En-bloc excision of Giant Cell Tumors of the distal radius and arthrodesis of the translocated ipsilateral ulna: A report of two cases

The distal radius is the third most common site of giant cell tumor of bone (GCTB). The local aggressive invasion of this rare neoplasm requires reconstructive solutions after wide excision. The authors present two cases of patients diagnosed with Campanacci grade III GCTB of the distal radius successfully treated with en-bloc excision and translocation of the ipsilateral ulna. Pre-operative application of denosumab was given for one year to both patients. At one year of follow-up, both patients are disease-free and reported satisfactory results on Quick - Disabilities of the Arm, Shoulder and Hand (Quick-DASH) questionnaire and modified Musculoskeletal Tumor Society (MSTS) score. Although a challenge, the reported procedure offers good oncological and functional outcomes. Keywords: Giant cell tumor of bone; distal radius; en-bloc excision; translocation; ipsilateral ulna; wrist arthrodesis

Hemicortical Resection and Biological Reconstruction using Allograft for Parosteal Osteosarcoma of the Distal Femur. A Case Series

Background: Parosteal osteosarcoma (PAO), which is a surface osteosarcoma, can be treated with wide excision and endoprosthetic or allograft application. However, due to the low local recurrence and metastasis rate, when it appears in the posterior surface of the distal femur, can be managed with hemicortical wide resection and biological reconstruction with hemicortical allograft.The purpose of this study was to evaluate the oncological and functional outcomes of patients with parosteal osteosarcoma (PAO) of the posterior cortex of the distal femur who underwent biological reconstruction after hemicortical resection. Methods: Eleven patients who underwent wide tumor resection and defect reconstruction of the posterior surface of the distal femur using hemicortical allograft were studied retrospectively. Local recurrence, metastasis, complications and the functional outcome using the Musculoskeletal Tumor Society scoring system (MSTS Score) were evaluated.Results: The average postoperative follow-up period was 53.64 months (range, 30 to 84 months). At the latest follow up, all patients were free of the disease without appearing any metastases. A patient with local recurrence underwent revision surgery with fibula autograft reconstruction. The mean MSTS score was 93.45 ± 3.56. Conclusions: In patients with PAO of the posterior aspect of the distal femur the treatment of hemicortical resection and allograft reconstruction has satisfactory oncological and functional outcomes and low complication rates.

Scapulectomy for Fibromatosis – Ocological and Functional Outcomes

Aggressive fibromatosis is a locally invasive tumor that does not metastasize. Only few cases of scapulectomy for fibromatosis of scapular muscles are reported in the world literature. We present two consecutive cases of scapulectomy done for fibromatosis of periscapular muscles at the Department of Surgical Oncology in our centre between 2014 and 2019. One patient underwent subtotal scapulectomy by posterior approach and the other patient underwent scapulectomy below spine of scapula by combined anterior and posterior approach. The follow-up period of both the patients was 5 years. One patient developed recurrence after 9 months of surgery dealt by re-resection followed by adjuvant radiation. The modified Musculoskeletal Tumor Society (MSTS) score for scapular surgery was 20 in the first patient and 22 in the second patient. Both of them are able to carry out normal regular activities with the compensation from the opposite upper limb. Scapulectomy for symptomatic fibromatosis of the scapular muscles gives acceptable functional results and good disease-free interval. Scapulectomy should be considered as part of resection for better tumor clearance in fibromatosis involving muscles around the scapula. Further studies are needed to evaluate and validate the need for radical surgery in this setting.

Avaliação de métodos intramedulares com polimetilmetacrilato para fixação em lesões ósseas de extremidades

Resumo Objetivo Avaliar o potencial melhor resultado funcional e controle álgico no tratamento de fraturas patológicas e fixações profiláticas tratadas com haste intramedular associada ao polimetilmetacrilato (PMMA) em comparação com o uso de haste intramedular em lesões tumorais em ossos longos. Métodos De janeiro de 2012 a setembro de 2017, 38 pacientes com 42 lesões patológicas (fraturas ou iminência segundo os critérios de Mirels) foram tratados cirurgicamente. Dezesseis pacientes submetidos a fixação com haste intramedular bloqueada foram alocados ao grupo controle e 22 pacientes com lesões patológicas foram alocados para tratamento com haste intramedular associada ao PMMA. No pós-operatório, foi realizada a submissão dos pacientes ao escore da Musculoskeletal Tumor Society (MSTS, na sigla em inglês) e à avaliação radiográfica do tratamento realizado, assim como à avaliação de intercorrências e complicações relacionadas ao tratamento. Resultados A avaliação através do questionário MSTS demonstrou melhor resultado funcional do grupo associado com PMMA quando comparado com o grupo controle, o qual obteve uma pontuação média de 16,375 em um máximo de 30 pontos (54,6%), enquanto o grupo em estudo com associação do PMMA obteve uma média de 22,36 pontos (74,5%). O procedimento mostrou-se seguro, taxas de complicações e gravidade semelhantes e sem diferença estatística quando comparado com o tratamento padrão. Conclusão A estabilização de lesões tumorais com fixação associada ao PMMA demonstrou reabilitação precoce e melhora na qualidade de vida, permitindo rápida recuperação funcional. A utilização do PMMA apresenta vantagens como diminuição do sangramento e da necrose tumoral e maior estabilidade mecânica.

What are the Results of Resection of Forearm Soft Tissue Sarcoma?

Only few reports have assessed the characteristics and oncological and functional outcomes of forearm soft tissue sarcomas (STS). Then, we aimed to investigate the clinical features and survival-related factors for forearm STS who underwent surgical excision at our institution. There were 38 patients. Fourteen patients (41%) were referred to our institution after an unplanned excision and tumor size and grade were significantly associated with the receipt of it. The postoperative median Musculoskeletal Tumor Society rating scale (MSTS) score was 28. Bone resection or major nerve palsy was the only factor influencing the postoperative MSTS score (P < 0.001). There was no significant difference in MSTS scores according to the reconstruction procedures (the use of flap or tendon reconstruction). The 5-year local recurrence-free survival (LRFS) rate was 86%. Univariate analysis revealed that the histological diagnosis of myxofibrosarcoma was the only factor that influenced LRFS (P = 0.047). The 5-year metastasis-free survival rate was 77%. The 5-year overall survival (OS) rate was 94%. Age was the only factor that influenced OS (P = 0.01). In conclusion, reconstruction of the skin and tendon can compensate for function. Careful follow-up is important, especially in patients with myxofibrosarcoma, due to its likelihood of local recurrence.

Analysis of the curative effect of limb salvage therapy in patients with soft tissue sarcoma who underwent extensive resection combined with skin flap transplantation

Purpose: Patients who were diagnosed with soft tissue sarcoma (STS) of limbs and met the indications for amputation because of no effective soft tissue coverage after extensive tumor resection were treated with skin flap transplantation and therapeutic courses were observed. Methods: A total of 23 patients, pathologically diagnosed as soft tissue sarcoma from January 2011 to June 2015 and whose effective soft tissue coverage was not guaranteed due to extensive tumor resections were included. They underwent extensive tumor excision and skin flap grafting. The postoperative follow-up, tumor control and functional recovery was evaluated as per the Musculoskeletal Tumor Society (MSTS) score. Results: The follow-up time was from 8 to 60 months, with an average follow-up of 39.69 months. Of the 23 patients, 10(43.47%) died of tumor metastasis from 8th to 23rd months after surgery. In these 10 cases, 2 cases (8.70%) subsequently underwent amputation because of local tumor recurrence. The remaining 13 patients are recurrence free till date of follow up. The MSTS limb function score at 3 months after surgery of all patients were 7-28 points, with an average of 22.56 points, and the excellent and fair scores are observed in 91.30% of patients. Conclusion: For patients who cannot achieve effective soft tissue coverage after extensive resection of soft tissue sarcoma and meet the indications of amputation can have limb preservation by extensive tumor resection combined with skin flap transplantation with a good functional results

Functional and Oncological Outcomes of Multidisciplinary Management of Ewing’s Sarcoma of Clavicle: A Single-Center Experience

Objectives Ewing’s sarcoma is best treated using a multidisciplinary approach. We discuss the functional and oncological outcomes of clavicular Ewing’s sarcoma which has been sparsely reported in literature. Materials and Methods We retrospectively evaluated patients who underwent resections for Ewing’s sarcoma of clavicle from January 2002 to December 2017. The study end points were locoregional recurrence free survival (LRFS), disease-free survival (DFS), and overall survival (OS) at 3 and 5 years, and functional outcomes measured by Musculoskeletal Tumor Society (MSTS) scores. Statistical Analysis The LRFS, DFS, and OS were calculated and analyzed using the Kaplan–Meier method and log-rank test. Results Data of 21 patients (male: 12, female: 9) was analyzed with a mean age [range] of 15.3 [6–40] years. Total clavicle excision was done in 62% (13 of 21) while 38% (n = 8) had partial resections. Radiotherapy was administered in 15 patients (71.5%). At a median follow-up of 42 months (range: 7–198), data of 20 patients was available for follow-up. Ten patients died (due to disease: nine, other reasons: One), eight are disease free and alive, one had metastasectomy on recurrence and is disease free and, one patient is alive with disease and on palliative chemotherapy. The LRFS, DFS, and OS were 95, 59, 65% and 95, 47, 59% at 3 and 5 years, respectively. The functional evaluation done for nine patients who are free of disease showed a mean MSTS score of 29 (range: 27–30; total clavicle excision: 28.5, partial clavicle excision: 29.5). Conclusion Patients with Ewing’s sarcoma of the clavicle who underwent resection without reconstruction have acceptable local control rates and excellent functional outcomes.

Outcome of modular megaprosthesis in management of Campanacci stage III giant cell tumor around the knee: a prospective study

Background: Juxta articular giant cell tumors around the knee constitute 50-60% of the total cases reported. If the disease is detected at an advanced stage, reconstruction of the joint after tumor excision poses problems and has poor functional outcome. The aim of the study was to determine the functional outcome after resection of juxta-articular giant cell tumors around the knee and its reconstruction with mega prosthetic arthroplasty will be analyzed.Methods: Between January 2017 and March 2021, 14 patients in the age group of 28-48 years (mean=42.85 years) with Campanacci stage three giant cell tumors around the knee were studied (12-distal femur patients, 2-proximal tibia). Patients underwent tumor excision and reconstruction with modular megaprosthesis. They were evaluated post-operatively using the Revised Musculoskeletal Tumor Society Score (MSTS) for lower limb. Results: All the patients were followed up for 12-44 months (mean=29.5 months), the average knee flexion at 6 months being 116.4 degrees. The mean MSTS at 6, 12, 18 and 24 months are 19.45, 23.23, 26.61 and 28.77 respectively. Complications observed were infection and tumor recurrence. Conclusions: In advanced cases where tumor excision leaves large bone segment loss, reconstruction with megaprosthesis can give desirable functional outcome.

Clinical outcomes of frozen autograft reconstruction for the treatment of primary bone sarcoma in adolescents and young adults

Age affects the clinical outcomes of cancer treatment, including those for bone sarcoma. Successful reconstruction using frozen autograft after excision of bone sarcoma has been reported; however, little is known about the clinical outcomes of frozen autograft reconstruction according to age. The purpose was to evaluate the clinical outcomes of the frozen autograft reconstruction focusing on skeletally mature adolescents and young adults (AYAs) that was 15 to 39 years of age. A total of 37 AYA patients with primary bone sarcoma on the appendicular skeleton were enrolled in this study. The mean follow-up period was 89 months. The graft survival (GS), overall survival (OS), recurrence-free survival (RFS), complications and the function were retrospectively evaluated using medical records. The 10-year GS, OS, and RFS rates were 76%, 84%, and 79%, respectively. Bone union was achieved with a rate of 94% within 1 year after surgery, and nonunion (n = 1) and fracture (n = 2) were infrequently observed. Graft removal was performed in 7 cases, and the most common reason for the removal was infection (n = 5). The Musculoskeletal Tumor Society score was excellent in 23 cases of the available 29 cases. Frozen autograft reconstruction for AYAs showed excellent clinical outcomes, although the long-term follow-up is required.

PROSPECTIVE INTERVENTIONAL STUDY OF ASSESS FUNCTIONAL OUTCOME OF GIANT CELL TUMOUR OF DISTAL END RADIUS TREATED BY EN BLOE RESECTION AND RECONSTRUCTION BY ULNAR TRANSLOCATION

Background: Giant cell tumour (GCT) of bone is a relatively rare, locally aggressive benign neoplasm associated with a wide pathological spectrum, ranging from latent benign to highly recurrent and, occasionally, malignant metastatic potential. Methods: This retrospective study was conducted on 30 hospitalized patients for surgery in in Jaipur. We followed up all patients with GCT of the distal radius who were treated with en bloc excision and custom prosthetic replacement. All cases were evaluated based on clinical and radiological examinations, passive range of motion (ROM) of the wrist joint, complications, and Musculoskeletal Tumor Society (MSTS) score. Results: Mean follow-up period was 52.36 months, mean resected length of the radius was 7.11±2.31 cm. One patient had tumor recurrence in the soft tissues after 16.32±2.31 months (recurrence rate 10.00 %). No patient had fracture, recurrence in the bone, metastases, or immune rejection. No complications were seen, such as loosening, rupture, or dislocation of the custom prosthesis. One patient developed superficial infection at the operative site which resolved after a course of antibiotics for 4 weeks. One patient experienced pain, which could be endured without the need for analgesics. Average ROM was 40.6° of dorsiflexion, 29.8° of volar flexion, 46.2° of supination, and 37.8° of pronation. Mean grip strength was 70 % (41–84 %). Overall revised MSTS score averaged 81.36 % with one being excellent, five good, and five satisfactory. Conclusion: The optimal treatment for GCTs arising around the knee remains controversial. Despite the trend towards better oncological control of this tumour after wide resections, the recurrence rates achieved through a more conservative procedure such as the curettage-based interventions seem to be acceptable. Additionally, curettage and local adjuvants allow for overall better function of the knee, in particular with proximal tibia GCTs. Keywords: GCT, MSTS, ROM