location of the lesion was the distal femur (19), proximal humerus (four), proximal tibia (three), mid-diaphyseal and proximal femur (one each). In 12 patients endoprosthetic reconstruction was indicated. Biological reconstruction was performed in 11 patients. Three patients underwent rotationplasty, two patients were amputated. Eight of 12 patients with endoprostheses have been revised, five have had multiple revisions. Causes for revision were bushing wear (four), aseptic loosening (four), infection (three) and periprosthetic fracture (one). There was no local recurrence in the endoprosthetic group. Two of 11 patients with biological reconstruction underwent revision due to pseudarthrosis and femoral fracture, respectively. There were two cases of local recurrence requiring secondary amputation. Two patients with rotationplasty underwent revision for wound healing disturbance and thrombectomy, respectively. Three patients developed lung metastases, leading to death of disease in two cases of amputation and rotationplasty. One patient with endoprosthetic reconstruction was alive 129.0 months after pulmonary
The February 2024 Oncology Roundup360 looks at: Does primary tumour resection improve survival for patients with sarcomas of the pelvis with metastasis at diagnosis?; Proximal femur replacements for an oncologic indication offer a durable endoprosthetic reconstruction option: a 40-year experience; The importance of awaiting biopsy results in solitary pathological proximal femoral fractures: do we need to biopsy solitary pathological fractures?; Effect of radiotherapy on local recurrence, distant metastasis, and overall survival in 1,200 extremity soft-tissue sarcoma patients; What to choose in bone tumour resections? Patient-specific instrumentation versus surgical navigation; Optimal timing of re-excision in synovial sarcoma patients: immediate intervention versus waiting for local recurrence; Survival differences of patients with resected extraskeletal osteosarcoma receiving two different (neo) adjuvant chemotherapy regimens; Solitary versus multiple bone metastases in the appendicular skeleton: should the surgical treatment be different?.
Neglected liposarcoma with late admission and huge tumour causes difficulties regarding surgical removal, obtaining tumour free margin and increased risk of local recurrence. Preoperative irradiation enables the surgeon to remove such tumours with ease of manipulation during surgery by maturation of the pseudocapsule with a decrease in local recurrence. Twenty-one patients with liposarcoma , 8 females, 13 males with a mean age of 49 (16–74) were treated by preoperative 5000 cGy irradiation and wide excision by the same surgeon between 1991–2004. Localization were 14 proximal thigh, 3 popliteal space, 3 gluteal region, 1 upper arm. Mean tumour volume was 550cc. Mean follow up was 37 months (6–144 mo.s). All patients were operated after 30 days of irradiation, 3 patients had arterial by pass and 1 patient had free latissimus dorsi flap reconstruction. Oncological results: 3 DOD, 18 NED. 4 patients developed lung metastasis, 1 of them with local recurrence, the other 3 had no local recurrence, all 3 of them had myxoid liposarcoma with round cell component. They had second primaries in the retroperitoneal space also. The only patient in the series with local recurrence was succesfully treated by wide excision and femoral artery by pass and
Low-grade central osteosarcoma (LGCOS), a rare type of osteosarcoma, often has misleading radiological and pathological features that overlap with those of other bone tumours, thereby complicating diagnosis and treatment. We aimed to analyze the clinical, radiological, and pathological features of patients with LGCOS, with a focus on diagnosis, treatment, and outcomes. We retrospectively analyzed the medical records of 49 patients with LGCOS (Broder’s grade 1 to 2) treated between January 1985 and December 2017 in a single institute. We examined the presence of malignant features on imaging (periosteal reaction, cortical destruction, soft-tissue invasion), the diagnostic accuracy of biopsy, surgical treatment, and oncological outcome.Aims
Methods
Current literature suggests that survival outcomes and local recurrence rates of primary soft-tissue sarcoma diagnosed in the very elderly age range, (over 90 years), are comparable with those in patients diagnosed under the age of 75 years. Our aim is to quantify these outcomes with a view to rationalizing management and follow-up for very elderly patients. Retrospective access to our prospectively maintained oncology database yielded a cohort of 48 patients across 23 years with a median follow-up of 12 months (0 to 78) and mean age at diagnosis of 92 years (90 to 99). Overall, 42 of 48 of 48 patients (87.5%) were managed surgically with either limb salvage or amputation.Aims
Methods
Cell-free DNA (cfDNA) and circulating tumour DNA (ctDNA) are used for prognostication and monitoring in patients with carcinomas, but their utility is unclear in sarcomas. The objectives of this pilot study were to explore the prognostic significance of cfDNA and investigate whether tumour-specific alterations can be detected in the circulation of sarcoma patients. Matched tumour and blood were collected from 64 sarcoma patients (n = 70 samples) prior to resection of the primary tumour (n = 57) or disease recurrence (n = 7). DNA was isolated from plasma, quantified, and analyzed for cfDNA. A subset of cases (n = 6) underwent whole exome sequencing to identify tumour-specific alterations used to detect ctDNA using digital droplet polymerase chain reaction (ddPCR).Aims
Methods
To evaluate the perioperative complications associated with total en bloc spondylectomy (TES) in patients with spinal tumours, based on the extent and level of tumour resection. In total, 307 patients who underwent TES in a single centre were reviewed retrospectively. There were 164 male and 143 female patients with a mean age at the time of surgery of 52.9 years (SD 13.3). A total of 225 patients were operated on for spinal metastases, 34 for a malignant primary tumour, 41 for an aggressive benign tumour, and seven with a primary of unknown origin. The main lesion was located in the thoracic spine in 213, and in the lumbar spine in 94 patients. There were 97 patients who underwent TES for more than two consecutive vertebrae.Aims
Methods
Local recurrence remains a challenging and common problem following curettage and joint-sparing surgery for giant cell tumour of bone (GCTB). We previously reported a 15% local recurrence rate at a median follow-up of 30 months in 20 patients with high-risk GCTB treated with neoadjuvant Denosumab. The aim of this study was to determine if this initial favourable outcome following the use of Denosumab was maintained with longer follow-up. Patients with GCTB of the limb considered high-risk for unsuccessful joint salvage, due to minimal periarticular and subchondral bone, large soft tissue mass, or pathological fracture, were treated with Denosumab followed by extended intralesional curettage with the goal of preserving the joint surface. Patients were followed for local recurrence, metastasis, and secondary sarcoma.Aims
Methods
For paediatric and adolescent patients with growth potential, preservation of the physiological joint by transepiphyseal resection (TER) of the femur confers definite advantages over arthroplasty procedures. We hypothesized that the extent of the tumour and changes in its extent after neoadjuvant chemotherapy are essential factors in the selection of this procedure, and can be assessed with MRI. The oncological and functional outcomes of the procedure were reviewed to confirm its safety and efficacy. We retrospectively reviewed 16 patients (seven male and nine female, mean age 12.2 years (7 to 16)) with osteosarcoma of the knee who had been treated by TER. We evaluated the MRI scans before and after neoadjuvant chemotherapy for all patients to assess the extent of the disease and the response to treatment.Aims
Methods
Iliac wing (Type I) and iliosacral (Type I/IV) pelvic resections for a primary bone tumour create a large segmental defect in the pelvic ring. The management of this defect is controversial as the surgeon may choose to reconstruct it or not. When no reconstruction is undertaken, the residual ilium collapses back onto the remaining sacrum forming an iliosacral pseudarthrosis. The aim of this study was to evaluate the long-term oncological outcome, complications, and functional outcome after pelvic resection without reconstruction. Between 1989 and 2015, 32 patients underwent a Type I or Type I/IV pelvic resection without reconstruction for a primary bone tumour. There were 21 men and 11 women with a mean age of 35 years (15 to 85). The most common diagnosis was chondrosarcoma (50%, n = 16). Local recurrence-free, metastasis-free, and overall survival were assessed using the Kaplan-Meier method. Patient function was evaluated using the Musculoskeletal Tumour Society (MSTS) and Toronto Extremity Salvage Score (TESS).Aims
Methods