The first purpose of this study was to survey patterns of unusual metastatic spread of soft tissue sarcoma in patients treated at the Musculoskeletal Tumour Unit in Pretoria, and the second to make recommendations regarding the treatment and follow-up of patients. In 3671 cases of musculoskeletal tumours treated from 1986 to 2003, 346 cases of soft tissue sarcoma were reported. Unusual metastases were present in 11 male and four female patients, ranging in age from 15 to 76 years. The interval between diagnosis and first metastasis ranged from 1 to 56 months. Pulmonary metastases occurred in only six patients, all with metastases in unusual sites. In 10 patients the unusual metastases were diagnosed after the patients themselves had discovered them on self-examination. Meticulous clinical examination combined with radiographs, CT scan and ultrasonographic examinations led to the diagnosis of the other metastases. This series highlights the importance of referring patients to tumour centres, where the multidisciplinary management approach facilitates the implementation of coordinated surveillance strategies and the early detection and treatment of distant metastases.
The purpose of this study is to compare functional results of hemipelvectomy and internal hemipelvectomy following resection of pelvic tumours. The emotional acceptance of such surgery is also examined. From 1998 to 2003, 19 male and 13 female patients, aged from 6 to 76 years, underwent hemipelvectomy, and 12 male and seven female patients, aged from 13 to 65 years, underwent internal hemipelvectomy. In the series as a whole, follow-up ranged from 1 to 156 months. Five patients with external hemipelvectomy, six with internal hemipelvectomy and one who underwent internal hemipelvectomy followed by external hemipelvectomy were evaluated functionally, clinically and psychologically. Patients expressed emotional concern about body image and mobility. Psychosocial adjustment was difficult for all patients, but some were able to overcome their difficulties more easily than others. Patients with internal hemipelvectomy rather than external hemipelvectomy had more difficulty adjusting emotionally. The site of the tumour and morbidity rates, which remain high when limb-sparing surgery is performed for pelvic tumours, are important considerations when deciding upon the type of surgery. Patients and their families need extensive preoperative psychological preparation and postoperative psychotherapy is imperative.
The purpose of this study was to evaluate functional ability following proximal humeral resection for bone/ soft tissue tumours. We studied the records of and clinically examined 19 patients with allograft reconstruction following resection of bone/soft tissue tumours. Although proximal functioning was impaired, all patients could use their arms for activities of daily living. Complications such as sepsis and nonunion occurred in six patients. The tumour recurred in one patient and there were proximal metastases in two. In seven patients there were no complications. Medical, psychological and social concerns were included in the evaluation and in these respects patients expressed satisfaction. Patient satisfaction and the complication rate were comparable with results in the international literature we surveyed.
