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. 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.Aim
Method
Aim of this study was to review surgical treatment of femural metastases, comparing nailing versus resection and prosthetic reconstruction. 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.Aim
Method
Telangiectatic osteosarcoma (TOS) is a rare subtype of osteosarcoma. We review our experience to characterize its prevalence, treatment, relapse and survivorship at long term follow-up. Eighty-seven patients aged from 4 to 60 years (mean 20 years), were treated from 1985 to 2008. Lesions affected the femur (38), humerus (20), tibia (19), fibula (4), pelvis (3), foot (2) and radius (1). Eight patients had metastatic disease at diagnosis. Seventy-eight patients were treated with neoadjuvant chemotherapy with three or more drugs according to different protocols, nine had surgery as first treatment. Limb salvage surgery was performed in 71 cases, amputation in 14 and rotationplasty in one. One patient died before surgery. Prognostic factors were evaluated with Kaplan-Meier analysis.Introduction
Methods
The current investigation includes a retrospective review of the experience of five Institutions with distal femur megaprostheses for tumor over a twenty year period, to analyze the incidence and etiology of failure, using a new classification system based upon the failure modes. Between 1974 and 2008, 2174 patients underwent primary limb preservation for a benign or malignant extremity tumor using a metallic megaprosthesis at five Institutions, 951 (43.7%) were distal femur replacements. Retrospective analysis of complications according to the Letson and Ruggieri Classification was performed and Kaplan-Meier curves of implant survival were defined. Segmental megaprosthetic reconstruction failures were categorized as mechanical and non-mechanical failures.Introduction
Methods
Dedifferentiated chondrosarcoma (D.C.) has a very poor prognosis. The efficacy of chemotherapy is still debated. Aim of this study was to evaluate the survival of patients with D.C. and to evaluate possible prognostic factors. Between 1990 and 2006, 109 patients were treated for D.C.: 55 males and 54 females, mean age of 59.6 years. In 81 cases tumor was located in the extremities and in 28 cases in the trunk. The most frequent dedifferentiation was in osteosarcoma (53.2%) followed by spindle cell sarcoma (21%), malignant fibrous histiocytoma (13.8%), fibrosarcoma (6.4%). All patients received surgery and mostly, limb salvage with tumor resection and implantation of a megaprosthesis or allograft (65 patients). Chemotherapy was given to 43 patients.Introduction
Methods
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. 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.Aim
Material and Methods
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. 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.Background
Aim
Although various reports analyzed “en-bloc” excision of sacral tumors, there are still technical problems to improve protection of nerve roots, preserve surrounding structures and reduce intraoperative bleeding, maintaining the oncologic result. We present a new technique for sacral resection, with short term preliminary results, derived with modification from Osaka technique. Seven patients were resected for their sacrococcygeal chordoma with the followed described technique. Two patients had previous surgery elsewhere. The sacrum is exposed by a posterior midline incision and complete soft-tissue dissection. Lateral osteotomies were performed through the sacral foramina using a threadwire saw and Kerrison rongeurs, to avoid sacral roots damage. After proximal osteotomy, the sacrum is laterally elevated and mobilized to allow dissection of presacral structures. Mean surgical time was 5 hours (range: 3 to 8). Mean blood loss was 3640 ml.Introduction
Methods
