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Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XXXVII | Pages 540 - 540
1 Sep 2012
Wang M Li H Hoey K Hansen E Niedermann B Helming P Wang Y Aras E Schattiger K Bunger C
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Study design: We conducted a prospective cohort study of 448 patients with a variety of spinal metastases. Objective. To compare the predictive value of the Tokuhashi scoring system (T12) and its revised edition (T15) for life expectancy both in the entire study group as well as in the various primary tumor subgroups. Summary of background data. In 1990 Tokuhashi and coworkers formulated a one point-addition-type prognostic scoring system with a total sum of 12 points for preoperative prediction of life expectancy as an adjunct in selecting appropriate treatment. Because the site of the primary tumor influences ultimate survival, the scoring system was revised in 2005 to a total sum of 15 points based on the origin of the primary tumor. Methods. This study included 448 patients with vertebral metastases, all of whom underwent surgical treatment during November 1992 to November 2009 at the Aarhus University Hospital. Data was retrieved from the Aarhus Spinal Metastases Algorithm. Scores based on the T12- and T15 scoring systems were calculated prospectively for each patient. All the patients were divided into three survival groups with different life expectancies according to their score points in both scoring systems. Furthermore, we divided all the patients into different groups dictated by the site of their primary tumor. The predictive value of each scoring system, both in the entire group and in each subgroup determined by the original tumour site, was evaluated by the Log-rank-test. The McNemar's test was used to compare the differences in accuracy rates between these two scoring systems. Survival curves were estimated using the Kaplan-Meier methods. Probability value less than 0.05 was considered statistically significant. Result. For the 448 patients with vertebral metastases, both the T12 and T15 scoring systems showed statistically significant predictive value (T12 group p<0.0001, T15 group p<0.0001, Log-rank test). The correlation between predicted survival period and real survival was significantly higher in T15 (p<0.0001, McNemar's test) than in T12. The further analyses by type of metastases showed that the predictive value of T12 and T15 was found in the prostate (p=0.0003), breast (p=0.0385), other tumor group (p<0.001) and lymphoma (p<0.05). Only T12 displayed predictive value in the colon group (p=0.0011). The accuracy rate of prognosis in T15 was significantly higher in those groups with spinal metastases originating from prostate (p=0.0032), breast (p<0.0001) and lung (p=0.0076). Conclusion. Both the T12 and T15 scoring systems have significant preoperative predictive value in terms of predicting the survival period for the entire vertebral metastases patient group as well as in the prostate, breast, lymphoma, and colon tumor groups. The accuracy rate was significantly improved in T15 for the total study group and in the subgroups of prostate, breast, and lung tumor


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XXXVII | Pages 492 - 492
1 Sep 2012
Ruggieri P Mavrogenis A Ussia G Angelini A Pala E Guerra G Drago G Mercuri M
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Background

There is doubt regarding resection compared to curettage for pelvic metastases. Previous studies have reported that curettage is associated with decreased survival compared with wide resection, and have justified a radical surgical approach to achieve pain palliation and tumor control.

Aim

To evaluate the role of wide en bloc resection compared to curettage/marginal resection for patients with pelvic metastases. The rationale was that wide resection does not improve survival even in patients with solitary pelvic metastases.


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XXXVII | Pages 187 - 187
1 Sep 2012
Ruggieri P Calabrò T Valencia JD Mavrogenis A Romantini M Guerra G Mercuri M
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Aim

Bone metastases of the upper limb are a frequent complication of primary tumors. The aim of this study is to evaluate treatment and functional results of patients with prosthetic reconstruction of the proximal humerus.

Method

Between 1975 and 2007, 67 patients were treated by resection of humeral metastasis and reconstruction with prosthesis. Cemented modular prostheses of the proximal humerus were implanted in 59 cases (all MRS Bioimpianti® prostheses), uncemented prostheses in 2 (HMRS® Stryker), 4 elbow Coonrad-Morrey prostheses (in 2 cases with bone allograft), 1 elbow custom-made cemented and 1 intercalary prosthesis (Osteobridge Merete®).

Sites of primary tumors: kidney (23), lung (13), bone and unknow (7 each), liver and breast (3 each), bladder, endometrium, thyroid, soft tissues and nervous tissues (2 each), ovarium (1).

Complications were evaluated and univariate analysis with actuarial Kaplan-Meier curves of implant survival was performed. Functional results were assessed with the MSTS system.


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XXXVII | Pages 186 - 186
1 Sep 2012
Ruggieri P Mavrogenis A Rossi G Rimondi E Angelini A Ussia G Mercuri M
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Aim

To present selective arterial embolization with N-2-butyl Cyanoacrylate for the palliative and/or adjuvant treatment of painful bone metastases not primarily amenable to surgery.

Material and Methods

From January 2003 to December 2009, 243 patients (148 men and 95 women; age range, 20–87 years) with painful bone metastases were treated with N-2-butyl Cyanoacrylate. Overall, 309 embolizations were performed; 56 patients had more than one embolization. Embolizations were performed in the pelvis (168 procedures), in the spine (83 procedures), in the upper limb (13 procedures), in the lower limb (38 procedures) and in the thoracic cage (21 procedures). Primary cancer included urogenital, breast, gastrointestinal, thyroid, lung, musculoskeletal, skin, nerve and unknown origin. Renal cell carcinoma was the most commonly treated tumor. In all patients, selective embolization was performed by transfemoral catheterization.


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XXXVII | Pages 181 - 181
1 Sep 2012
Ruggieri P Pala E Calabrò T Romagnoli C Romantini M Casadei R Abati C Mercuri M
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Aim

Aim of this study was to review surgical treatment of femural metastases, comparing nailing versus resection and prosthetic reconstruction.

Method

Between 1975 and 2008 110 patients were surgically treated for metastatic disease of the femur. Prostheses were implanted in 57 cases (16 HMRS® Stryker, 38 MRP® Bioimpianti, 2 Osteobridge® and 1 GMRS®). In 53 patients femoral nailing was performed with different types of locked nails (32 Gamma, 14 Grosse-Kempft and 6 T2-Stryker®). Sites of primary tumor were breast (33 cases), kidney (18), lung (17), undifferentiated carcinoma (14), g.i. (8), bladder and prostate (5 each), endometrium and thyroid (3 each), skin (2), pheochromocytoma and pancreas (1 each). Indications to nails were given in patients with femoral metastasis and poor prognosis: multiple metastases, short free interval, unfavourable histotype, poor general conditions. Resection and prosthesis was preferred for patients with solitary metastasis, long free interval, favourable histotype, good general conditions or in whenever the extent of the lesion was not amenable to a durable internal fixation. Complications were analysed. Univariate analysis by Kaplan-Meier curves of implant and oncological survival was performed. Functional results were assessed with MSTS system.