Functional and oncological outcome after surgical resection of the scapula and clavicle for primary chondrosarcoma

Chondrosarcoma of the Flat Bones: Differential Survival Between High-Grade Lesions of the Pelvis and Scapula

BACKGROUND

Flat bone chondrosarcomas have worse outcomes than extremity tumors, but there is no data directly comparing the different flat bones. The aim of this study was to examine differences in recurrence and survival between pelvic and scapular chondrosarcoma.

METHODS

One hundred and sixty-nine (42 scapula, 127 pelvic) patients with chondrosarcoma who underwent surgical resection were reviewed. High-grade tumors were defined as lesions that were Grade 3 or dedifferentiated on surgical pathology.

RESULTS

Patients with low-intermediate grade lesions of the scapula were more likely to have positive margins during definitive surgical management (14% vs. 3%, OR 5, 95% CI [1.15, 22.6], p = 0.02), however, this did not translate to differences in recurrence or survival (p > 0.05). The presence of an associated soft tissue mass in low-intermediate grade lesions was not associated with increased recurrence. Among high-grade tumors, patients with scapular lesions had worse DSS (HR 2.99, 95% CI [1.05, 8.51], p = 0.04). One- and 2-year DSS for high-grade pelvic tumors was 75% and 57%, respectively, and 50% and 33% for scapular tumors.

CONCLUSION

Survival for high-grade chondrosarcoma of the flat bones is poor, particularly for those of the scapula. Despite a higher rate of positive margins for low-intermediate grade lesions of the scapula, there was no significant difference in survival compared to low-intermediate grade lesions of the pelvis. Additional studies with larger sample sizes are needed to further elucidate differences between these locations.

Oncological and functional outcomes after resection of malignant tumours of the scapula

Aims

The scapula is a rare site for a primary bone tumour. Only a small number of series have studied patient outcomes after treatment. Previous studies have shown a high rate of recurrence, with functional outcomes determined by the preservation of the glenohumeral joint and deltoid. The purpose of the current study was to report the outcome of patients who had undergone tumour resection that included the scapula.

Methods

We reviewed 61 patients (37 male, 24 female; mean age 42 years (SD 19)) who had undergone resection of the scapula. The most common resection was type 2 (n = 34) according to the Tikhoff-Linberg classification, or type S1A (n = 35) on the Enneking classification.

Results

The ten-year disease-specific survival was 76%. High tumour grade (hazard ratio (HR) 4.27; p = 0.016) and a total resection of the scapula (HR 3.84; p = 0.015) were associated with worse survival. The ten-year metastasis-free and local recurrence-free survivals were 82% and 86%, respectively. Total scapular resection (HR 6.29; p = 0.004) was associated with metastatic disease and positive margins were associated with local recurrence (HR 12.86; p = 0.001). At final follow-up, the mean shoulder forward elevation and external rotation were 79° (SD 62°) and 27° (SD 25°), respectively. The most recent functional outcomes evaluated included the mean Musculoskeletal Tumor Society Score (76% (SD 17%)), the American Shoulder and Elbow Score (73% (SD 20%)), and the Simple Shoulder Test (7 (SD 3)). Preservation of the glenoid (p = 0.001) and scapular spine (p < 0.001) improved clinical outcomes; interestingly, preservation of the scapular spine without the glenoid improved outcomes (p < 0.001) compared to preservation of the glenoid alone (p = 0.05).

Conclusion

Resection of the scapula is a major undertaking with an oncological outcome related to tumour grade, and a functional outcome associated with the status of the scapular spine and glenoid. Positive resection margins are associated with local recurrence.

Can low-grade chondrosarcoma in flat bones be treated with intralesional curettage and cryotherapy?

BACKGROUND AND OBJECTIVES

Chondrosarcomas in flat bones are thought to be more aggressive in their behavior, and little is known about intralesional treatment outcomes of low-grade chondrosarcoma in these locations. We tried to find the differences between patients who had low-grade chondrosarcoma in their flat bones versus those with long bone involvement with regard to (1) disease outcome, (2) functional outcome, and (3) treatment complications.

METHODS

We retrospectively reviewed 44 patients with primary low-grade chondrosarcoma who were treated with intralesional curettage and cryotherapy. The patients were divided by location of tumor, group I (flat bones, seven patients) and group II (long bones, 37 patients).

RESULTS

The local recurrence rate was higher in group I with 5 years disease-free survival of 80.0% in group I and 97.0% in group II (p = 0.001). All recurrent cases were noted to have initially presented with soft tissue extension (Enneking stage IB). The mean Musculoskeletal Tumor Society score at the last follow-up was 21.7 in group I and 27.9 in group II (p = 0.045).

CONCLUSIONS

Intralesional curettage and cryotherapy for low-grade chondrosarcoma appear to be a safe and reasonable surgical option for patients with lesions confined to bone (Enneking stage IA).

LEVEL OF EVIDENCE

Level III, retrospective cohort study. See the Guidelines for Authors for a complete description of levels of evidence.

Management of Scapular Tumors

Scapular resections are large oncologic undertakings. Due to the soft tissue coverage of the scapula, tumors are often able to be resected with a negative margin. Involvement of the brachial plexus and axillary vessels is rare, allowing for a limb-salvage surgery in most cases. Functional outcomes are based on the magnitude of resection; patients undergoing a partial scapulectomy and those with glenoid preservation demonstrate improved outcomes compared to patients undergoing a total scapulectomy or glenoid resection. Although scapular endoprosthetics are available, there is limited data to support their routine use.

Oncologic and functional outcomes of different reconstruction modalities after resection of chondrosarcoma of the scapula: a medium- to long-term follow-up study

Objectives

To evaluate the oncologic and functional results of scapular reconstruction after partial or total scapulectomy for chondrosarcoma.

Materials and methods

Twenty-one patients with chondrosarcoma who underwent partial or total scapulectomy between January 2005 and July 2019 were reviewed retrospectively.

Results

At a mean follow-up of 62.6 months (range, 13–123 months), four patients developed local recurrence, and three developed distant metastases, one of which developed both recurrence and metastasis. The overall survival rate of patients at 5 years was 84.6%, the disease-free survival rate was 69.3%, and the complication rate was 19% (4/21). The 1993 American Musculoskeletal Tumor Society (MSTS93) scores of patients in the partial scapulectomy group, total scapulectomy + humeral suspension group and prosthetic reconstruction group were 26.50 ± 1.38, 19.00 ± 2.58, and 21.38 ± 2.62, respectively. There was a statistically significant difference between the partial scapulectomy group and the total scapulectomy + humeral suspension or prosthetic reconstruction group ( P = 0.006 and 0.0336, respectively). The range of motion of the shoulder joint for forward flexion was 80.83° ± 11.14°, 51.25° ± 21.36°, and 52.50° ± 11.02°, respectively. The p-values for the comparison between the partial scapulectomy group and the total scapulectomy + humeral suspension or prosthetic reconstruction group were 0.0493 and 0.0174, respectively. And the range of motion of abduction was 75.00° ± 10.49°, 32.50° ± 11.90°, 41.88° ± 11.63°, respectively. Patients in the partial scapulectomy group had significantly better postoperative shoulder abduction function than the total scapulectomy + humeral suspension or prosthetic reconstruction group (P = 0.0035 and 0.0304, respectively). There was no significant difference in MSTS93 scores and flexion and abduction function of the shoulder joint in the upper extremity after total scapulectomy with humeral suspension or prosthetic reconstruction (P > 0.05).

Conclusions

Surgical treatment of chondrosarcoma of the scapula can achieve a satisfactory prognosis and shoulder function. Total scapulectomy followed by prosthetic reconstruction or humeral suspension are both feasible treatments.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12891-022-05661-7.

Surgical treatment of chondrosarcoma of the scapula can achieve good oncologic and functional outcomes.

Prosthetic reconstruction of the scapula after scapulectomy does not provide better functional results than humeral suspension, and both are feasible treatment modalities.

Impact of tumour stage on the surgical outcomes of scapular chondrosarcoma

PURPOSE

Chondrosarcomas are common primary bone tumours in adults, often affecting the flat bones. Oncologic outcomes are often tied to tumour grade; however, grade is only a factor in the aggressiveness of a tumor. Extracompartmental extension, or tumor stage, has been found to be predictive of a poor outcome in other flat bone chondrosarcomas; however, this relationship has not been identified in the scapula. The purpose of the current study was to analyze the impact of tumour stage on the outcome of patients with scapular chondrosarcoma.

METHODS

Thirty-nine patients (26 males:13 females) with a mean age of 46 ± 17 undergoing surgical resection of a scapular chondrosarcomas were reviewed. Most patients had grade 1 (n = 24) tumors, with 26 (67%) having extracompartmental extension. The mean follow-up was eight years.

RESULTS

The ten year disease-specific survival was 77%. High-grade tumours (HR 18.15, p < 0.01) were associated with death due to disease. The ten year local recurrence- and metastatic-free survival were 77% and 74%. Positive surgical margins (HR 8.85, p < 0.01) were associated with local recurrence, and local recurrence was associated with metastatic disease (HR3.37, p = 0.04). All disease recurrences and death due to disease occurred in patients with extracompartmental extension (p < 0.05).

CONCLUSION

Extracompartmental extension was associated with a worse oncologic outcome in patients with scapular chondrosarcomas. Positive margins were associated with local recurrence, which was associated with metastatic disease; wide local excision with negative margins should be a goal for all patients, regardless of tumour grade.

MRI differentiation of low-grade and high-grade chondrosarcoma of the shoulder girdle, chest wall and pelvis: a pictorial review based on 111 consecutive cases

Approximately 40% of conventional chondrosarcomas arise from the shoulder girdle, chest wall and pelvis. This pictorial review describes the MRI features which may aid in the differentiation of Grade 1 chondrosarcoma (Gd1-CS) from high-grade chondrosarcoma (HG-CS) and dedifferentiated chondrosarcoma (DD-CS) in these locations, based on literature review and assessment of 111 consecutive cases presenting to the senior authors institution over a 13-year period. Of the 111 patients reviewed (71 males and 40 females; mean age 54.3 years; range 17-92 years), 27 were Gd1-CS, 72 were HG-CS and 12 were DD-CS. Tumours arising from the scapula, acetabulum, pubis/ischium and sacrum were more likely to be HG-CS, as were intramedullary tumours. MRI features associated with HG-CS and DD-CS included cortical destruction, bone oedema, soft tissue oedema, tumour necrosis, intermediate T2W SI and joint invasion. The presence of a soft tissue mass became a significant differentiating feature for tumours arising within the medullary cavity, but this was location-specific and did not differentiate between Gd1-CS and HG-CS/DD-CS arising from the sternum or clavicle.

The need for improved patient reported outcome measures in patients with extremity sarcoma: A narrative review

BACKGROUND

Extremity sarcoma causes impairments to functionality and quality of life. Patient-reported outcome measures (PROMS) assess patient perspectives relating to domains of health and quality of life.

METHODS

To describe PROMs utilised in extremity sarcoma, the available literature was screened for studies that utilised PROMs to evaluate outcomes in extremity sarcoma following surgery.

RESULTS

Seventy articles met eligibility criteria; six PROMs were identified. The Toronto Extremity Salvage Score, The Short-Form 36, The EORTC QLQ-C30, The Disabilities of the Arm, Shoulder and Hand questionnaire, the Reintegration to Normal Living index and the Patient-Reported Outcomes Measurement Information System. Most sarcoma patients score well in these tools, with bone sarcoma, and extent of resection being predictors of poor outcomes.

CONCLUSION

TESS is the only sarcoma-specific PROM, and though a valid assessment of functionality, it has difficulty differentiating patients with minor functional impairments. The absence of a disease-specific measure of health is concerning, as generic tools do not account for the unique experiences sarcoma patients face and may impair their accuracy in analysing intervention effectiveness.

Pedicle screw system reconstruction in shoulder resection type IV-total scapulectomy: A case report and short term follow up

Introduction

Shoulder resection remains a challenging procedure after scapulectomy for tumour resection. The results have various functional outcome, wound coverage, and cosmetic aspect. In this case report, we reported the outcome of pedicle screw application after scapulectomy procedure within 1 month follow up after surgical tumour excision.

Case presentation

A 74-year-old female presented with a painful lump on the left shoulder since nine months before admission. We performed physical examination, radiological evaluation using x-ray and MRI. We performed limb salvage surgery with shoulder girdle resection of tumour procedure using Malawer technique type IVB and applied pedicle and screw in proximal end clavicula and proximal end of humerus. We performed histopathological examination to ensure the tumour. We evaluated the patient one month after surgery using DASH score.

Discussion

MRI examination revealed that there was a solid mass with malignant characteristic destructing left scapular bone with the acromioclavicular and glenohumeral joint involvement. We used pedicle and screw to reconstruct the patient with efficient cost spending consideration. Clinical valuation showed there was no pain left and hand-free movement except the limitation of shoulder abduction. DASH score evaluation pre operative and post operative showed improvement from 70.8 to 45.0.

Conclusion

Limb salvage procedure using pedicle screw system may be one of treatment of choice for treating tumour of the shoulder affecting glenohumeral joint with excellent result of evaluation both clinical and functional outcome.

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Limb salvage surgery with shoulder girdle resection of tumour procedure using Malawer technique type IVB

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Pedicle screw application after scapulectomy procedure

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Excellent DASH score evaluation

[Complication management following resection and reconstruction of the upper limbs and shoulder girdle]

BACKGROUND

Sarcomas of the upper limbs commonly affect the proximal humerus or scapula. Complications after tumor resection and reconstruction are rare but cannot be neglected, particularly after tumor endoprosthetic reconstructions.

MATERIALS AND METHODS

The most common complications after resection of sarcomas of the upper limbs and shoulder girdle are described, and current knowledge regarding complication management is presented. Additionally, a selective literature search was performed, incorporating personal experiences.

RESULTS

Wound healing disorders and infections after tumor resection without specific reconstruction (clavicle resection, scapulectomy) usually respond well to conservative or surgical treatment. However, periprosthetic infections after reconstruction using a megaendoprosthesis constitute a severe and frequent complication, with an incidence of 5-10%. Two-stage implant replacement still represents the gold standard, although in selected cases, one-stage revision with retention of the prosthetic stem appears warranted. Secondary amputation as a result of periprosthetic infection is rare compared to the situation with infections of the lower limb. Mechanical complications necessitating surgical revision are mostly limited to joint dislocation after inverse total shoulder replacement (TSR). (Sub)luxation in anatomic TSR can be tolerated provided there is no tendency toward perforation of the skin in a asymptomatic patient. Biological reconstructions are most often indicated for reconstruction of intercalary defects of the humerus, and revision is necessitated most frequently by mechanical complications. Despite multiple surgical revisions, stable reconstructions and limb salvage can usually be achieved in the upper limb.

Application of a three-dimensional printed segmental scapula prosthesis in the treatment of scapula tumors

Chondrosarcoma is characterized by the presence of histologically aggressive behavior, and commonly involves the scapula. Currently, limb salvage surgery is the recommended surgical treatment. Owing to the irregularity of the tumor, the suitability of an implant after tumor resection is a challenge for surgeons. Three-dimensional (3D) printing technology has the potential to make personalized limb salvage surgery a reality. We report the case of a 53-year-old man who was diagnosed with chondrosarcoma of the scapula. Considering the low-grade malignancy and lack of invasion of the glenoid, we agreed upon segmental scapula replacement as the treatment protocol. Nevertheless, reconstruction of the irregular bony defect remaining after tumor resection can be complicated. Therefore, a personalized prosthesis and navigation template corresponding to tumor was designed with 3D printing technique, and tumor resection, prosthesis implantation, and rotator cuff reconstruction were completed. The affected shoulder achieved satisfactory function during a 32-month follow-up with no tumor recurrence. 3D printing technique can help implement the individualized design of the implant and accurate reconstruction after tumor resection, simplify complicated operations, improve operational efficiency, and allow early functional recovery.

A Comparison of Limb Salvage Versus Amputation for Nonmetastatic Sarcomas Using Patient-reported Outcomes Measurement Information System Outcomes

INTRODUCTION

The Patient-reported Outcomes Measurement Information System (PROMIS) is a scoring tool that allows comparisons between patients with rare conditions and more common ailments, or the general US population. PROMIS outcomes were compared between the limb salvage and amputee patients for nonmetastatic sarcomas to the US population.

METHODS

One hundred thirty-eight patients were included in the analysis. Patients were divided into the limb salvage and amputee cohorts, as well as based on the follow-up (1 to 11 or 12+ months).

RESULTS

Seven PROMIS domains were evaluated, and higher scores were found in both the limb salvage group and patients >12 months from surgery. The limb salvage group also had improved emotional health compared with the US population.

DISCUSSION

Improvements in PROMIS values are observed in limb salvage patients and in patients >12 months from surgery. Limb salvage patients demonstrate improved emotional health compared with the US population.

Evaluation of Planned versus Unplanned Soft-Tissue Sarcoma Resection Using PROMIS Measures

Background

The Patient Reported Outcomes Measurement Information System (PROMIS) is a tool developed by the National Institutes of Health that allows comparisons across conditions or even the United States (U.S.) general population.

Objectives

Our purpose was to compare PROMIS outcomes between patients who underwent a planned resection to those who underwent an initial unplanned excision of their sarcoma followed by a definitive oncologic resection. We then compared these groups to the U.S. general population.

Methods

Eighty-five patients were included and were divided into those who underwent an initial planned resection (67) and unplanned excision (18). These patients were then further categorized based on the length of follow-up since their last surgery, either early (<12 months) or late (>12 months).

Results

We evaluated seven PROMIS domains and found no differences between patients who underwent planned resection versus those who underwent an initial unplanned excision followed by a wide resection of the previous wound bed. When compared to the U.S. population, both cohorts demonstrated significantly improved scores in several emotional health domains.

Conclusions

Patients who undergo an unplanned excision followed by a definitive oncologic procedure have similar PROMIS scores compared to patients who undergo an initial planned resection.

An Evaluation of PROMIS Health Domains in Sarcoma Patients Compared to the United States Population

Background

The Patient Reported Outcomes Measurement Information System (PROMIS) is a patient-directed system that allows comparisons across medical conditions. With this tool, comparisons can now be made between rare conditions, such as sarcomas, and more common ailments, of the United States general population. This allows comparisons between rare conditions, such as sarcomas, to more common ailments, or even the United States (US) general population.

Objectives

Our purpose was to use PROMIS to compare outcomes in patients that had undergone resection of a nonmetastatic sarcoma to the US population.

Methods

One hundred thirty-eight patients were included in the analysis. These patients were divided into early (<2 years) and late follow-up (>2 years).

Results

We evaluated results from seven health domains and found significantly lower scores in the physical function and depression domains. These differences were present in both the early and late cohorts when compared to the US population.

Conclusion

While physical function was found to be worse in the sarcoma cohorts, we observed significantly improved levels of depression in these patients when compared to the US population. This finding was maintained over time and is an important reminder that a patient's goals and desires change following a cancer diagnosis and must be taken into consideration when planning treatment and determining a successful outcome.

Importance of latissimus dorsi muscle preservation for shoulder function after scapulectomy

BACKGROUND

Scapulectomy is an inevitable treatment for sarcomas of the scapula. This procedure is unavoidable because it reduces the local recurrence rate but can impair shoulder movements and affect the activities of daily living. This study investigated the factors influencing functional outcomes after scapulectomy.

MATERIALS AND METHODS

The clinical results of 8 patients (5 males, 3 females) who were diagnosed with primary or metastatic sarcomas of the scapula were retrospectively reviewed. The mean age was 49 years (range, 11-86 years). We examined the correlation between the type of excision of the scapula (total, subtotal, or partial) and postoperative functional outcomes according to the Musculoskeletal Tumor Society (MSTS) score. In partial excision, the glenohumeral joint was preserved; in subtotal excision, the glenoid was completely resected and some bony components were preserved; and in total excision, the entire bony component of the scapula was resected. The average follow-up period was 55 months (range, 9-142 months).

RESULTS

The partial, subtotal, and total excision groups had mean functional scores of 96.7%, 76.7%, and 62.2%, respectively. Although the mean functional scores were lower in patients who underwent total and subtotal excisions, 3 patients in whom the latissimus dorsi muscle was preserved had better function (mean MSTS score, 76.7%) than the 2 patients in whom it was not preserved (mean MSTS score, 55.0%).

CONCLUSION

These results suggest that the latissimus dorsi muscle, along with the deltoid and pectoralis major muscles, is one of the stabilizers of the proximal humerus after scapulectomy.