Desmoid tumors are rare benign but aggressive lesions. They are characterized by bland-appearing fibroblasts, indistinct margins, and the ability of local invasion and recurrence. Though they are not cancer they may metastasize and can cause significant morbidity. Treatment is primarily surgical, although radiation or systemic therapy can be beneficial if surgery is not feasible. We retrospectively reviewed our patients since 1980 in respect to treatment modalities and outcome.

Between 1980 and 2008 26 patients (16 m, 10 f) with desmoid tumours had been surgically treated. The mean age with diagnosis was 37 years (7 – 69 years). The mean age at surgery was 46 years (10 – 81 years). 17 of the patients had only one resection. In 6 patients two resections, in 2 three resections and in one patient four resections had to be performed. Only 7 patients achieved a R0-situation. In 9 patients adjuvant radiotherapy was used. Two patients had several courses of Vinblastine or MTX based chemotherapy, three patients had Sulindac or Tamoxifen, several other patients combinations of different NSARs. All patients were still alive, one patient developed metastatic disease from the initial lesion in the groin to the foot. After an average of 17 months (7 – 42 months) 11 patients showed recurrent disease. 13 patients are without recurrence after an average of more than 9 years. In 4 patient stable disease is seen without progression in 42 to 156 months (Ø 95 months).

In conclusion desmoid tumours did show an inpredictable course of disease. Due to many alterations in treatment in the 28 years since the first patient of this study and the rareness of this disease no clear predicitve factor could be established. Remarkably no patient did need an amputation. A more detailed analysis regarding the dose effect of irradiated patients is intented.

Introduction: Soft tissue sarcomas represent a rare malignancy showing 2–3 new cases/100.000/year. Based on that and other factors the therapeutic approach is not standardized. In the last years the most radical procedures as compartment resections hade been no longer adviced but there is still no common recommondation which surgical approach seems to be the best in respect to oncological and functional outcome. Radiation theray is part of the multimodal concept is unquestionable but there is still a discussion regarding timing and inclusion of patients. There are many ongoing studies to evaluate the effect of systemic chemotherapies with or without local procedures as hyperthermia or perfusion of the extremities. Aim of this review is therefore to give an overview about facts and speculations in this subject.

Methods: All relevant studies regarding the prognostic impact of resection margin, timing of radiation therapy, chemotherapy and local combined treatment modalities of the last 20 years had been reviewed. The foccus had only been the non-metastazised patient.

Results: Regrading the influence of resection margins an advantage of radical compartment resections could not been shown. There are conflicting datas showing prognostic disadvantages with resectionmargins of millimrters but also demonstrating no benefit with margins of serveral centimeters. The benficial effect of radiation in respect to local reccurencies is well accepted. By applying radiation before surgery the treated volumes are smaller, posttherapeutic complications hence reduced. But the risk of local complications regarding surgery seems to be enhanced. The systemic advantage is unclear. The position of intraoperative radiation therapy is also conflicting. Regarding systemic chemotherapy the results are also conflicting. One has to be aware that only 20% to 30% of the patients will have a regression of the tumour whereas a prolongation of survival still is debated. Local combined therapies show a sometimes dramatic effect to the tumour but seem not to alter prognosis.

Conclusions: Radical compartment resections seem no longer to be justified in comparision to wide resections. The local benefical effect of radiation therapy is well accepted, timing depended on local factors. Systemic chemotherapy shows conflicting results. Local combined therapies may influence the tumour but seem not to influence the prognosis of the patient.

Introduction: Due to an increase in survival skeletal metastasis becomes a significant factor on life quality in carcinoma patients. Also shown in publications of the last years the surgical approach and the expected prognosis are very much based on the primary. Especially patients with breast carcinoma show very long survival times, which must be considered in choosing the adequate surgical approach. Aim of this study was to proof that on a large collective of consecutively treated patients.

Methods: Between 1980 and 2005 115 patients with metastatic disease to the bone due to breast carcinoma had been surgically treated. In 112 female and 3 male the mean age at surgery was 58 years (17–84 years). Retrospectively location and extension of the disease, symptoms, surgical approaches, complications, recurrencies and survival time had been evaluated.

Results: The most often peformed procedure was a decompression with or without stabilisation of the spine in 42 cases. Four vertebroplasties had been additionally performed. The proximal femur had to be reconstructed with an endoprotsthetic device in 24 cases, an endoprostehtic reconstruction of the humerus was necessary in 2 patients, of the pelvis in one case. One diaphyseal prothesis was implanted. Two resctions/amputation without any reconstruction had to be performed. In 20 cases a compound osteosynthesis, in 19 cases a biopsy only was done. In most of the cases postsurgical radiation was administered in some cases preoperative radiation had been applied. Follow-up was done 1 to 26 years after surgery (average 11.7 years).

Many pateints showed an extented survival despite disseminated disease with a high and quality of life. Radical resection as tried in a few patients did not proof to be beneficial regarding the prognsotic effect.

Conclusions: Patients with skeletal manifestations of breast carcinoma showed long survival times despite extented disease. The intralesional surgical approach including radiation therapy showed a better functional outcome in comparison to radical procedures with no disadvantage in survival time or local recurrencies.

Introduction: Due to a lack of techniques there is only some data of testing mechanical influence on chondroctyes grown in 3-D tissue-culture over several months. In a new perfusion-chamber these mechanical factors could be studied in in-vitro tissue culture. Experimental Method: Chondrocytes which had been isolated by enzymatic digestion of mature pigs were seeted in Aga-rose on resorpable PDA/PGA (Ethisorb®) implants. These implants were cultured for 2, 6 and 12 weeks with alternating pressures of 0.5 MPa. Beneath a unpressurized control group, pressure was applied for 1 sec with a rest of 1 sec, for 2 sec with a rest of 8 sec and for 20 sec with a rest of 80 sec. Dulbecos medium was used for perfusion. Results and discussion: After 6 weeks the resorbable carrier has dissolved, in the following weeks the different groups showed different cartilage development (Fig. 1). After 12 weeks the 20/80 sec group showed collagen II and also major collagen I production in immunohistology, the 1/1 sec group showed only small traces of collagen I and masses of collagen II production. Further immunochemistry and scaning electron microscopy was able to show typical aspects of differentiated cartilage. Conclusion: The in-vitro differentiation of chondrocytes to mature cartilage is linked to certain mechanical factors. A frequency of 1/1 sec pressure is more favourable than lesser frequencies.

Introduction: Due to a lack of techniques there is only some data of testing mechanical influence on chondroc-tyes grown in 3-D tissue-culture over several months. The authors developed therfore a new perfusion-chamber to study these mechanical factors in in-vitro tissue culture. Methods: A pneumatic computer-controlled bioreactor which allows the application of pressure between 0,1 – 2 MPa in frequencies less than 1 Hz over a period of several months was developed. The reactor is made of stainless steel and closed to the surrounding atmosphere with a steril, flexible and pressure resistant layer of film. 8 scaffolds with a maximal diameter of 10 mm and a maximal height of 15 mm can be studied independently in respect to pressure parameters. A continous flow of medium allows an excellent nutrition, temperature is controlled by a closed heat unit. In a first system three bioreactors are used simultaneousely. Results: In first cultures of tissues over a period of three months sterility was well contained without any mechanical problems. With a high degree of automation a nearly uncontrolled running was possible.