Aims

Acridine orange (AO) demonstrates several biological activities. When exposed to low doses of X-ray radiation, AO increases the production of reactive radicals (radiodynamic therapy (AO-RDT)). We elucidated the efficacy of AO-RDT in breast and prostate cancer cell lines, which are likely to develop bone metastases.

Since1986 we have monitored the actual diagnosis of all cases referred to our Unit with the diagnosis of ‘possible primary malignant bone tumour’. We have excluded all patients referred with a known diagnosis of either a benign condition or known to have bone metastases. In most cases the suspected diagnosis was based on X-rays alone, sometimes supported by further imaging. Method. Retrospective review of a prospective database that was started in 1986 identifying the actual diagnosis. Results. There were 5922 patients with a confirmed diagnosis over the 23 year time period of this study. 2205 (37%) were found to have a primary malignant bone sarcoma and 1309 (22%) had a benign bone tumour. 992 patients had a general orthopaedic condition (e.g. geode or a vascular necrosis) whilst 303 (5%) had a haematological malignancy and 289 (4.9%) infection. 533 patients (9%) had metastases. There was a similar pattern of frequency of all diagnoses except for metastatic disease and haematologic malignancy at different ages. The incidence of metastases increased from the age of 35 onwards. Discussion. Analysis of this data has led to an algorithm for investigating ‘worrying’ bones that should lead to earlier diagnosis whilst avoiding unnecessary investigations

Introduction. We aimed to determine the extent of osseous integration of the hydroxyapatite collars of tumour endoprostheses implanted in our unit. Methods. We identified 57 patients who had massive endoprostheses implanted over the last six years and reviewed clinical records and x-rays. There were 20 proximal femoral, 23 distal femoral, 6 proximal tibial, 8 proximal humeral and 1 distal humeral replacements. Patients fell into three groups: 1.Primary bone tumours, 2. Metastatic bone tumours and 3. Non-tumour indications. Results. There were 32 patients in Group 1. Mean age 32(10-71) years. Mean follow up was 22 (12-60) months. Osseous integration of the collars was noted in 19 patients (60%). Eight patients had no bony ongrowth on the collars. Nine patients underwent revision, seven for aseptic loosening and one for infection. There were 23 patients in Group 2. Mean age 72(45-83) years. The primary tumour was lung in four and renal in three. One patient had bilateral surgery. Mean follow up was 6(4-9) months. One prosthesis required revision for aseptic loosening in spite of showing good growth over the collar. True osseous integration of the collar occurred only in one patient. There were two patients in Group 3: one with a distal femoral fracture non union who demonstrated good integration of the collar. The other had a revision for infected total hip replacement with no osseous integration. Discussion. Hydroxyapatite coated collars may help integration of massive endoprostheses, but ongrowth is not always seen. Integration is best after resection of primary bone tumours. Their role in metastatic tumour surgery is questionable

Aim. To study the efficacy of Zoledronic acid in the treatment of benign osteolytic tumours or tumour like conditions of bone as a therapeutic or as an adjuvant agent. Method. 31 patients- 19 female, 12 male, age from 8 yrs to 42 yrs, were treated with intravenous zoledronic acid. In 17 patients (fibrous dysplasia-10, nonossifying fibroma- 4, UBC- 3) zoledronic acid alone was used as a therapeutic agent. In 14 patients (ABC- 3, GCT- 11), it was used as an adjuvant agent after curettage. Four patients presented with pathological fracture. In all patients, 4 mg. zoledronic acid was given at 2 monthly intervals. In 12 adult patients, in addition oral bisphosphonates - alendronate was given weekly for at least 6 months. Results. Patients were evaluated using visual analog pain scale and x-rays. At last follow-up (6-40 months), in 15 patients, treated with zoledronic acid alone, there was thickening of cortices and reduction in the size of the lesion. Pain score decreased from an average of 8 to 2. All four fractures healed. In 2 patients, there was progression in size of the lesion. In 14 patients, where it was used as an adjuvant agent, there was early thickening of bone cortices. There was no local recurrence in this group. There was no adverse reaction to the drug in any of the patient. Conclusion. Zoledronic acid is a third generation bisphosphonates and a proven anti-osteolytic agent. It has proved effective in the treatment of number of osteolytic conditions. Our study also suggests that Zoledronic acid not only help to stabilize these lesions but also resulted in pronounced healing in majority of the patients. It also reduced recurrence rate in aggressive benign bone tumours such as ABC or GCT when used as an adjuvant treatment

Aim. Giant cell tumour (GCT) of bone is a benign but locally aggressive tumour. Although topical adjuvants have been used in the past, local recurrence following intralesional excision of GCT of bone continues to remain a problem. The use of bisphosphonates as an anti-osteoclastic agent in the management of osteolytic bone metastases is well accepted. Therefore our study aims to retrospectively demonstrate whether the administration of bisphosphonate as an adjuvant can control aggressive local recurrence of GCT and prevent wide resections of bones or amputations. Method. A retrospective study was performed between 2004 and 2010. 6 patients were diagnosed with aggressive local recurrence of appendicular GCT. All patients were treated for the primary tumour by surgical curettage and cryoablation followed by cementation or biological reconstruction. In 5 patients the tumour was located in the distal radius and in one in the first metacarpal bone. All recurrences were in the bone with large soft-tissue extension. After histological diagnosis – by CT core needle biopsy – the patients were treated by intravenous bisphosphonate, followed by clinical & radiological assessments. Results. Average follow-up of 42 months, ranging from 12 to 72 consecutive months. All patients showed good response to bisphosphonate treatment: lesions become calcified gradually as shown in x-rays & CT scans, reduction in size of soft tissue components, patient reported relief of pain & improvement of the affected limb. All treated patients did not report any untoward effects. Conclusion. In the current study bisphosphonate treatment is found to be an effective treatment for local control of aggressive local recurrence of GCT of the extremities and can therefore be a good alternative to wide resections of bone and complicated reconstructions. Functional results are shown to be promising as well. The study results need further investigation & a larger scale of patients

Aim. We investigated low grade intramedullary chondrosarcomas to see if curettage and cementation remains a strong alternative treatment to local resection. Methods. 39 patients with biopsy proven low grade chondrosarcoma treated with curettage and cementation in our clinic between 1993-2009. 32 were females and 7 were males. Mean age was 44. Mean follow up was 40.5 months. Anatomical localizations were 16 proximal humerus and 16 proximal femur, 6 distal femur and 1 proximal tibia. All patients had plain X-ray, CT scan, Tc99 bone scan and MRI before open biopsy. 28 patients had frozen intraoperative biopsy. Histological diagnosis were grade I chondrosarcoma in all our patients. Curettage followed by high speed burr and cementation with high viscosity bone cement was applied without any internal fixation. Active physiotherapy began after 2 days of the operation and full weight bearing is permitted at about 2 weeks later. Results. At 72.6 months follow up 2 patients (1 proximal humerus, 1 distal femur) developed local recurrence at 3rd month and converted to local wide excision and reconstruction with tumour prosthesis. No infection occurred in the series. All patients followed by plain X-rays and if needed CT or MRI every third month in the first year and every fourth month at the second year and 6 months thereafter. Chest CT scans obtained at every 6 months for two years. No patient developed distant metastasis including recurrence cases. Conclusion. Curettage and cementation in the treatment of low grade chondrosarcomas with a local recurrence rate of 5.1 percent proved itself as a safe and function sparing surgical method. Recurred patients turned out to be Grade II chondrosarcoma at the re-examination of resected specimens. Recurrences could be easily detected around bone cement and prompt resection with prosthetic replacement seemed to be effective

Aim. Assess the oncological and clinical outcomes associated with intralesional curettage, phenol and bone grafting of the lesions. Method. A retrospective study was performed using data from the Leiden University Medical Center. Ninety patients with low grade central chondrosarcoma of long bones and small tubular bones were treated using phenol and ethanol as adjuvant therapy after intralesional curettage. Standard clinical follow-up contained regular visits to the orthopaedic department, physical examination and radiological follow-up with plain X-rays and dynamic Gadolineum-enhanced MRI scans. Results. Between 1994 and 2005 thirty-three males and fifty-seven females with a mean age of 47 years (range 5.6-73.1) were treated in our clinic. Mean follow-up 6.5 years (range 0.2-14.1). Location of chondrosarcoma. Femur (43%), humerus (32%), tibia (10%), fibula (6%), metacarpalia (4%), radius (2%), ulna (1%), phalanx (1%). Average tumour volume of all lesions, including metacarpals and phalanges, was 22 cm3 (range 1-104). With a mean follow up of 6.5 years, 86% of the patients are free of tumour on plain X-ray and dynamic Gd-MRI. Two femoral fractures occurred within 6 weeks after surgery, treated by ORIF. 14% of the patients had re-intervention(s) due to suspected recurrence or residual tumour on dynamic Gd-MRI (7 recurettage, 6 RFA). Histology: Grade I Chondrosarcoma (7), no recurrence (2), non conclusive (4). Overall, there were no cases of metastases. Conclusion. This study presents a large number of patients included, all with same diagnosis and uniform treatment for lowgrade central chondrosarcoma. Periodically clinical and radiological follow-up by dynamic Gd-MRI only showed 8% histological proven recurrences, no upgrading of tumour or occurrence of metastases were seen. Compared to other studies, the complication rates and impairment for the patients are low. Intralesional treatment of low-grade central chondrosarcoma, followed by phenol and ethanol is an effective and safe method with low morbidity for these patients

Aims

We retrospectively report our experience of managing 30 patients with a primary malignant tumour of the distal tibia; 25 were treated by limb salvage surgery and five by amputation. We compared the clinical outcomes of following the use of different methods of reconstruction.