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Funovics PT. [Primary malignant bone tumors]. ORTHOPADIE (HEIDELBERG, GERMANY) 2023:10.1007/s00132-023-04387-1. [PMID: 37278729 DOI: 10.1007/s00132-023-04387-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Accepted: 04/17/2023] [Indexed: 06/07/2023]
Abstract
Primary malignant bone tumors are rare. Due to an associated worsening of the prognosis by diagnostic delay, these tumors must not be overlooked in the routine clinical practice and should therefore always be included in the differential diagnosis for the clarification of musculoskeletal complaints. A correct interpretation of the diagnostic procedure, radiological investigations and a biopsy of doubtful lesions can confirm the diagnosis. Osteosarcoma, chondrosarcoma and Ewing's sarcoma are the three most frequent primary malignant bone tumors and other entities occur only sporadically. While the prognosis of osteosarcoma and Ewing's sarcoma has been vastly improved with chemotherapy, chondrosarcomas mostly respond only poorly or not at all to systemic chemotherapy. Wide resection represents the gold standard in the surgical management of all primary malignant bone tumors. In addition, Ewing's sarcoma responds well to irradiation. The multidisciplinary management of primary malignant bone tumors should be performed at dedicated and specialized centers.
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Affiliation(s)
- Philipp Theodor Funovics
- Universitätsklinik für Orthopädie und Unfallchirurgie, Klinische Abteilung für Orthopädie, Medizinische Universität Wien, Allgemeines Krankenhaus der Stadt Wien, Währinger Gürtel 18-20, 1090, Wien, Österreich.
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Brown JM, Rakoczy K, Hart J, Jones KB, Groundland JS. Presenting features and overall survival of chondrosarcoma of the pelvis. Cancer Treat Res Commun 2022; 30:100510. [PMID: 34999477 DOI: 10.1016/j.ctarc.2022.100510] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 01/02/2022] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Chondrosarcoma is the second most common sarcoma of bone. This sarcoma is generally unresponsive to chemotherapy and radiation and is primarily managed through surgical excision. Pelvic chondrosarcoma presents a distinct therapeutic challenge due the complexity of resection, frequent recurrence and metastasis, and high post-operative morbidity. METHODS The SEER database was queried for pelvic chondrosarcoma diagnosed between 2004 and 2015. Cases were described by age, sex, tumor size, extension, grade, metastasis, and therapeutic intervention. These same variables were assessed for the upper extremities, lower extremities, skull and facial bones, thoracic bones, and vertebral column. RESULTS In total, 472 cases of pelvic chondrosarcoma were identified, representing 18.4% out of 2571 cases of chondrosarcoma distributed throughout the skeletal system. Among pelvic cases, 288 were male and 184 were female, with a median age of diagnosis of 54. Median tumor size was 96 mm, 64.9% of tumors were considered extracompartmental, and 11.3% of tumors were metastatic at time of diagnosis. The 2, 5, and 10-year survival rates for all cases of primary chondrosarcoma of the pelvis are 76.7%, 61.8%, and 52.2%, respectively. Survival was worse for patients with metastasis, male sex, age >60, tumor size >8 cm, dedifferentiated histology, and no surgical resection. On multivariate assessment high grade and metastasis most significantly predicted worse overall survival. CONCLUSION Pelvic chondrosarcoma commonly presents with high-risk features including larger tumor size, extracompartmental extension, and metastatic disease at diagnosis, predicting worse overall survival compared to non-pelvic tumors, and were the least amenable to surgical resection.
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Affiliation(s)
- Jeffrey Mark Brown
- University of Miami Miller School of Medicine, Orthopaedics, Miami, FL, United States of America.
| | - Kyla Rakoczy
- University of Miami Miller School of Medicine, Orthopaedics, Miami, FL, United States of America
| | - Jacqueline Hart
- Department of Orthopaedics, Musculoskeletal Surgical Oncology, University of Utah, Huntsman Cancer Institute, Salt Lake City, UT, United States of America
| | - Kevin B Jones
- Department of Orthopaedics, Musculoskeletal Surgical Oncology, University of Utah, Huntsman Cancer Institute, Salt Lake City, UT, United States of America
| | - John S Groundland
- Department of Orthopaedics, Musculoskeletal Surgical Oncology, University of Utah, Huntsman Cancer Institute, Salt Lake City, UT, United States of America
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Sambri A, Tuzzato G, Donati DM, De Paolis M, Bianchi G. Pathological fracture does not affect prognosis in dedifferentiated chondrosarcoma of the limbs. J Orthop Sci 2021; 26:473-477. [PMID: 32564907 DOI: 10.1016/j.jos.2020.04.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 03/12/2020] [Accepted: 04/15/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND The aim of this retrospective study is to analyze history and treatment outcomes of pathological fracture (PF) in dedifferentiated chondrosarcoma (DdChS) of the limbs.. METHODS We retrospectively reviewed 175 adult patients with primary DdChS of the limbs.Disease-specific survival (OS) and local recurrence (LR) were analyzed. RESULTS Median age was 66 years (range, 29-91). Most DdChS (121, 69.1%) were localized in the femur. Forty-nine (28.0%) had metastasis at diagnosis; thirty-nine DdChS (22.3%) had a PF.OS rate was lower in patients with metastasis at diagnosis (8.6% Vs 41.0% at 10 years, p < 0.001). A similar OS was observed among patients with localized disease, whether with/without PF (p = 0.638), with/without chemotherapy (p = 0.543) and independently from the type of surgery (resection/amputation) (p = 0.877). Amputation reduces the risk of LR (80.0% vs 63.1% at 5 years, p = 0.039), particularly in the PF group.. CONCLUSION Patients with metastases have a particularly poor prognosis in DdChS, but pathological fracture does not influence prognosis in terms of survival and local control. Initial curative resection is essential in order to reduce the chance of recurrences. Amputation might be an option in patients with localized disease and a PF to reduce the risk of LR..
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Affiliation(s)
- Andrea Sambri
- University of Bologna, Italy; AOU Sant'Orsola Malpighi, Bologna, Italy.
| | | | - Davide Maria Donati
- IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy; University of Bologna, Italy
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Zang J, Guo W, Yang R, Tang X, Liang H. Differences in clinical characteristics and tumor prognosis between primary and secondary conventional pelvic chondrosarcoma. BMC Cancer 2020; 20:1054. [PMID: 33138794 PMCID: PMC7607637 DOI: 10.1186/s12885-020-07530-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 10/15/2020] [Indexed: 10/26/2022] Open
Abstract
BACKGROUND Chondrosarcoma (CS) most commonly involves the pelvis. This study aimed to analyze differences in clinical characteristics and prognostic factors between primary and secondary conventional pelvic CS, and provide reference for clinical diagnosis and treatment. METHODS Eighty patients (54 primary cases and 26 secondary cases) with pelvic CS were included in this retrospective study. The tumor site, Enneking stage, soft tissue mass, margin, initial tumor grade, incidence of local recurrence and distant metastasis were evaluated. Kaplan-Meier method was used to calculate the overall survival rate. X2 test and log-rank test were used for univariate analysis, and Cox test was used in multivariate analysis. RESULTS The average age of patients with secondary CS was significantly younger than that of patients with primary CS (P < 0.001). The soft tissue mass of patients with secondary CS was significantly larger than that of patients with primary CS (P = 0.002). There was a significant difference in initial tumor pathologic grade between the two groups (P = 0.002). No statistically significant difference was observed in the local recurrence rate between the two groups. The median recurrence time of patients with primary CS after the first treatment was significantly shorter than that of patients with secondary CS (P < 0.001). The overall survival rate of patients with secondary CS was much higher than that of patients with primary CS (P = 0.003). Cox regression analysis showed that the initial tumor grade was an independent factor in the overall survival rate of patients with CS. CONCLUSION There were significant differences in age, soft tissue mass, initial tumor grade, and overall survival rate between the two groups. The overall survival rate of pelvic CS was related to the initial tumor grade of CS.
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Affiliation(s)
- Jie Zang
- Musculoskeletal Tumor Center, Peking University People's Hospital, No.11 Xizhimen South Street, Xicheng District, Beijing, 100044, China
| | - Wei Guo
- Musculoskeletal Tumor Center, Peking University People's Hospital, No.11 Xizhimen South Street, Xicheng District, Beijing, 100044, China.
| | - Rongli Yang
- Musculoskeletal Tumor Center, Peking University People's Hospital, No.11 Xizhimen South Street, Xicheng District, Beijing, 100044, China
| | - Xiaodong Tang
- Musculoskeletal Tumor Center, Peking University People's Hospital, No.11 Xizhimen South Street, Xicheng District, Beijing, 100044, China
| | - Haijie Liang
- Musculoskeletal Tumor Center, Peking University People's Hospital, No.11 Xizhimen South Street, Xicheng District, Beijing, 100044, China
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Tsuda Y, Gregory JJ, Fujiwara T, Abudu S. Secondary chondrosarcoma arising from osteochondroma: outcomes and prognostic factors. Bone Joint J 2019; 101-B:1313-1320. [PMID: 31564158 DOI: 10.1302/0301-620x.101b9.bjj-2019-0190.r1] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS The aim of this study was to report the outcomes of patients who underwent definitive surgery for secondary chondrosarcomas arising from osteochondromas. PATIENTS AND METHODS A total of 51 patients with secondary chondrosarcomas occurring from osteochondromas were reviewed. Median age was 36 years (interquartile range (IQR) 15 to 82). Median follow-up was 6.9 years (IQR 2.8 to 10.6). The pelvis was the most commonly affected site (59%). Histological grades were grade I in 35 (69%), grade II in 13 (25%), and grade III in three patients (6%). RESULTS Preoperative biopsy histology correctly predicted the final histological grade in 27% of patients. The ten-year disease-specific survival (DSS) for all patients was 89.4%. Local recurrence occurred in 15 patients (29%), more commonly in pelvic tumours (37%) compared with limb tumours (19%). Four patients with pelvic tumours died from progression of local recurrence. No patient with limb tumours died of disease. Wide/radical margin was associated with improved local recurrence-free survival (p = 0.032) and local recurrence was associated with worse DSS (p = 0.005). CONCLUSION We recommend that a secondary chondrosarcoma arising from osteochondroma of the pelvis is resected with wide/radical resection margins. The balance between the morbidity of surgery and risk of local recurrence needs to be considered in patients with limb secondary chondrosarcomas. Cite this article: Bone Joint J 2019;101-B:1313-1320.
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Affiliation(s)
- Yusuke Tsuda
- The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK
| | - Jonathan J Gregory
- The Royal Orthopaedic Hospital, Birmingham, UK.,Molecular and Clinical Cancer Sciences, University of Manchester, Manchester, UK
| | | | - Seggy Abudu
- The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK
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Differential diagnosis and treatment of enchondromas and atypical cartilaginous tumours of the pelvis: analysis of 21 patients. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2019; 30:25-30. [PMID: 31502011 DOI: 10.1007/s00590-019-02547-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Accepted: 09/05/2019] [Indexed: 10/26/2022]
Abstract
INTRODUCTION Studies focusing on enchondroma and atypical cartilaginous tumour (ACT) of the pelvis are lacking. The purpose of this study was to verify possible clinical and radiological findings with regard to distinguishing enchondromas from ACT of the pelvis. In addition, this study analysed functional and oncological outcomes in patients with enchondromas or ACT of the pelvis treated with curettage or resection. MATERIALS AND METHODS We retrospectively reviewed the medical records of 21 patients with confirmed enchondroma or ACT of the pelvis treated by curettage or resection from 1985 to 2018. The minimum follow-up was 18 months. The relationship between clinical and radiological factors and tumour type or local recurrence was assessed using Fisher exact test and Mann-Whitney U test. RESULTS Endosteal scalloping (p = 0.039), tumour size (0.005) and age (0.006) were shown to statistically favour ACT over enchondroma; by contrast, enchondroma and ACT patients had no difference in pain frequency (p = 0.5528). All patients with enchondroma had no local recurrence; in contrast, local recurrence occurred in one patient with ACT, initially treated with resection. The patient with local recurrence had a disease progression with a higher histological grade than the original tumour. Patients treated with curettage had better functional outcomes than patients treated with resection (p = 0.001). DISCUSSION Endosteal scalloping, tumour size and age could be helpful in the differential diagnosis between enchondroma and ACT of the pelvis. In addition, our study showed that ACT of the pelvis can be safely treated with curettage due to a low risk of local recurrence and better functional results compared with resection. In case of recurrence, we suggest to treat these patients with resection for the risk of disease progression.
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Chen L, Long C, Liu J, Duan X, Xiang Z. Prognostic nomograms to predict overall survival and cancer-specific survival in patients with pelvic chondrosarcoma. Cancer Med 2019; 8:5438-5449. [PMID: 31353800 PMCID: PMC6745823 DOI: 10.1002/cam4.2452] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 06/28/2019] [Accepted: 07/16/2019] [Indexed: 02/05/2023] Open
Abstract
Background The pelvis is the most common site of chondrosarcoma (CS), and the prognosis for patients with pelvic CS is worse than that for patients with CS in the extremities. However, clinicians have had few tools for estimating the likelihood of survival in patients with pelvic CS. Our aim was to develop nomograms to predict survival of patients with pelvic CS. Methods Data from the Surveillance, Epidemiology, and End Results (SEER) database of patients with pelvic CS between 2004 and 2016 were retrieved for retrospective analysis. Univariate and multivariate Cox analyses were used to identify independent prognostic factors. On the basis of the results of the multivariate analyses, nomograms were constructed to predict the likelihood of 3‐ and 5‐year overall survival (OS) and cancer‐specific survival (CSS) of patients with pelvic CS. The concordance index (C‐index) and calibration curves were used to test the models. Results In univariate and multivariate analyses of OS, sex, pathologic grade, tumor size, tumor stage, and surgery were identified as the independent risk factors. In univariate and multivariate analyses of CSS, pathologic grade, tumor size, tumor stage, and surgery were identified as the independent risk factors. These characteristics except surgery were integrated in the nomograms for predicting 3‐ and 5‐year OS and CSS, and the C‐indexes were 0.758 and 0.786, respectively. Conclusion The nomograms precisely and individually predict OS and CSS of patients with pelvic CS and could aid in personalized prognostic evaluation and individualized clinical decision‐making.
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Affiliation(s)
- Li Chen
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, China
| | - Cheng Long
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, China
| | - Jiaxin Liu
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, China
| | - Xin Duan
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, China
| | - Zhou Xiang
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, China
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Baltic A, Laback C, Auer T, Leithner A, Bernhardt GA. Incarcerated hernia after internal hemipelvectomy for G2 chondrosarcoma: a preventable complication? ANZ J Surg 2019; 90:381-383. [PMID: 30828966 PMCID: PMC7079183 DOI: 10.1111/ans.15148] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Revised: 12/19/2018] [Accepted: 02/12/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Andrea Baltic
- Department of Orthopaedics and Trauma, Medical University of Graz, Graz, Austria
| | - Christian Laback
- Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Graz, Austria
| | - Thomas Auer
- Division of General Surgery, Department of Surgery, Medical University of Graz, Graz, Austria
| | - Andreas Leithner
- Department of Orthopaedics and Trauma, Medical University of Graz, Graz, Austria
| | - Gerwin A Bernhardt
- Department of Orthopaedics and Trauma, Medical University of Graz, Graz, Austria
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Laitinen MK, Parry MC, Le Nail LR, Wigley CH, Stevenson JD, Jeys LM. Locally recurrent chondrosarcoma of the pelvis and limbs can only be controlled by wide local excision. Bone Joint J 2019; 101-B:266-271. [DOI: 10.1302/0301-620x.101b3.bjj-2018-0881.r1] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Aims The purpose of this study was to investigate the potential for achieving local and systemic control after local recurrence of a chondrosarcoma of bone Patients and Methods A total of 126 patients with local recurrence (LR) of chondrosarcoma (CS) of the pelvis or a limb bone were identified from a prospectively maintained database, between 1990 and 2015 at the Royal Orthopaedic Hospital, Birmingham, United Kingdom. There were 44 female patients (35%) and 82 male patients (65%) with a mean age at the time of LR of 56 years (13 to 96). The 126 patients represented 24.3% of the total number of patients with a primary CS (519) who had been treated during this period. Clinical data collected at the time of primary tumour and LR included the site (appendicular, extremity, or pelvis); primary and LR tumour size (in centimetres); type of operation at the time of primary or LR (limb-salvage or amputation); surgical margin achieved at resection of the primary tumour and the LR; grade of the primary tumour and the LR; gender; age; and oncological outcomes, including local recurrence-free survival and disease-specific survival. A minimum two years’ follow-up and complete histopathology records were available for all patients included in the study. Results For patients without metastases prior to or at the time of local recurrence, the disease-specific survival after local recurrence was 62.5% and 45.5% at one and five years, respectively. After univariable analysis, significant factors predicting disease-specific survival were grade (p < 0.001) and surgical margin (p = 0.044). After multivariable analysis, grade, increasing age at the time of diagnosis of local recurrence, and a greater time interval from primary surgery to local recurrence were significant factors for disease-specific survival. A secondary local recurrence was seen in 26% of patients. Wide margins were a good predictor of local recurrence-free survival for subsequent recurrences after univariable analysis when compared with intralesional margins (p = 0.002) but marginal margins did not reach statistical significance when compared with intralesional margins (p = 0.084) Conclusion In cases of local recurrence of a chondrosarcoma of bone, we have shown that if the tumour is non-metastatic at re-staging, an increase in disease-specific survival and in local recurrence-free survival is achievable, but only by resection of the local recurrence with a wide margin. Cite this article: Bone Joint J 2019;101-B:266–271.
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Affiliation(s)
- M. K. Laitinen
- Department of Orthopaedics and Traumatology, Helsinki University Hospital, Helsinki, Finland
| | - M. C. Parry
- Unit of Oncology, Royal Orthopaedic Hospital, Birmingham, UK; Honorary Senior Lecturer, Aston University Medical School, Birmingham, UK
| | - L-R. Le Nail
- Unit of Oncology, Royal Orthopaedic Hospital, Birmingham, UK; Centre Hospitalier Régional Universitaire (CHU) de Tours, Tours, France
| | - C. H. Wigley
- Unit of Oncology, Royal Orthopaedic Hospital, Birmingham, UK
| | - J. D. Stevenson
- Unit of Oncology, Royal Orthopaedic Hospital, Birmingham, UK; Honorary Senior Lecturer, Aston University Medical School, Birmingham, UK
| | - L. M. Jeys
- Unit of Oncology, Royal Orthopaedic Hospital, Birmingham, UK
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Are Limb-sparing Surgical Resections Comparable to Amputation for Patients With Pelvic Chondrosarcoma? A Case-control, Propensity Score-matched Analysis of the National Cancer Database. Clin Orthop Relat Res 2019; 477:596-605. [PMID: 30762693 PMCID: PMC6382183 DOI: 10.1097/corr.0000000000000622] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Chondrosarcoma is the second most frequent primary sarcoma of bone and frequently occurs in the pelvis. Surgical resection is the primary treatment with the two main operative modalities being limb-sparing resection and amputation. Contemporary management has trended toward limb-sparing procedures; however, whether this approach has an adverse effect on long-term survival is unclear. QUESTIONS/PURPOSES (1) What are the 5- and 10-year survival rates after limb-sparing surgery and amputation? (2) What factors are associated with survival after contemporary surgical management of pelvic chondrosarcoma? METHODS The 2004-2014 National Cancer Database, a nationwide registry that includes approximately 70% of all new cancers in the United States with requirement for 90% followup, was reviewed for patients diagnosed with pelvic chondrosarcoma who had undergone limb-sparing surgery or amputation. To compare survival, patient demographics, tumor attributes, and treatment characteristics were used to generate one-to-one propensity score-matched cohorts. Other factors associated with survival were determined through multivariable Cox regression. Three hundred eighty-five patients (75%) underwent limb-sparing surgery and 131 (25%) underwent amputation. Propensity score matching resulted in two balanced cohorts of 131 patients. RESULTS With the numbers available, we could not demonstrate a difference in overall survival between limb-sparing procedures and amputation. The 5-year survivorship was 70% (95% confidence interval [CI], 62%-79%) for limb-sparing surgery versus 70% (95% CI, 62%-79%) for amputation. The 10-year survivorship was 60% (95% CI, 48%-75%) for limb-sparing surgery versus 59% (95% CI, 48%-72%) for amputation. Kaplan-Meier survival analysis did not demonstrate a difference in survival (p = 0.9). Older age (hazard ratio [HR] = 1.029, p < 0.001), higher Charlson/Deyo comorbidity score (HR = 3.039, p = 0.004), higher grade (HR = 2.547, p = 0.005 for Grade 2; HR = 7.269, p < 0.001 for Grade 3; HR = 10.36, p < 0.001 for Grade 4), and positive surgical margins (HR = 1.61, p = 0.039) were associated with decreased survival. CONCLUSIONS Our findings support the trend toward increased use of limb-sparing surgery for patients with pelvic chondrosarcoma. Orthopaedic oncologists may use our results when counseling their patients regarding treatment options. However, the choice of limb-sparing surgery versus amputation for these challenging patients should still be a highly individualized decision with careful discussion between the patient and the surgeon. LEVEL OF EVIDENCE Level III, therapeutic study.
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Guided Pelvic Resections in Tumor Surgery. Tech Orthop 2018. [DOI: 10.1097/bto.0000000000000299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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12
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Stevenson JD, Laitinen MK, Parry MC, Sumathi V, Grimer RJ, Jeys LM. The role of surgical margins in chondrosarcoma. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2018; 44:1412-1418. [DOI: 10.1016/j.ejso.2018.05.033] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Revised: 05/10/2018] [Accepted: 05/24/2018] [Indexed: 11/28/2022]
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Ogilvie CM, Schwartz AM, Reimer NB. What's New in Musculoskeletal Tumor Surgery. J Bone Joint Surg Am 2017; 99:2127-2132. [PMID: 29257020 DOI: 10.2106/jbjs.17.01072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Christian M Ogilvie
- Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, Minnesota
| | - Andrew M Schwartz
- Department of Orthopaedic Surgery, Emory University, Atlanta, Georgia
| | - Nickolas B Reimer
- Department of Orthopaedic Surgery, Emory University, Atlanta, Georgia
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Deng L, Yu L, Wei C, Wang B, Zhu S. [Intramedullary nail combined with auxiliary plate and bone cement in treatment of pathologic fracture of extremities caused by metastatic tumors]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2017; 31:1442-1446. [PMID: 29806384 DOI: 10.7507/1002-1892.201707047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Objective To explore the application of intramedullary nail fixation combined with auxiliary plate and bone cement in the palliative treatment of pathologic fracture of extremities caused by metastatic tumors. Methods Clinical data of 11 cases with pathologic fracture of extremities caused by metastatic tumors between April 2015 and October 2016 were retrospectively analyzed. All the patients were treated by intramedullary nail fixation combined with auxiliary plate and bone cement. There were 6 males and 5 females with an age of 54-72 years (mean, 62.9 years). The disease duration was 1.0-1.5 months. Of the 11 patients, 4 metastatic tumors were diagnosed at humerus, 6 at femur, and 1 at tibia, respectively. And the tumor infiltration length ranged from 3.3 to 5.6 cm (mean, 4.6 cm), the depth could reach the bilayer of limb bones. All the patients had suffered the limbs pain and incapability of physical movement. The preoperative visual analogue scale (VAS) score was 6.36±1.03, and the Karnofsky Performance Status (KPS) score was 42.73±10.09. The operation time, intraoperative blood loss, and postoperative complications were recorded. The VAS score, KPS score, and Musculoskeletal Tumor Society (MSTS) score were used to evaluate the effectiveness at 3 months after operation. Results The operation time was 1.1-1.8 hours (mean, 1.5 hours), the intraoperative blood loss was 102.5-211.3 mL (mean, 135.6 mL). Postoperative limb incisions healed well without infection, necrosis, and delayed healing or other complications. All the patients were followed up 7-10 months (mean, 8.2 months). At 3 months after operation, the functions of limbs recovered. The VAS score decreased to 0.82±0.75 and the KPS score increased to 85.45±5.22, both showing significant difference when compared with preoperative ones ( t=35.218, P=0.000; t=-18.470, P=0.000); and the MSTS score was 23.91±2.47. At last follow-up, the anteroposterior and lateral X-ray films showed that all the limbs healing well and no breakage of intramedullary nail and steel plate, or loosening in bone cement, limb shortening, malalignment, or other complications occurred. Conclusion In treating metastatic tumors of extremities, the combination of intramedullary nail fixation with auxiliary plate and bone cement will contribute to an invariable length and fixed location for limbs, resulting in biomechanical stability for skeleton. Under this premise, the tumor lesions can be eliminated and pathological pains be relieved, so as to improve patients' life quality.
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Affiliation(s)
- Linglong Deng
- Department of Orthopedics, Zhongnan Hospital of Wuhan University, Wuhan Hubei, 430071, P.R.China
| | - Li Yu
- Department of Orthopedics, Zhongnan Hospital of Wuhan University, Wuhan Hubei, 430071, P.R.China
| | - Chi Wei
- Department of Orthopedics, Zhongnan Hospital of Wuhan University, Wuhan Hubei, 430071, P.R.China
| | - Bing Wang
- Department of Orthopedics, Zhongnan Hospital of Wuhan University, Wuhan Hubei, 430071, P.R.China
| | - Shaobo Zhu
- Department of Orthopedics, Zhongnan Hospital of Wuhan University, Wuhan Hubei, 430071,
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