scholarly journals Treatment-Related Prognostic Factors in Managing Osteosarcoma around the Knee with Limb Salvage Surgery: A Lesson from a Long-Term Follow-Up Study

2019 ◽  
Vol 2019 ◽  
pp. 1-13 ◽  
Author(s):  
Jianping Hu ◽  
Chunlin Zhang ◽  
Kunpeng Zhu ◽  
Lei Zhang ◽  
Tao Cai ◽  
...  
Keyword(s):  
Overall Survival ◽  
Prognostic Factors ◽  
Local Recurrence ◽  
Limb Salvage ◽  
Salvage Surgery ◽  
Survival Rates ◽  
Tumor Resection ◽  
Limb Salvage Surgery ◽  
Related Factors

Purpose. The aim of this study was to assess the treatment-related factors associated with local recurrence and overall survival of patients with osteosarcoma treated with limb-salvage surgery. Patients and Methods. Treatment-related factors were analyzed to evaluate their effects on local recurrence-free survival (LRFS) and overall survival (OS) in 182 patients from 2004 to 2013. Results. The mean length of follow-up was 73.4 ± 34.7 months (median, 68 months; range, 12-173 months), and 63 patients died by the end of the follow-up. The 5-year and 10-year overall survival rates were 68.6 ± 6.6% and 59.4 ± 10.6%, respectively. Univariate analysis showed that treatment-related prognostic factors for overall survival were prolonged symptom intervals >=60 days, biopsy/tumor resection performed by different centers, previous medical history, incomplete preoperative chemotherapy (<8 weeks), and prolonged postoperative interval >21 days. In the multivariate analysis, biopsy/tumor resection performed by different centers, incomplete implementation of planned new adjuvant chemotherapy, and delayed resumption of postoperative chemotherapy (>21 days) were risk factors for poor prognosis; biopsy/tumor resection performed by different centers and tumor necrosis <90% were independent predictors of local recurrence. Conclusion. For localized osteosarcoma treated with limb-salvage surgery, it is necessary to optimize timely standard chemotherapy and to resume postoperative chemotherapy to improve survival rates. Biopsies should be performed at experienced institutions in cases of developing local recurrence.

scholarly journals Preoperative surgical risk stratification in osteosarcoma based on the proximity to the major vessels

2019 ◽  
Vol 101-B (8) ◽  
pp. 1024-1031 ◽  
Author(s):  
T. Fujiwara ◽  
M. R. Medellin ◽  
A. Sambri ◽  
Y. Tsuda ◽  
J. Balko ◽  
...  
Keyword(s):  
Overall Survival ◽  
Local Recurrence ◽  
Blood Vessels ◽  
Limb Salvage ◽  
Local Control ◽  
Salvage Surgery ◽  
Limb Salvage Surgery ◽  
Poor Prognostic Factor ◽  
Type 3

Aims The aim of this study was to determine the risk of local recurrence and survival in patients with osteosarcoma based on the proximity of the tumour to the major vessels. Patients and Methods A total of 226 patients with high-grade non-metastatic osteosarcoma in the limbs were investigated. Median age at diagnosis was 15 years (4 to 67) with the ratio of male to female patients being 1.5:1. The most common site of the tumour was the femur (n = 103) followed by tibia (n = 66). The vascular proximity was categorized based on the preoperative MRI after neoadjuvant chemotherapy into four types: type 1 > 5 mm; type 2 ≤ 5 mm, > 0 mm; type 3 attached; type 4 surrounded. Results Limb salvage rate based on the proximity type was 92%, 88%, 51%, and 0% for types 1 to 4, respectively, and the overall survival at five years was 82%, 77%, 57%, and 67%, respectively (p < 0.001). Local recurrence rate in patients with limb-salvage surgery was 7%, 8%, and 22% for the types 1 to 3, respectively (p = 0.041), and local recurrence at the perivascular area was observed in 1% and 4% for type 2 and 3, respectively. The mean microscopic margin to the major vessels was 6.9 mm, 3.0 mm, and 1.4 mm for types 1 to 3, respectively. In type 3, local recurrence-free survival with limb salvage was significantly poorer compared with amputation (p = 0.025), while the latter offered no overall survival benefit. In this group of patients, factors such as good response to chemotherapy or limited vascular attachment to less than half circumference or longitudinal 10 mm reduced the risk of local recurrence. Conclusion The proximity of osteosarcoma to major blood vessels is a poor prognostic factor for local control and survival. Amputation offers better local control for tumours attached to the blood vessels but does not improve survival. Limb salvage surgery offers similar local control if the tumour attachment to blood vessels is limited. Cite this article: Bone Joint J 2019;101-B:1024–1031.

scholarly journals What Are the Results of Limb Salvage Surgery for Primary Malignant Bone Tumor in the Forearm?

2020 ◽  
Author(s):  
Weifeng Liu ◽  
Yongkun Yang ◽  
Tao Jin ◽  
Yang Sun ◽  
Yuan Li ◽  
...  
Keyword(s):  
Local Recurrence ◽  
Limb Salvage ◽  
Distant Metastasis ◽  
Salvage Surgery ◽  
Univariate Analysis ◽  
Survival Rates ◽  
Surgical Margin ◽  
Functional Results ◽  
Limb Salvage Surgery ◽  
Proximal Ulna

Abstract Background The forearm primary malignant bone tumor is rare and limb salvage is difficult. The purpose of this study was to analyze epidemiological characteristics of forearm primary malignant bone tumors and to explore oncological and functional results of limb salvage surgery in forearm.Methods 369 patients with primary forearm malignant bone tumors were retrospectively analyzed from 2000 to 2017. There were 266 patients with radius tumor and 46 (17.3%) of them were malignancy, while 103 patients with ulna lesion and 22 (21.4%) of them were malignant tumor. The oncological results, prognostic factors and functional results after limb salvage surgery of forearm malignancy were analyzed.Results A total of 60 patients received limb salvage surgery. Fifty-six patients followed more than 12 months or progressions within 12 months were included in final evaluation. Radius resection was performed in 38 patients and distal radius (25 patients) was most frequent. Ulna resection was performed in 18 patients and proximal ulna (13 patients) was most frequent. The surgical margin contained intracapsular resection in 3 patients, marginal resection in 8 patients and wide resection in 45 patients. The follow-up averaged 72.1 (7-192, median 62.5) months. Local recurrence occurred in 11 patients (19.6%) and distant metastasis occurred in 14 patients (25%). The 5-year recurrence free survival rates was 79.8%. Univariate analysis showed history of unplanned resection, tumor located in ulna, tumor located in proximal forearm and inadequate surgical margin were associated with recurrence. The overall 5-year and 10-year survival rates were 83.5% and 71.7%, respectively. Univariate analysis showed inadequate surgical margin, local recurrence and distant metastasis were associated with death. Forty-two patients were evaluated by MSTS score with an average of (93.0 ± 5.1) %.Conclusions The incidence of radius malignant tumor is higher than that of ulna. The distal radius and proximal ulna are most frequency involved sites. Unplanned resection, tumor located in ulna, tumor located in proximal forearm and inadequate surgical margin are risk factors for local recurrence; local recurrence and distant metastasis are independent prognostic factors of death. The oncology control and function result of limb salvage surgery was satisfactory.

scholarly journals The Correlation of Surgical Margins and Outcome Of Soft Tissue Sarcomas of The Extremities and Trunk in Hospital Sultan Ismail, Johor Bahru

2018 ◽  
Vol 17 (1) ◽  
Author(s):  
Muhamad Firdaus bin Zainudin
Keyword(s):  
Overall Survival ◽  
Soft Tissue ◽  
Local Recurrence ◽  
Survival Rates ◽  
Soft Tissue Sarcomas ◽  
Surgical Margin ◽  
Study Patient ◽  
P Value ◽  
Limb Salvage Surgery

Introduction: Patients with soft tissue sarcoma are treated following the standardized guidelines, however it is not guaranteed patient will remain free from local recurrence (LR) and metastasis. This study was conducted to determine the association between microscopic marginal status with local recurrence, metastasis and the survival of the patient. Materials and Methods: This retrospective study was conducted from January 2015 to December 2017 in Hospital Sultan Ismail, Johor Bahru. All patients underwent complete standadized resection of the tumour and had been follow up for 5 years. An operating and follow-up records of 70 cases who fulfill the inclusion and exclusion criteria were collected and analysed using Pearson chi square test and Kaplan-Meier curves. Results: Of the 70 patients, 52 were males and 18 were females. The age of the patients were between 16 and 73 years with the means age of 48.8 years old. Sixty eight patients underwent limb salvage surgery and 2 had amputation. 42 of them had positive post-operative microscopic surgical margin (PMSM) while 28 were negative. Local recurrence was noted in 28 and metastasis in 30 patients. Patient who had PMSM has higher risk to get local recurrence and metastasis compared to patient with negative margin (p-value <0.001). The overall median survival was 23 months. Overall survival rates for 3 years was 80% and for 5 years was 65%. Conclusion: In our study, patient with positive post-operative microscopic surgical margin had higher possibility to develop local recurrence, metastases and decrease overall survival rate.

Prognosis and surgical outcome of soft tissue sarcoma with malignant fungating wounds

2020 ◽  
Vol 51 (1) ◽  
pp. 78-84
Author(s):  
Koichi Okajima ◽  
Hiroshi Kobayashi ◽  
Tomotake Okuma ◽  
Sho Arai ◽  
Liuzhe Zhang ◽  
...  
Keyword(s):  
Overall Survival ◽  
Soft Tissue ◽  
Local Recurrence ◽  
Soft Tissue Sarcoma ◽  
Limb Salvage ◽  
Salvage Surgery ◽  
Wound Complications ◽  
Limb Salvage Surgery ◽  
High Grade ◽  
Surgical Wound

Abstract Objective Malignant fungating wounds are ulcerating tumors that infiltrate the overlying skin. Little evidence exists regarding the prognosis or treatment of malignant fungating wound in soft tissue sarcoma. This study aimed to reveal the prognosis and outcome of surgical treatment of malignant fungating wound in soft tissue sarcoma. Methods We retrospectively reviewed 26 patients with malignant fungating wound in high-grade soft tissue sarcoma between 2005 and 2018. The patients’ characteristics, treatments, surgical wound complications, local recurrences and prognoses were analyzed. Overall survival was analyzed using the Kaplan–Meier method and compared with that of the control cohort, consisting of 236 consecutive patients with non-malignant fungating wound high-grade soft tissue sarcoma treated during the same period. Results Among the 26 patients, undifferentiated pleomorphic sarcoma was the most common subtype. Twenty-three patients, including 20 (87%) and 3 (13%), underwent limb-salvage surgery and amputation, respectively. Among the 20 patients who underwent limb-salvage surgery, 4 (20%) had surgical wound complications, which required additional surgical procedures. Excluding the patients who underwent palliative surgery, local recurrence occurred in 2 patients (11%). The 5-year overall survival rate for all high-grade malignant fungating wound and non-malignant fungating wound patients was 26.0 and 67.3% (P &lt; 0.0001), respectively. Conclusions Malignant fungating wounds in soft tissue sarcoma were significantly associated with a poor prognosis; however, the incidence of surgical complications and local recurrence after limb-salvage surgery was comparable to that of general soft tissue sarcoma cases. Limb-salvage surgery should be considered, if possible, to preserve the patient’s quality of life because of the dismal prognosis of patients with malignant fungating wound in soft tissue sarcoma.

scholarly journals Functional Outcome in Sarcomas Treated With Limb-Salvage Surgery or Amputation

Sarcoma ◽  
1998 ◽  
Vol 2 (1) ◽  
pp. 19-23 ◽  
Author(s):  
Rikke Johansen ◽  
Ole S. Nielsen ◽  
Johnny Keller
Keyword(s):  
Functional Outcome ◽  
Limb Salvage ◽  
Salvage Surgery ◽  
Univariate Analysis ◽  
Soft Tissue Sarcomas ◽  
Post Treatment ◽  
Limb Salvage Surgery ◽  
Functional Evaluation ◽  
Functional Scores

Purpose.In all patients treated at the Centre for Bone and Soft Tissue Sarcomas of Aarhus the functional outcome is prospectively evaluated by use of the Enneking system for the functional evaluation after surgical treatment of tumours of the musculoskeletal system. This system has been accepted by the Musculoskeletal Tumour Society and the International Symposium on Limb Salvage.Patients/methods.In the present study the functional outcome after limb-salvage surgery (89 patients) and amputation (58 patients) was compared. In the limb-salvage group the treatment was surgery alone in 50% and surgery combined with either radiotherapy in 39% or chemotherapy in 11%. Inclusion criteria were: Deep seated extremity sarcomas, age >14 years, more than 1 year post-treatment follow-up time and alive at the end of the study. Median age was 49 years (range 14–88 years). Median tumour diameter was 8 cm (range 1–20 cm), median follow-up time was 4.8 years (range 1–11 years). Wilcoxon andχ2-tests were used for statistical analyses.Results.The two groups were comparable according to age, sex, size of tumour, type of tumour, location of tumour, as well as post-treatment follow-up time. The functional scores were significantly higher after limb-salvage surgery as compared to amputation, the median scores being 85 and 47, respectively (p<0.001). A similar difference was observed if the Enneking scores were subdivided into general health-related scores and extremity-related scores. No association was found between functional scores and the following factors by use of univariate analysis: size of tumour, radiation therapy, localization of tumour and surgical margin.Discussion.We conclude that this study indicates that limb-salvage surgery is associated with a better functional outcome than that observed after amputation. However, whether this also indicates a difference in quality of life needs further studies.

scholarly journals Management of Local Soft Tissue Recurrent Osteosarcoma After Wide Resection and Reconstruction with Megaprosthesis: A Case Report

2019 ◽  
Vol 13 (4) ◽  
pp. 137
Author(s):  
Venansius Herry Perdana Suryanta ◽  
Muhammad Naseh Sajadi Budi
Keyword(s):  
Local Recurrence ◽  
Limb Salvage ◽  
Salvage Surgery ◽  
Malignant Neoplasm ◽  
Quadriceps Muscle ◽  
Response To Therapy ◽  
Wide Resection ◽  
Surgical Removal ◽  
Limb Salvage Surgery ◽  
Surgical Methods

Introduction: Limb salvage surgery involves all of the surgical methods to achieve the eradication of a malignant neoplasm and restoration of the limb with a satisfactory oncologic, functional, and cosmetic outcome. Rates of local recurrence are 4% to 10%. There is a chance of local recurrence from the contamination of biopsy path. Neoadjuvant chemotherapy has a guarding effect on managing neoplasm infiltration at the biopsy location.Case Presentation: An 18 year old male experienced a new painless lump at his right anterior thigh with size about 5 cm in diameter since 5 months ago. Previously, he underwent limb salvage surgery with megaprosthesis about 6 months ago due to osteosarcoma at his right distal femur. He also got neoadjuvant and adjuvant chemotherapy for 6 cycles. Mass removal was done and 1.5 cm mass in diameter was found within quadriceps muscle with a soft consistency and well-defined border from the previous biopsy site that had not been resected. The specimen result was osteosarcoma surrounded by tumor-free tissue. Postoperatively, he still had the same range of motion function as before.Conclusions: We need to consider the previously contaminated biopsy path that could lead to local recurrence. Factors that affect the prediction of the recurrent disease are the disease-free time period, location of recurrence and histological response to therapy and the capability to achieve total surgical removal. Tumor removal followed by the local radiation and chemotherapy is the preferred treatment for recurrence.

Does neo-adjuvant chemotherapy increase the risk of infection after limb salvage surgery for bone tumors?

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 20532-20532
Author(s):  
S. Sankaranarayanan ◽  
V. Sokolovskiy ◽  
V. Voloshin ◽  
M. Aliev ◽  
V. Zubikov ◽  
...  
Keyword(s):  
Adjuvant Chemotherapy ◽  
Limb Salvage ◽  
Bone Tumors ◽  
Salvage Surgery ◽  
Limb Salvage Surgery ◽  
Team Approach ◽  
Group A ◽  
Neo Adjuvant Chemotherapy ◽  
Group B

20532 Background: Neo-adjuvant chemotherapy is commonly used to eradicate the micro metastases and to prepare the patient for limb-salvage surgery. It helps the surgeon to get good oncological margin intraoperatively. Methods: Between the period of 1992 - 2005, 321 patients underwent limb salvage surgery for bone tumors at the Department of General Oncology (Bone & Soft tissue tumors), N. N. Blokhin Russian Cancer Research Center & Moscow Regional Clinical Research Institute, Moscow, Russian Federation. 230/321 patients (Group A) received neo-adjuvant chemotherapy. The course of chemotherapy ranges from 2 to 11 cycles. 95/321 patients (Group B) did not receive neo-adjuvant chemotherapy. The histological diagnoses were: 155 - High grade osteosarcoma, 38 - Giant cell tumor, 36 - Malignant fibrous histiocytoma, 29 - Chondrosarcoma, 25 - Periosteal osteosarcoma, 21 - Metastasis from other organs and 17 - Ewing's tumor. Results: In Group A, 27 patients (11.7%) and in Group B, 7 (7.3%) had infection of endoprosthetic bed. Suppression of the immune system by chemotherapeutic agents is the main reason for the higher incidence of infection in Group A. All the 27 patients in Group A and 2 patients in Group B had revisional endoprosthetic replacement. In group A 7/27 and in Group B none of the 7 patients died of post operative infection. The follow-up ranged from 1 - 13 years (mean follow-up 6 years). Discussion: In our opinion, it has a major disadvantage, i.e. it increases the risk of postoperative infection. How best to combine this drug is still unknown. In the future, therapy for bone tumors should be enhanced by advances in pharmacology, immunology, and molecular genetics that will lead to more efficacious, specific and less toxic treatments. An interdisciplinary team approach is needed in order to advance the goal of local tumor control, limb salvage with optimum extremity function, minimal morbidity and improved long term survival. No significant financial relationships to disclose.

scholarly journals Massive autoclaved allografts and autografts for limb salvage surgery A1-8 year follow-up of 23 patients

1997 ◽  
Vol 68 (4) ◽  
pp. 392-395 ◽  
Author(s):  
Naohiro Asada ◽  
Hiroyuki Tsuchiya ◽  
Katsuhiko Kitaoka ◽  
Yoshihiko Mori ◽  
Katsuro Tomita
Keyword(s):  
Limb Salvage ◽  
Salvage Surgery ◽  
Limb Salvage Surgery

scholarly journals Assessment of prognostic factors in extracranial germ cell tumors in children

2021 ◽  
Vol 67 (6) ◽  
pp. 829-836
Author(s):  
Symbat Salieva ◽  
Riza Boranbayeva ◽  
Bakhram Zhumadullayev ◽  
Ergali Sarsekbayev ◽  
Oleg Bydanov
Keyword(s):  
Overall Survival ◽  
Prognostic Factors ◽  
Survival Rate ◽  
Germ Cell ◽  
Malignant Tumors ◽  
Survival Rates ◽  
Tumor Resection ◽  
Germ Cell Tumors ◽  
Morphological Structure ◽  
High Sensitivity

Germ cell neoplasms in the group of benign and malignant tumors heterogeneous in morphological structure, clinical features and prognosis. A special characteristic of germ cell tumors is their high sensitivity to platinum-containing chemotherapy, which allows cure of up to 80–90% patients. However 20–25% of patients with a common type have overall survival rate of less than 50%. The aim of the study is to assess the survival rate of children with extracranial germ cell tumors and to identify adverse risk factors. Methods. The study includes 116 children with extracranial germ cell tumors treated from 2013 to September 2009. Treatment consisted of tumor resection and platinum based on platinum chemotherapy. Survival rate was assessed by the Kaplan-Mayer method. Prognostic factors are determined according to IGCCCG, MaGIC, MAKEI, RODO. Results. Overall and event free survival rates were 79±5% and 76±4%, respectively. The worst overall survival had patients with extragonadal tumors, advanced stages of a disease, high initial level of AFP (≥10 000 ng/ml), non-seminoma version of state treasury bills and extra pulmonary metastases. Conclusion. Survival rate in children with extracranial germ cell tumors depends on the prognostic factors. Statistically significant predictors of the poor prognosis were extragonadal localization of a tumor and the AFP level ≥10 000 ng/ml.

scholarly journals Clinical and Functional Outcomes using the Kyocera Modular Limb Salvage System for Lower Extremity Reconstruction

2020 ◽  
Author(s):  
Donnel Alexis Ting Rubio ◽  
Katsuhiro Hayashi ◽  
Norio Yamamoto ◽  
Toshiharu Shirai ◽  
Akihiko Takeuchi ◽  
...  
Keyword(s):  
Aseptic Loosening ◽  
Limb Salvage ◽  
Functional Outcomes ◽  
Salvage Surgery ◽  
Valgus Deformity ◽  
Limb Salvage Surgery ◽  
Superficial Infection ◽  
Prosthesis Survival ◽  
Tumor Group

Abstract Background: Segmental metallic endoprostheses are widely used and important in reconstructive procedures of the lower limb. Most of the currently available endoprostheses are made in Europe or the United States of America and are too large for Asian knees. The Japanese Musculoskeletal Oncology Group developed a tumor prosthesis better suited for Asian skeletal anatomy, the Kyocera Modular Limb Salvage System (KLS).Methods: We performed a retrospective review of the records of patients who underwent reconstruction using KLS implants. Thirty-five patients fulfilled the inclusion criteria, 20 having undergone limb salvage surgery for tumor and 15, joint arthroplasty. Functional outcomes were evaluated using the revised Musculoskeletal rating scale for the tumor group and the Japanese Orthopedic Association Knee Score for the arthroplasty group. Complications and survivorship of the implants were also assessed.Results: At the latest follow-up, in the tumor group, 13 were alive with no evidence of recurrence, 6 died of disease, and 1 was alive with evidence of disease. The average MSTS scores on latest follow-up were 63 for the proximal femur, 67 for the distal femur, and 92 for the proximal tibia. The mean prosthesis survival was 28 months. Complications include 4 cases of aseptic loosening, 2 deep infections, 1 superficial infection, 1 valgus deformity, 2 periprosthetic fractures, 2 incidences of excessive polyethylene wear, and 2 local tumor recurrences. In the arthroplasty group, 1 patient had a persistent low grade infection on the latest follow-up. The post-operative JOA score was 61(mean). Complications included 3 cases of aseptic loosening, 2 deep infections, 2 implant failures, 1 superficial infection, 1 valgus deformity, and 1 soft tissue defect.Conclusion: Early results of the KLS implant system are encouraging, with comparable clinical outcomes to other systems in the literature. A longer follow-up study with increased numbers of patients is necessary to further validate the functional outcomes and prosthesis survival using the KLS system for limb salvage surgery.

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