Aims

To clarify the effectiveness of the induced membrane technique (IMT) using beta-tricalcium phosphate (β-TCP) for reconstruction of segmental bone defects by evaluating clinical and radiological outcomes, and the effect of defect size and operated site on surgical outcomes.

Introduction and aims

After internal hemipelvectomy for malignant pelvic tumors, pelvic reconstruction is necessary for eventual weight bearing and ambulation. Non-vascularised, fibular grafts (NVFG) offer fast, and stable reconstruction, post- modified Enneking's type I and I/IV resection. This study aimed to evaluate the success of graft union and patient function after NVFG reconstruction.

Tartrate-resistant acid phosphatase is contained in multinucleated giant cells of giant cell tumour of bone (GCT) and chondroblastoma (CBL) as well as in osteo-clasts. Yet few studies have so far been done regarding serum acid phosphatase (AcP) level in patients of GCT or CBL. The purpose of this study is to elucidate the clinical significance of serum AcP as a tumour marker for GCT and CBL. Serum AcP value was examined in nine GCT patients and three CBL patients before and after surgery. In the GCT cases, serum AcP values before surgery were high in five cases. They were 14.0 IU/L, 68.7 IU/L, 45.9 IU/L, 21.9 and 31.3 IU/L (normal value; 7.1–12.6 IU/L). They decreased after surgery to 7.7 IU/L (55% of the preoperative value), 8.2 IU/L (12%), 7.8 IU/L (17%), 6.1 IU/L (28%) and 10.0 IU/L (32%), respectively. Serum AcP values before surgery were within normal limits in the remaining four GCT cases. Even in these four cases, postoperative serum AcP level was lower than the preoperative level. Postoperative/preoperative AcP ratios in these four cases were 67%, 80%, 69% and 76%. In the CBL cases, serum AcP values were high in all cases. They were 15.1 IU/L, 13.1 IU/L and 13.7 IU/L. They decreased after surgery to 10.3 IU/L (68% of the pre-operative value), 10.2 IU/L (78%) and 9.7 IU/L (71%), respectively, all within normal limits. Therefore, it is concluded that serum AcP is a useful tumour marker for GCT and CBL in diagnosing the tumour as well as in evaluating the efficacy of treatment.

It is frequently difficult to diagnose and treat of malignant sacral bone tumors. This tumor is diagnosed with lumbar disc hernia, instability coccygitis, hemorrhoids. We reviewed the surgical treatment of primary malignant (14) and secondary (metastatic) sacral tumors (11) in 25 patients from 1983 to 2000. Primary tumors consisted of chordoma in 11 patients, chordoma with spindle cell sarcoma, malignant peripheral nerve sheath tumor (MPNST), giant cell tumor of bone in 1 patient each. The secondary tumors consisted of invading carcinoma in 7 patients, metastatic carcinoma in 4 patients. Location of the sacral tumor was showed total sacrum in 2 patients, below S2 in 18, S3 in 2 and S4 in 3. Preserving nerves were L5 in 1 patient, S1 in 17, S2 in 2, S3 in 3, and 2 performed curettage. Posterior approach was used in 8 patients, and an anterior and posterior combined approach in 17. Sacrectomy only in 7 patients, and sacrectomy and colostomy in 8, including with rectum was performed in 8, and 2 patients had extensive curettage and bone graft or hydroxyapatite (HA) transplantation. Six tumor excisions were used modified T-saw which pass through the sacral canal preserving nerve roots. Surgical margin of chordoma in primary sacral tumors had wide in 10, wide excision with partial contamination in 2, except curettage in 1. MPNST had curettage and giant cell tumor of bone had marginal in 1 each. Secondary sacral tumors had wide in 9, marginal in 2.

Adjuvant therapy was used radiation therapy in 3 patients and chemotherapy in 2 and ethanol in 1. Musculocutaneous flap was reconstracted tensor fascia lata flap and gluteal muscle flap in 2 patients. Interval between initial chief complaints and diagnosis of chordoma detected from 6 months to 10 years, avarage 5 years 3 months by rectal examination, radiogram, genital ultra echo and MRI; invading carcinoma from 2 months to 3 years, avarage 8 months, and metastatic carcinoma from 2 months to 4 months, average 3 months. Six of 12 patients of chordoma in primary sacral tumors are alive from 6 months to 18 years, average 4 years 6 months; remaining patients were died 6 month to 8 years, average 3 years 2 months, except 2 patient died with infection. The patient with a MPNST died after 2 years 6 months, and a giant cell tumor of bone had no recurrence or lung metastases in 10 years.

One of 11 patients of secondary sacral tumor (initial surgery) is alive in 14 years 6 months, remaining 10 patients died 3 months to 4 years 6 months, average 1 year 10 months, except 2 patients died with infection. Complications were much bleeding, infection, skin slough, nerve injury. We recommend better surgical method that anterior and posterir approach use above S3, and posterior approach blow S4, A modified T-saw performed an osteotomy of the pars lateral of the sacrum, proved to be easier and faster than osteotomies performed using the old method.

Background: For the treatment of osteosarcoma, the significance of the preoperative cisplatin (CDDP) as single agent has not been assessed in conjunction with prognostic value.

Purpose: To assess the effect of preoperative CDDP as single agent and its impact on the prognosis of the limb osteosarcoma in the multi-institutional group study.

Patients and methods: Forty-seven cases were entered for the study between December 1983 and June 1993 at cooperative institutions. Three cases were eliminated from the study because of presence of lung metastasis at diagnosis. Forty-four cases of stage IIB limb osteosarcoma treated with CDDP as initial preoperative chemotherapy were evaluated in this study. Mean age was 17.1 years old (7–29 yo.), and mean follow up periods of the living patients were 150 months (58–189 mo.). Two to four courses of CDDP (3 mg/kg, mean 2.4 courses) were administered intravenous and/or intraarterial rout as initial preoperative treatment. All the patients underwent postoperative multi-drug combination chemotherapy with CDDP, doxorubicin, with/without HD-MTX. We evaluated the effect of initial preoperative CDDP by synthesizing the results of clinical findings, radiological findings, serum alkaline phosphatase level, and histological findings. Each findings were evaluated into four grades, and final evaluation was done according to our criteria.

Results: Favorable response ((Complete response(CR) and Partial response (PR)) were obtained in 25 patients, and poor response (No change (NC) and Progression of the disease (PD)) were obtained in 19 patients. Survival rate of all patients in this study was 59.1%, and 64.0% in patients with CR and PR effects, and 52.6% in NC and PD groups. No statistical differences were found between the groups (p=0.3886). Necrotic ratios were examined in 20 patients, and average necrotic ratio was 74.5 %. Good histological response (%necrosis > 80%) was obtained in 11 patients and poor response was obtained in 9 patients. Survival rate of the patients with good histological response was 72.7%, and 44.4% in patients with poor histological response, with no statistical differences between the groups (p=0.14).

Discussion: CDDP has been postulated as one of the most effective chemotherapeutic agents for the treatment of osteosarcoma. In this study, we obtained 57% response rate (25/44) by initial preoperative CDDP administration. In this study, local response to single CDDP treatment is not significant prognostic factor. For treatment planning of neoadjuvant chemotherapy, local response should be evaluated after multi-drug combination preoperative regimen to predict patients¡Ç prognosis.