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Boccolari P, Pantaleoni F, Tedeschi R, Donati D. The mechanics of the collateral ligaments in the metacarpophalangeal joints: A scoping review. Morphologie 2024; 108:100770. [PMID: 38428155 DOI: 10.1016/j.morpho.2024.100770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 02/12/2024] [Accepted: 02/12/2024] [Indexed: 03/03/2024]
Abstract
BACKGROUND The metacarpophalangeal (MCP) joint's collateral ligaments have been extensively debated, with no clear consensus on their mechanics. Understanding their function is crucial for comprehending joint movement and stability. METHODS A thorough search was conducted across databases, including PubMed, Scopus, Cochrane library and grey literature. A total of 59 articles were identified, and after rigorous evaluation, six articles were included in the review. RESULTS The analysis underscores two principal findings. Firstly, the principal and accessory collateral ligaments exhibit consistent tension influenced by the MCP joint's position. This tension varies across different sections of the ligaments. Secondly, the ligaments' interaction with the joint structure plays a pivotal role in defining the range of motion of the joint. CONCLUSION Preliminary findings from this review indicate that MCP joint collateral ligament tension varies with joint position. Increased tension in the principal collateral ligament during flexion and isometric behavior of its volar portion in extension are observed. The accessory ligament may tighten during extension. The shape of the metacarpal head appears to influence this tension. These insights, while informative, call for further detailed research to deepen our understanding of MCP joint mechanics.
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Affiliation(s)
- P Boccolari
- Azienda Ospedaliero - Universitaria di Modena Policlinico, Modena, Italy
| | - F Pantaleoni
- Azienda Ospedaliero - Universitaria di Modena Policlinico, Modena, Italy
| | - R Tedeschi
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy.
| | - D Donati
- Physical Therapy and Rehabilitation Unit, Policlinico di Modena, Modena, Italy; Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy
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Lozano-Calderon SA, Rijs Z, Groot OQ, Su MW, Werenski JO, Merchan N, Yeung CM, Sodhi A, Berner E, Oliveira V, Bianchi G, Staals E, Lana D, Donati D, Segal O, Marone S, Piana R, Meo SD, Pellegrino P, Ratto N, Zoccali C, Scorianz M, Tomai C, Scoccianti G, Campanacci DA, Andreani L, Franco SD, Boffano M, Pensado MP, Ruiz IB, Moreno EH, Ortiz-Cruz EJ, van de Sande M. Outcomes of Long Bones Treated With Carbon-Fiber Nails for Oncologic Indications: International Multi-institutional Study. J Am Acad Orthop Surg 2024; 32:e134-e145. [PMID: 37824083 DOI: 10.5435/jaaos-d-22-01159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 07/27/2023] [Indexed: 10/13/2023] Open
Abstract
BACKGROUND Intramedullary nail fixation is commonly used for prophylactic stabilization of impending and fixation of complete pathological fractures of the long bones. However, metallic artifacts complicate imaging evaluation for bone healing or tumor progression and postoperative radiation planning. Carbon-fiber implants have gained popularity as an alternative, given their radiolucency and superior axial bending. This study evaluates incidences of mechanical and nonmechanical complications. METHODS Adult patients (age 18 years and older) treated with carbon-fiber nails for impending/complete pathological long bone fractures secondary to metastases from 2013 to 2020 were analyzed for incidences and risk factors of mechanical and nonmechanical complications. Mechanical complications included aseptic screw loosening and structural failures of host bone and carbon-fiber implants. Deep infection and tumor progression were considered nonmechanical. Other complications/adverse events were also reported. RESULTS A total of 239 patients were included; 47% were male, and 53% were female, with a median age of 68 (IQR, 59 to 75) years. Most common secondary metastases were related to breast cancer (19%), lung cancer (19%), multiple myeloma (18%), and sarcoma (13%). In total, 17 of 30 patients with metastatic sarcoma received palliative intramedullary nail fixation for impending/complete pathological fractures, and 13 of 30 received prophylactic nail stabilization of bone radiated preoperatively to manage juxta-osseous soft-tissue sarcomas, where partial resection of the periosteum or bone was necessary for negative margin resection. 33 (14%) patients had complications. Mechanical failures included 4 (1.7%) structural host bone failures, 7 (2.9%) implant structural failures, and 1 (0.4%) aseptic loosening of distal locking screws. Nonmechanical failures included 8 (3.3%) peri-implant infections and 15 (6.3%) tumor progressions with implant contamination. The 90-day and 1-year mortalities were 28% (61/239) and 53% (53/102), respectively. The literature reported comparable failure and mortality rates with conventional titanium treatment. CONCLUSIONS Carbon-fiber implants might be an alternative for treating impending and sustained pathological fractures secondary to metastatic bone disease. The seemingly comparable complication profile warrants further cohort studies comparing carbon-fiber and titanium nail complications.
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Affiliation(s)
- Santiago A Lozano-Calderon
- From the Massachusetts General Hospital-Harvard Medical School, Boston, MA (Lozano-Calderon, Groot, Werenski, Merchan, Yeung, Sodhi, and Berner), Leiden University Medical Center Leiden, The Netherlands (Rijs, Su, and van de Sande), Centro Hospitalar Universitário do Porto, Oporto University Hospital Center, Porto, Portugal (Oliveria), IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy (Bianchi, Staals, and Donati), Ospedale Maggiore Trauma Center, Bologna, Italy (Lana), Tel Aviv Sourasky Medical Center, Tel Aviv, Israel (Segal), Centro Traumatologico Ortopedico, Turin, Italy (Marone, Piana, Meo, Pellegrino, and Ratto), Department of General Surgery, Plastic Surgery, and Orthopaedics, Policlinico Umberto I Hospital-Sapienza, Orthopaedic and Traumatology Unit, University of Rome, Rome, Italy (Zoccali). Orthopaedic Oncology Unit, Careggi University Hospital, Florence, Italy (Tomai, Scoccianti, and Campanacci), University Hospital of Pisa, Pisa, Italy (Andreani and Franco), Hospital Universitario La Paz, Madrid, Spain (Pensado, Ruiz, Moreno, and Ortiz-Cruz), Regina Margherita Children's Hospital Torino, TO, Italy (Boffano)
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Palmerini E, Gambarotti M, Italiano A, Nathenson MJ, Ratan R, Dileo P, Provenzano S, Jones RL, DuBois SG, Martin-Broto J, de Alava E, Baldi GG, Grignani G, Ferraresi V, Brunello A, Paoluzzi L, Bertulli R, Hindi N, Montemurro M, Rothermundt C, Cocchi S, Salguero-Aranda C, Donati D, Martin JD, Abdelhamid Ahmed AH, Mazzocca A, Carretta E, Cesari M, Pierini M, Righi A, Sbaraglia M, Laginestra MA, Scotlandi K, Dei Tos AP, Ibrahim T, Stacchiotti S, Vincenzi B. A global collaboRAtive study of CIC-rearranged, BCOR::CCNB3-rearranged and other ultra-rare unclassified undifferentiated small round cell sarcomas (GRACefUl). Eur J Cancer 2023; 183:11-23. [PMID: 36791667 DOI: 10.1016/j.ejca.2023.01.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 12/16/2022] [Accepted: 01/04/2023] [Indexed: 01/19/2023]
Abstract
BACKGROUND Undifferentiated small round cell sarcomas (URCSs) represent a diagnostic challenge, and their optimal treatment is unknown. We aimed to define the clinical characteristics, treatment, and outcome of URCS patients. METHODS URCS patients treated from 1983 to 2019 at 21 worldwide sarcoma reference centres were retrospectively identified. Based on molecular assessment, cases were classified as follows: (1) CIC-rearranged round cell sarcomas, (2) BCOR::CCNB3-rearranged round cell sarcomas, (3) unclassified URCSs. Treatment, prognostic factors and outcome were reviewed. RESULTS In total, 148 patients were identified [88/148 (60%) CIC-rearranged sarcoma (median age 32 years, range 7-78), 33/148 (22%) BCOR::CCNB3-rearranged (median age 17 years, range 5-91), and 27/148 (18%) unclassified URCSs (median age 37 years, range 4-70)]. One hundred-one (68.2%) cases presented with localised disease; 47 (31.8%) had metastases at diagnosis. Male prevalence, younger age, bone primary site, and a low rate of synchronous metastases were observed in BCOR::CCNB3-rearranged cases. Local treatment was surgery in 67/148 (45%) patients, and surgery + radiotherapy in 52/148 (35%). Chemotherapy was given to 122/148 (82%) patients. At a 42.7-month median follow-up, the 3-year overall survival (OS) was 92.2% (95% CI 71.5-98.0) in BCOR::CCNB3 patients, 39.6% (95% CI 27.7-51.3) in CIC-rearranged sarcomas, and 78.7% in unclassified URCSs (95% CI 56.1-90.6; p < 0.0001). CONCLUSIONS This study is the largest conducted in URCS and confirms major differences in outcomes between URCS subtypes. A full molecular assessment should be undertaken when a diagnosis of URCS is suspected. Prospective studies are needed to better define the optimal treatment strategy in each URCS subtype.
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Affiliation(s)
- Emanuela Palmerini
- Osteoncology, Soft Tissue and Bone Sarcomas, Innovative Therapy Unit, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy.
| | - Marco Gambarotti
- Department of Pathology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Antoine Italiano
- Early Phase Trial and Sarcoma Unit, Institut Bergonié, Bordeaux, France; Faculty of Medicine, University of Bordeaux, Bordeaux, France
| | | | - Ravin Ratan
- Department of Sarcoma Medical Oncology, The University of Texas, MD Anderson Cancer Center, Houston, TX, USA
| | - Palma Dileo
- London Sarcoma Service, University College London Hospital, London, UK
| | - Salvatore Provenzano
- Adult mesenchymal tumours and rare cancers unit, Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Robin L Jones
- Sarcoma Unit, The Royal Marsden and Institute of Cancer Research, London, UK
| | - Steven G DuBois
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Javier Martin-Broto
- Medical Oncology Department, University Hospital Fundación Jimenez Diaz, Madrid, Spain; University Hospital General de Villalba, Madrid, Spain; Instituto de Investigacion Sanitaria Fundacion Jimenez Diaz (IIS/FJD; UAM), Madrid, Spain
| | - Enrique de Alava
- IBIS Instituto de Biomedicina de Sevilla, Sevilla, Spain; Vigem Del Rocio University Hospital/CSIC/University of Seville/CIBERONC, Spain; Department of Normal and Pathological Cytology and Histology, School of Medicine, University of Seville, Spain
| | | | - Giovanni Grignani
- Candiolo Cancer Institute, FPO-IRCCS, Candiolo, Turin, Italy; Azienda Ospedaliero-Universitaria CItta della Scienza e della Salute di Torino, Torino, Italy
| | | | - Antonella Brunello
- Department of Oncology, Istituto Oncologico Veneto IOV-IRCCS, Padua, Italy
| | - Luca Paoluzzi
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Rossella Bertulli
- Adult mesenchymal tumours and rare cancers unit, Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Nadia Hindi
- Medical Oncology Department, University Hospital Fundación Jimenez Diaz, Madrid, Spain; University Hospital General de Villalba, Madrid, Spain; Instituto de Investigacion Sanitaria Fundacion Jimenez Diaz (IIS/FJD; UAM), Madrid, Spain
| | - Michael Montemurro
- Department of Oncology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Christian Rothermundt
- Department of Medical Oncology and Haematology Kantonsspital St.Gallen, St. Gallen, Switzerland
| | - Stefania Cocchi
- Department of Pathology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Carmen Salguero-Aranda
- IBIS Instituto de Biomedicina de Sevilla, Sevilla, Spain; Vigem Del Rocio University Hospital/CSIC/University of Seville/CIBERONC, Spain; Department of Normal and Pathological Cytology and Histology, School of Medicine, University of Seville, Spain
| | - Davide Donati
- Department of Orthopaedic Surgery, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Juan D Martin
- IBIS Instituto de Biomedicina de Sevilla, Sevilla, Spain; Vigem Del Rocio University Hospital/CSIC/University of Seville/CIBERONC, Spain; Department of Normal and Pathological Cytology and Histology, School of Medicine, University of Seville, Spain
| | | | - Alessandro Mazzocca
- Department of Medical Oncology, Università Campus Bio-medico di Roma, Rome, Italy
| | - Elisa Carretta
- Department of Medicine, University of Padua, Padua, Italy
| | - Marilena Cesari
- Osteoncology, Soft Tissue and Bone Sarcomas, Innovative Therapy Unit, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Michela Pierini
- Osteoncology, Soft Tissue and Bone Sarcomas, Innovative Therapy Unit, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Alberto Righi
- Department of Pathology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | | | - Maria A Laginestra
- Laboratory of Experimental Oncology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Katia Scotlandi
- Laboratory of Experimental Oncology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | | | - Toni Ibrahim
- Osteoncology, Soft Tissue and Bone Sarcomas, Innovative Therapy Unit, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Silvia Stacchiotti
- Adult mesenchymal tumours and rare cancers unit, Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Bruno Vincenzi
- Department of Medical Oncology, Università Campus Bio-medico di Roma, Rome, Italy
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Blay JY, Hindi N, Bollard J, Aguiar S, Angel M, Araya B, Badilla R, Bernabeu D, Campos F, Caro-Sánchez CHS, Carvajal B, Carvajal Montoya A, Casavilca-Zambrano S, Castro-Oliden V, Chacón M, Clara M, Collini P, Correa Genoroso R, Costa FD, Cuellar M, Dei Tos AP, Dominguez Malagon HR, Donati D, Dufresne A, Eriksson M, Farias-Loza M, Fernandez P, Frezza AM, Frisoni T, Garcia-Ortega DY, Gelderblom H, Gouin F, Gómez-Mateo MC, Gronchi A, Haro J, Huanca L, Jimenez N, Karanian M, Kasper B, Lopes David BB, Lopez-Pousa A, Lutter G, Martinez-Said H, Martinez-Tlahuel J, Mello CA, Morales Pérez JM, Moura David S, Nascimento AG, Ortiz-Cruz EJ, Palmerini E, Patel S, Pfluger Y, Provenzano S, Righi A, Rodriguez A, Salas R, Santos TTG, Scotlandi K, Soule T, Stacchiotti S, Valverde C, Waisberg F, Zamora Estrada E, Martin-Broto J. Corrigendum to "SELNET clinical practice guidelines for soft tissue sarcoma and GIST" [Cancer Treat. Rev. 102 (2021) 102312]. Cancer Treat Rev 2023; 115:102523. [PMID: 36796283 DOI: 10.1016/j.ctrv.2023.102523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Affiliation(s)
- J Y Blay
- Léon Bérard Center, 28 rue Laennec, 69373 Lyon Cedex 08, France.
| | - N Hindi
- Research Health Institute Fundacion Jimenez Diaz (IIS/FJD), 28015 Madrid, Spain; Hospital Fundación Jimenez Diaz University Hospital, 28040 Madrid, Spain; General de Villalba University Hospital, 28400 Madrid, Spain; General de Villalba University Hospital, 28400 Madrid, Spain
| | - J Bollard
- Léon Bérard Center, 28 rue Laennec, 69373 Lyon Cedex 08, France
| | - S Aguiar
- A.C. Camargo Cancer Center, Rua prof Antonio Prudente, 211 - Liberdade, São Paulo, SP 01509-010, Brazil
| | - M Angel
- Instituto Alexander Fleming, Av. Cramer 1180, CP C1426ANZ, Buenos Aires, Argentina
| | - B Araya
- Hospital Dr. R. A. Calderón Guardia, 7-9 Av, 15-17 St, Aranjuez, San José, Costa Rica
| | - R Badilla
- Hospital Dr. R. A. Calderón Guardia, 7-9 Av, 15-17 St, Aranjuez, San José, Costa Rica
| | - D Bernabeu
- Hospital Universitario La Paz, Paseo de la Castellana, 261, 28046 Madrid, Spain
| | - F Campos
- A.C. Camargo Cancer Center, Rua prof Antonio Prudente, 211 - Liberdade, São Paulo, SP 01509-010, Brazil
| | - C H S Caro-Sánchez
- Instituto Nacional de Cancerologia, Torre Nueva de Hospitalización, primer piso, Av. San Fernando 86, Colonia Niño Jesus, CP 14080 Tlalpan, Mexico
| | - B Carvajal
- Fundación GIST México, Altadena 59, Nápoles, Benito Juárez, 03810 Ciudad de Mexico, CDMX, Mexico
| | - A Carvajal Montoya
- Hospital Dr. R. A. Calderón Guardia, 7-9 Av, 15-17 St, Aranjuez, San José, Costa Rica
| | - S Casavilca-Zambrano
- Instituto Nacional de Enfermedades Neoplásicas, Av. Angamos Este 2520, Lima 34, Peru
| | - V Castro-Oliden
- Instituto Nacional de Enfermedades Neoplásicas, Av. Angamos Este 2520, Lima 34, Peru
| | - M Chacón
- Instituto Alexander Fleming, Av. Cramer 1180, CP C1426ANZ, Buenos Aires, Argentina
| | - M Clara
- Instituto Nacional de Cancerologia, Torre Nueva de Hospitalización, primer piso, Av. San Fernando 86, Colonia Niño Jesus, CP 14080 Tlalpan, Mexico
| | - P Collini
- Fondazione IRCCS Istituto Nazionale dei Tumori, Via Giacomo Venezian, 1, 20133 Milano, Italy
| | - R Correa Genoroso
- Hospital Clínico Universitario Virgen de la Victoria, Campus Universitario de Teatinos s/n, 29010 Malaga, Spain
| | - F D Costa
- A.C. Camargo Cancer Center, Rua prof Antonio Prudente, 211 - Liberdade, São Paulo, SP 01509-010, Brazil
| | - M Cuellar
- Fundación GIST México, Altadena 59, Nápoles, Benito Juárez, 03810 Ciudad de Mexico, CDMX, Mexico
| | - A P Dei Tos
- Treviso General Hospital Treviso, University of Padua, Padova, Italy
| | - H R Dominguez Malagon
- Instituto Nacional de Cancerologia, Torre Nueva de Hospitalización, primer piso, Av. San Fernando 86, Colonia Niño Jesus, CP 14080 Tlalpan, Mexico
| | - D Donati
- IRCCS Istituto Ortopedico Rizzoli, Via Pupilli, 1, 40136 Bologna, Italy
| | - A Dufresne
- Léon Bérard Center, 28 rue Laennec, 69373 Lyon Cedex 08, France
| | - M Eriksson
- Skane University Hospital and Lund University, Lund, Sweden
| | - M Farias-Loza
- Instituto Nacional de Enfermedades Neoplásicas, Av. Angamos Este 2520, Lima 34, Peru
| | | | - A M Frezza
- Fondazione IRCCS Istituto Nazionale dei Tumori, Via Giacomo Venezian, 1, 20133 Milano, Italy
| | - T Frisoni
- IRCCS Istituto Ortopedico Rizzoli, Via Pupilli, 1, 40136 Bologna, Italy
| | - D Y Garcia-Ortega
- Instituto Nacional de Cancerologia, Torre Nueva de Hospitalización, primer piso, Av. San Fernando 86, Colonia Niño Jesus, CP 14080 Tlalpan, Mexico
| | - H Gelderblom
- Leiden University Medical Center, Leiden, the Netherlands
| | - F Gouin
- Léon Bérard Center, 28 rue Laennec, 69373 Lyon Cedex 08, France
| | - M C Gómez-Mateo
- Hospital Universitario Miguel Servet, Paseo Isabel la Católica, 1-3, 50009 Zaragoza, Spain
| | - A Gronchi
- Fondazione IRCCS Istituto Nazionale dei Tumori, Via Giacomo Venezian, 1, 20133 Milano, Italy
| | - J Haro
- Instituto Nacional de Enfermedades Neoplásicas, Av. Angamos Este 2520, Lima 34, Peru
| | - L Huanca
- Instituto Nacional de Enfermedades Neoplásicas, Av. Angamos Este 2520, Lima 34, Peru
| | - N Jimenez
- Hospital Dr. R. A. Calderón Guardia, 7-9 Av, 15-17 St, Aranjuez, San José, Costa Rica
| | - M Karanian
- Léon Bérard Center, 28 rue Laennec, 69373 Lyon Cedex 08, France
| | - B Kasper
- University of Heidelberg, Mannheim Cancer Center, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
| | - B B Lopes David
- Fondazione IRCCS Istituto Nazionale dei Tumori, Via Giacomo Venezian, 1, 20133 Milano, Italy
| | - A Lopez-Pousa
- Hospital de la Santa Creu i Sant Pau, Carrer de Sant Quintí, 89, 08041 Barcelona, Spain
| | - G Lutter
- Instituto Alexander Fleming, Av. Cramer 1180, CP C1426ANZ, Buenos Aires, Argentina
| | - H Martinez-Said
- Centro Oncologico Integral, Hospital Medica Sur, Planta Baja Torre III - Cons, 305, Col. Toriello Guerra, Deleg. Tlalpan, C.P. 14050 Mexico, D.F, Mexico
| | - J Martinez-Tlahuel
- Instituto Nacional de Cancerologia, Torre Nueva de Hospitalización, primer piso, Av. San Fernando 86, Colonia Niño Jesus, CP 14080 Tlalpan, Mexico
| | - C A Mello
- A.C. Camargo Cancer Center, Rua prof Antonio Prudente, 211 - Liberdade, São Paulo, SP 01509-010, Brazil
| | - J M Morales Pérez
- Hospital Universitario Virgen del Rocio, Av Manuel Siurot s/n, 41013 Sevilla, Spain
| | - S Moura David
- Hospital Universitario Virgen del Rocio, Av Manuel Siurot s/n, 41013 Sevilla, Spain
| | - A G Nascimento
- A.C. Camargo Cancer Center, Rua prof Antonio Prudente, 211 - Liberdade, São Paulo, SP 01509-010, Brazil
| | - E J Ortiz-Cruz
- Hospital Universitario La Paz, MD Anderson Cancer Center, Calle de Arturo Soria, 270, 28033 Madrid, Spain
| | - E Palmerini
- IRCCS Istituto Ortopedico Rizzoli, Via Pupilli, 1, 40136 Bologna, Italy
| | - S Patel
- UT MD Anderson Cancer Center, Houston, TX, USA
| | - Y Pfluger
- Instituto Alexander Fleming, Av. Cramer 1180, CP C1426ANZ, Buenos Aires, Argentina
| | - S Provenzano
- Fondazione IRCCS Istituto Nazionale dei Tumori, Via Giacomo Venezian, 1, 20133 Milano, Italy
| | - A Righi
- IRCCS Istituto Ortopedico Rizzoli, Via Pupilli, 1, 40136 Bologna, Italy
| | - A Rodriguez
- Instituto Alexander Fleming, Av. Cramer 1180, CP C1426ANZ, Buenos Aires, Argentina
| | - R Salas
- Fundación GIST México, Altadena 59, Nápoles, Benito Juárez, 03810 Ciudad de Mexico, CDMX, Mexico
| | - T T G Santos
- A.C. Camargo Cancer Center, Rua prof Antonio Prudente, 211 - Liberdade, São Paulo, SP 01509-010, Brazil
| | - K Scotlandi
- IRCCS Istituto Ortopedico Rizzoli, Via Pupilli, 1, 40136 Bologna, Italy
| | - T Soule
- Instituto Alexander Fleming, Av. Cramer 1180, CP C1426ANZ, Buenos Aires, Argentina
| | - S Stacchiotti
- Fondazione IRCCS Istituto Nazionale dei Tumori, Via Giacomo Venezian, 1, 20133 Milano, Italy
| | - C Valverde
- Vall d́Hebrón University Hospital, Passeig de la Vall d'Hebron, 119, 08035 Barcelona, Spain
| | - F Waisberg
- Instituto Alexander Fleming, Av. Cramer 1180, CP C1426ANZ, Buenos Aires, Argentina
| | - E Zamora Estrada
- Hospital Dr. R. A. Calderón Guardia, 7-9 Av, 15-17 St, Aranjuez, San José, Costa Rica
| | - J Martin-Broto
- Research Health Institute Fundacion Jimenez Diaz (IIS/FJD), 28015 Madrid, Spain; Hospital Fundación Jimenez Diaz University Hospital, 28040 Madrid, Spain; General de Villalba University Hospital, 28400 Madrid, Spain; General de Villalba University Hospital, 28400 Madrid, Spain
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Armentano S, Giuffrida M, Vercellone B, Migliore M, Donati D, Meineri M, Cirio A, Pellegrino L, Borghi F. Dealing with post-operative complications in eras colorectal patients: A single centre experience. Clin Nutr ESPEN 2022. [DOI: 10.1016/j.clnesp.2022.06.061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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6
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Blay JY, Hindi N, Bollard J, Aguiar S, Angel M, Araya B, Badilla R, Bernabeu D, Campos F, Caro-Sánchez CHS, Carvajal B, Carvajal Montoya A, Casavilca-Zambrano S, Castro-Oliden V, Chacón M, Clara M, Collini P, Correa Genoroso R, Costa FD, Cuellar M, Dei Tos AP, Dominguez Malagon HR, Donati D, Dufresne A, Eriksson M, Farias-Loza M, Fernandez P, Frezza AM, Frisoni T, Garcia-Ortega DY, Gelderblom H, Gouin F, Gómez-Mateo MC, Gronchi A, Haro J, Huanca L, Jimenez N, Karanian M, Kasper B, Lopes David BB, Lopez-Pousa A, Lutter G, Martinez-Said H, Martinez-Tlahuel J, Mello CA, Morales Pérez JM, Moura David S, Nascimento AG, Ortiz-Cruz EJ, Palmerini E, Patel S, Pfluger Y, Provenzano S, Righi A, Rodriguez A, Salas R, Santos TTG, Scotlandi K, Soule T, Stacchiotti S, Valverde C, Waisberg F, Zamora Estrada E, Martin-Broto J. SELNET clinical practice guidelines for soft tissue sarcoma and GIST. Cancer Treat Rev 2022; 102:102312. [PMID: 34798363 DOI: 10.1016/j.ctrv.2021.102312] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 10/30/2021] [Indexed: 12/12/2022]
Affiliation(s)
- J Y Blay
- Léon Bérard Center, 28 rue Laennec 69373 Lyon Cedex 08, France.
| | - N Hindi
- Research Health Institute Fundacion Jimenez Diaz (IIS/FJD), 28015 Madrid, Spain; Hospital Fundación Jimenez Diaz University Hospital, 28040 Madrid, Spain; General de Villalba University Hospital, 28400 Madrid, Spain
| | - J Bollard
- Léon Bérard Center, 28 rue Laennec 69373 Lyon Cedex 08, France
| | - S Aguiar
- A.C.Camargo Cancer Center, Rua prof Antonio Prudente, 211 - Liberdade, São Paulo - SP 01509-010, Brazil
| | - M Angel
- Instituto Alexander Fleming. Av. Cramer 1180. CP C1426ANZ, Buenos Aires, Argentina
| | - B Araya
- Hospital Dr. R. A. Calderón Guardia, 7-9 Av, 15-17 St, Aranjuez, San José, Costa Rica
| | - R Badilla
- Hospital Dr. R. A. Calderón Guardia, 7-9 Av, 15-17 St, Aranjuez, San José, Costa Rica
| | - D Bernabeu
- Hospital Universitario La Paz, Paseo de la Castellana, 261, 28046 Madrid, Spain
| | - F Campos
- A.C.Camargo Cancer Center, Rua prof Antonio Prudente, 211 - Liberdade, São Paulo - SP 01509-010, Brazil
| | - C H S Caro-Sánchez
- Instituto Nacional de Cancerologia. Torre Nueva de Hospitalización, primer piso. Av. San Fernando 86, Colonia Niño Jesus. CP 14080, Tlalpan Mexico
| | - B Carvajal
- Fundación GIST México, Altadena 59, Nápoles, Benito Juárez, 03810 Ciudad de Mexico, CDMX, Mexico
| | - A Carvajal Montoya
- Hospital Dr. R. A. Calderón Guardia, 7-9 Av, 15-17 St, Aranjuez, San José, Costa Rica
| | - S Casavilca-Zambrano
- Instituto Nacional de Enfermedades Neoplásicas, Av. Angamos Este 2520, Lima 34, Peru
| | - V Castro-Oliden
- Instituto Nacional de Enfermedades Neoplásicas, Av. Angamos Este 2520, Lima 34, Peru
| | - M Chacón
- Instituto Alexander Fleming. Av. Cramer 1180. CP C1426ANZ, Buenos Aires, Argentina
| | - M Clara
- Instituto Nacional de Cancerologia. Torre Nueva de Hospitalización, primer piso. Av. San Fernando 86, Colonia Niño Jesus. CP 14080, Tlalpan Mexico
| | - P Collini
- Fondazione IRCCS Istituto Nazionale dei Tumori, Via Giacomo Venezian, 1, 20133 Milano, Italy
| | - R Correa Genoroso
- Hospital Clínico Universitario Virgen de la Victoria, Campus Universitario de Teatinos s/n, 29010 Malaga, Spain
| | - F D Costa
- A.C.Camargo Cancer Center, Rua prof Antonio Prudente, 211 - Liberdade, São Paulo - SP 01509-010, Brazil
| | - M Cuellar
- Fundación GIST México, Altadena 59, Nápoles, Benito Juárez, 03810 Ciudad de Mexico, CDMX, Mexico
| | - A P Dei Tos
- Treviso General Hospital Treviso, University of Padua, Padova, Italy
| | - H R Dominguez Malagon
- Instituto Nacional de Cancerologia. Torre Nueva de Hospitalización, primer piso. Av. San Fernando 86, Colonia Niño Jesus. CP 14080, Tlalpan Mexico
| | - D Donati
- IRCCS Istituto Ortopedico Rizzoli, University of Bologna, Via Pupilli, 1, 40136 Bologna, Italy
| | - A Dufresne
- Léon Bérard Center, 28 rue Laennec 69373 Lyon Cedex 08, France
| | - M Eriksson
- Skane University Hospital and Lund University, Lund, Sweden
| | - M Farias-Loza
- Instituto Nacional de Enfermedades Neoplásicas, Av. Angamos Este 2520, Lima 34, Peru
| | | | - A M Frezza
- Fondazione IRCCS Istituto Nazionale dei Tumori, Via Giacomo Venezian, 1, 20133 Milano, Italy
| | - T Frisoni
- IRCCS Istituto Ortopedico Rizzoli, University of Bologna, Via Pupilli, 1, 40136 Bologna, Italy
| | - D Y Garcia-Ortega
- Instituto Nacional de Cancerologia. Torre Nueva de Hospitalización, primer piso. Av. San Fernando 86, Colonia Niño Jesus. CP 14080, Tlalpan Mexico
| | - H Gelderblom
- Leiden University Medical Center, Leiden, the Netherlands
| | - F Gouin
- Léon Bérard Center, 28 rue Laennec 69373 Lyon Cedex 08, France
| | - M C Gómez-Mateo
- Hospital Universitario Miguel Servet, Paseo Isabel la Católica, 1-3, 50009 Zaragoza, Spain
| | - A Gronchi
- Fondazione IRCCS Istituto Nazionale dei Tumori, Via Giacomo Venezian, 1, 20133 Milano, Italy
| | - J Haro
- Instituto Nacional de Enfermedades Neoplásicas, Av. Angamos Este 2520, Lima 34, Peru
| | - L Huanca
- Instituto Nacional de Enfermedades Neoplásicas, Av. Angamos Este 2520, Lima 34, Peru
| | - N Jimenez
- Hospital Dr. R. A. Calderón Guardia, 7-9 Av, 15-17 St, Aranjuez, San José, Costa Rica
| | - M Karanian
- Léon Bérard Center, 28 rue Laennec 69373 Lyon Cedex 08, France
| | - B Kasper
- University of Heidelberg, Mannheim Cancer Center, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
| | - B B Lopes David
- Fondazione IRCCS Istituto Nazionale dei Tumori, Via Giacomo Venezian, 1, 20133 Milano, Italy
| | - A Lopez-Pousa
- Hospital de la Santa Creu i Sant Pau, Carrer de Sant Quintí, 89, 08041 Barcelona, Espagne
| | - G Lutter
- Instituto Alexander Fleming. Av. Cramer 1180. CP C1426ANZ, Buenos Aires, Argentina
| | - H Martinez-Said
- Centro Oncologico Integral, Hospital Medica Sur, Planta Baja Torre III - Cons. 305, Col. Toriello Guerra, Deleg. Tlalpan. C.P. 14050, Mexico, D.F
| | - J Martinez-Tlahuel
- Instituto Nacional de Cancerologia. Torre Nueva de Hospitalización, primer piso. Av. San Fernando 86, Colonia Niño Jesus. CP 14080, Tlalpan Mexico
| | - C A Mello
- A.C.Camargo Cancer Center, Rua prof Antonio Prudente, 211 - Liberdade, São Paulo - SP 01509-010, Brazil
| | - J M Morales Pérez
- Hospital Universitario Virgen del Rocio, Av Manuel Siurot s/n, 41013 Sevilla, Spain
| | - S Moura David
- Hospital Universitario Virgen del Rocio, Av Manuel Siurot s/n, 41013 Sevilla, Spain
| | - A G Nascimento
- A.C.Camargo Cancer Center, Rua prof Antonio Prudente, 211 - Liberdade, São Paulo - SP 01509-010, Brazil
| | - E J Ortiz-Cruz
- Hospital Universitario La Paz, MD Anderson Cancer Center, Calle de Arturo Soria, 270 28033 Madrid, Spain
| | - E Palmerini
- IRCCS Istituto Ortopedico Rizzoli, University of Bologna, Via Pupilli, 1, 40136 Bologna, Italy
| | - S Patel
- UT MD Anderson Cancer Center, Houston, TX, USA
| | - Y Pfluger
- Instituto Alexander Fleming. Av. Cramer 1180. CP C1426ANZ, Buenos Aires, Argentina
| | - S Provenzano
- Fondazione IRCCS Istituto Nazionale dei Tumori, Via Giacomo Venezian, 1, 20133 Milano, Italy
| | - A Righi
- IRCCS Istituto Ortopedico Rizzoli, University of Bologna, Via Pupilli, 1, 40136 Bologna, Italy
| | - A Rodriguez
- Instituto Alexander Fleming. Av. Cramer 1180. CP C1426ANZ, Buenos Aires, Argentina
| | - R Salas
- Fundación GIST México, Altadena 59, Nápoles, Benito Juárez, 03810 Ciudad de Mexico, CDMX, Mexico
| | - T T G Santos
- A.C.Camargo Cancer Center, Rua prof Antonio Prudente, 211 - Liberdade, São Paulo - SP 01509-010, Brazil
| | - K Scotlandi
- IRCCS Istituto Ortopedico Rizzoli, University of Bologna, Via Pupilli, 1, 40136 Bologna, Italy
| | - T Soule
- Instituto Alexander Fleming. Av. Cramer 1180. CP C1426ANZ, Buenos Aires, Argentina
| | - S Stacchiotti
- Fondazione IRCCS Istituto Nazionale dei Tumori, Via Giacomo Venezian, 1, 20133 Milano, Italy
| | - C Valverde
- Vall d́Hebrón University Hospital, Passeig de la Vall d'Hebron, 119, 08035 Barcelona, Spain
| | - F Waisberg
- Instituto Alexander Fleming. Av. Cramer 1180. CP C1426ANZ, Buenos Aires, Argentina
| | - E Zamora Estrada
- Hospital Dr. R. A. Calderón Guardia, 7-9 Av, 15-17 St, Aranjuez, San José, Costa Rica
| | - J Martin-Broto
- Research Health Institute Fundacion Jimenez Diaz (IIS/FJD), 28015 Madrid, Spain; Hospital Fundación Jimenez Diaz University Hospital, 28040 Madrid, Spain; General de Villalba University Hospital, 28400 Madrid, Spain
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Bunzli S, O'Brien P, Aston W, Ayerza MA, Chan L, Cherix S, de Las Heras J, Donati D, Eyesan U, Fabbri N, Ghert M, Hilton T, Idowu OK, Imanishi J, Puri A, Rose P, Sabah D, Turcotte R, Weber K, Dowsey MM, Choong PFM. Life or limb: an international qualitative study on decision making in sarcoma surgery during the COVID-19 pandemic. BMJ Open 2021; 11:e047175. [PMID: 34475158 PMCID: PMC8413468 DOI: 10.1136/bmjopen-2020-047175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
OBJECTIVES The COVID-19 pandemic is unprecedented as a global crisis over the last century. How do specialist surgeons make decisions about patient care in these unprecedent times? DESIGN Between April and May 2020, we conducted an international qualitative study. Sarcoma surgeons from diverse global settings participated in 60 min interviews exploring surgical decision making during COVID-19. Interview data were analysed using an inductive thematic analysis approach. SETTING Participants represented public and private hospitals in 14 countries, in different phases of the first wave of the pandemic: Australia, Argentina, Canada, India, Italy, Japan, Nigeria, Singapore, Spain, South Africa, Switzerland, Turkey, UK and USA. PARTICIPANTS From 22 invited sarcoma surgeons, 18 surgeons participated. Participants had an average of 19 years experience as a sarcoma surgeon. RESULTS 17/18 participants described a decision they had made about patient care since the start of the pandemic that was unique to them, that is, without precedence. Common to 'unique' decisions about patient care was uncertainty about what was going on and what would happen in the future (theme 1: the context of uncertainty), the impact of the pandemic on resources or threat of the pandemic to overwhelm resources (theme 2: limited resources), perceived increased risk to self (theme 3: duty of care) and least-worst decision making, in which none of the options were perceived as ideal and participants settled on the least-worst option at that point in time (theme 4: least-worst decision making). CONCLUSIONS In the context of rapidly changing standards of justice and beneficence in patient care, traditional decision-making frameworks may no longer apply. Based on the experiences of surgeons in this study, we describe a framework of least-worst decision making. This framework gives rise to actionable strategies that can support decision making in sarcoma and other specialised fields of surgery, both during the current crisis and beyond.
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Affiliation(s)
- Samantha Bunzli
- Department of Surgery, St Vincent's Hospital Melbourne, The University of Melbourne, Melbourne, Victoria, Australia
| | - Penny O'Brien
- Department of Surgery, St Vincent's Hospital Melbourne, The University of Melbourne, Melbourne, Victoria, Australia
| | - Will Aston
- Royal National Orthopaedic Hospital London, London, UK
| | - Miguel A Ayerza
- Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
- University of Buenos Aires, Buenos Aires, Argentina
| | | | - Stephane Cherix
- Service d'orthopédie et de traumatologie, Centre des sarcomes, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
| | - Jorge de Las Heras
- Hospital La Paz, Madrid, Spain
- Universidad Autónoma de Madrid, Madrid, Spain
| | - Davide Donati
- IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
- Docente di Ortopedia e Traumatologia Università degli Studi di Bologna, Bologna, Italy
| | - Uwale Eyesan
- Bowen University Teaching Hospital, Ogbomoso, Nigeria
| | - Nicola Fabbri
- Department of Surgery, Orthopaedic Surgery, Memorial Sloan Kettering Cancer Center, New York City, New York, USA
- Weill College of Medicine, Cornell University, Ithaca, New York, USA
| | - Michelle Ghert
- Division of Orthopaedics, McMaster University, Hamilton, Ontario, Canada
| | - Thomas Hilton
- Groote Schuur Hospital, Cape Town, South Africa
- Red Cross Childrens Hospital, Cape Town, South Africa
| | | | - Jungo Imanishi
- Saitama Medical University International Medical Center, Saitama, Japan
| | - Ajay Puri
- Department of Orthopaedic Oncology, Tata Memorial Centre Department of Surgical Oncology, Mumbai, India
- Homi Bhabha National Institute, Mumbai, India
| | - Peter Rose
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Dundar Sabah
- Department of Orthopedics and Traumatology, Ege University Faculty of Medicine, Izmir, Turkey
| | - Robert Turcotte
- McGill University Health Centre, Montréal, Québec, Canada
- Montreal General Hospital, Montréal, Québec, Canada
| | - Kristy Weber
- Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Michelle M Dowsey
- Department of Surgery, St Vincent's Hospital Melbourne, The University of Melbourne, Melbourne, Victoria, Australia
| | - Peter F M Choong
- Department of Surgery, St Vincent's Hospital Melbourne, The University of Melbourne, Melbourne, Victoria, Australia
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8
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Errani C, Tsukamoto S, Almunhaisen N, Mavrogenis A, Donati D. Intercalary reconstruction following resection of diaphyseal bone tumors: A systematic review. J Clin Orthop Trauma 2021; 19:1-10. [PMID: 34040979 PMCID: PMC8138587 DOI: 10.1016/j.jcot.2021.04.033] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 04/11/2021] [Accepted: 04/30/2021] [Indexed: 12/31/2022] Open
Abstract
INTRODUCTION The options for the reconstruction of diaphyseal defects following the resection of bone tumors include biological or prosthetic implants. The purpose of our study was to evaluate different types of intercalary reconstruction techniques, including massive bone allograft, extracorporeal devitalized autograft, vascularized free fibula, and modular prosthesis. METHODS We performed a systematic review of articles using the terms diaphyseal bone tumor and intercalary reconstruction. All the studies reporting the non-oncological complications such as infection, nonunion and fracture of the intercalary reconstructions were included. We excluded articles published before 2000 or did not involve humans in the study. Case reports, reviews, technique notes and opinion articles were also excluded based on the abstracts. Thirty-three articles included in this review were then studied to evaluate failure rates, complications and functional outcome of different surgical intercalary reconstruction techniques. RESULTS Nonunion rates of allograft ranged 6%-43%, while aseptic loosening rates of modular prosthesis ranged 0%-33%. Nonunion rates of allograft alone and allograft with a vascularized fibula graft ranged 6%-43% and 0%-33%, respectively. Fracture rates of allograft alone and allograft with a vascularized fibula graft ranged 7%-45% and 0%-44%, respectively. Infection rates of allograft alone and allograft with a vascularized fibula graft ranged 0%-28% and 0%-17%, respectively. All of the allograft (range: 67%-92%), extracorporeal devitalized autograft including irradiation (87%), autoclaving (70%), pasteurization (88%), low-heat (90%) or freezing with liquid nitrogen (90%), and modular prosthesis (range: 77%-93%) had similar Musculoskeletal Tumor Society functional scores. Addition of a vascularized fibula graft to allograft did not affect functional outcome [allograft with a vascularized fibula graft (range: 86%-94%) vs. allograft alone (range: 67%-92%)]. CONCLUSION Aseptic loosening rates of modular prosthesis seem to be less than nonunion rates of allograft. Adding a vascularized fibula graft to allograft seems to increase bone union rate and reduce the risk of fractures and infections, though a vascularized fibula graft needs longer surgical time and has the disadvantage of donor site morbidity. These various intercalary reconstruction techniques with or without a vascularized fibula autograft had similar functional outcome.
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Affiliation(s)
- Costantino Errani
- Orthopaedic Service, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy,Corresponding author. Orthopaedic Service, IRCCS Istituto Ortopedico Rizzoli, via pupilli n1, 40136, Bologna, Italy.
| | - Shinji Tsukamoto
- Department of Orthopaedic Surgery, Nara Medical University, Nara, Japan
| | | | - Andreas Mavrogenis
- First Department of Orthopaedics, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Davide Donati
- Orthopaedic Service, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
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9
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Focaccia M, Gambarotti M, Hakim R, Paioli A, Cesari M, Spazzoli B, Spinnato P, Donati D, Rocca M, Longhi A. Chondroblastoma's Lung Metastases Treated with Denosumab in Pediatric Patient. Cancer Res Treat 2020; 53:279-282. [PMID: 32777878 PMCID: PMC7812007 DOI: 10.4143/crt.2020.384] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 08/05/2020] [Indexed: 12/15/2022] Open
Abstract
Chondroblastoma is a rare benign chondrogenic tumor that occurs in skeletally immature patients between ages 10 and 20 years old. In literature are reported few cases of lung metastases, mainly occurred after surgery or local recurrences. There is no evidence on the pathogenesis of lung metastasis, as well as pulmonary disease course. Few treatments for metastases with aggressive behavior were based on chemotherapy regimen employed in other sarcoma with no results or not satisfying ones. Denosumab is approved for treatment of giant cell tumors and it is under investigation for other giant cell-rich bone tumors. Here, we report a case of a 16-year-old male chondroblastoma of the left humerus with bilateral lung metastases at presentation and progressing during follow-up, treated with denosumab for almost 2 years. We confirm that denosumab treatment can be effective in controlling chondroblastoma metastasis and it has been a safe procedure in an adolescent patient.
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Affiliation(s)
- Marco Focaccia
- Orthopedic Division, IRCCS, Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Marco Gambarotti
- Department of Pathology, IRCCS, Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Rossella Hakim
- Chemotherapy Division, IRCCS, Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Anna Paioli
- Chemotherapy Division, IRCCS, Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Marilena Cesari
- Chemotherapy Division, IRCCS, Istituto Ortopedico Rizzoli, Bologna, Italy
| | | | - Paolo Spinnato
- Department of Radiology, IRCCS, Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Davide Donati
- Orthopedic Division, IRCCS, Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Michele Rocca
- General Surgery Division, IRCCS, Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Alessandra Longhi
- Chemotherapy Division, IRCCS, Istituto Ortopedico Rizzoli, Bologna, Italy
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10
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Sambri A, Medellin MR, Errani C, Campanacci L, Fujiwara T, Donati D, Parry M, Grimer R. Denosumab in giant cell tumour of bone in the pelvis and sacrum: Long-term therapy or bone resection? J Orthop Sci 2020; 25:513-519. [PMID: 31155442 DOI: 10.1016/j.jos.2019.05.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 04/08/2019] [Accepted: 05/06/2019] [Indexed: 01/02/2023]
Abstract
INTRODUCTION Surgery of GCTB in sacrum and pelvis is challenging, with high rates of complications and local recurrence. Denosumab can consolidate the peripheral rim of the tumour, thus reducing the rate of morbidities of surgery. The aim of this paper is to evaluate the use of denosumab in pelvic/sacrum giant cell tumours of bone (GCTB). PATIENTS AND METHODS We retrospectively reviewed a cohort of 26 patients with aggressive GCTB in sacrum or pelvis treated with denosumab at two referral centres. Clinical response and local recurrence were recorded and the radiologic responses were evaluated with the MDA criteria. RESULTS 69% of the pelvic GCTB treated with denosumab presented partial or good radiologic responses (type 2A or 2B) after 49 weeks of treatment. Denosumab was administered as adjuvant therapy prior and after surgery in 11 patients (group A), and as the only treatment in 15 patients (group B). In group A, 62% of local recurrence was observed in patients treated with intralesional curettage. No recurrences were identified after en bloc resection. In group B, 9 patients were on continuous bimonthly long term denosumab administration with type 2A and 2B responses. Six patients stopped denosumab and 66% remained stable after 10 months of follow-up. CONCLUSIONS Long-term denosumab therapy can be considered with curative intent for pelvic and sacrum GCTB. If surgical intervention is required wide resection may be advisable to reduce the risk of recurrence.
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Sambri A, Bianchi G, Parry M, Frenos F, Campanacci D, Donati D, Jeys L. Is Arthrodesis a Reliable Salvage Option following Two-Stage Revision for Suspected Infection in Proximal Tibial Replacements? A Multi-Institutional Study. J Knee Surg 2019; 32:911-918. [PMID: 30227450 DOI: 10.1055/s-0038-1672121] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The aim of this multicentric retrospective study was to verify whether knee arthrodesis (KA) is a viable reconstructive option after two-stage revision for infection of proximal tibia (PT) endoprosthetic reconstruction (EPR). Sixty patients who underwent a two-stage revision were included. Definitive EPR or a KA with a modular system was performed following consideration of soft tissue and extensor mechanism conditions. Patients were evaluated with Musculoskeletal Tumor Society Score and Oxford Knee Score. Implant survival was assessed on the basis of recurrence of infection. Five patients did not receive any reconstruction after the first stage. In 14 cases, a KA was performed, and in 41, an EPR was implanted. At 5 years follow-up, reinfection rate in the KA group was lower (10 vs. 17.5% in KA and EPR groups, respectively). In reinfected patients, the KA group had a reduced rate of amputation when compared with those with EPR (50 vs. 88%). Functional evaluation did not show any significant differences between the two groups. A successful KA using a modular implant can eradicate infection and allow preservation of the limb with good function and good pain relief in after two-stage revision for an infected PT EPR.
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Affiliation(s)
- Andrea Sambri
- Department of Orthopedic Oncology, Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Giuseppe Bianchi
- Department of Orthopedic Oncology, Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Michael Parry
- Department of Orthopedic Oncology, Royal Orthopaedic Hospital, Birmingham, United Kingdom
| | - Filippo Frenos
- Department of Orthopedic Oncology, Azienda Ospedaliero Universitaria Careggi, Firenze, Toscana, Italy
| | - Domenico Campanacci
- Department of Orthopedic Oncology, Azienda Ospedaliero Universitaria Careggi, Firenze, Toscana, Italy
| | - Davide Donati
- Department of Orthopedic Oncology, Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Lee Jeys
- Department of Orthopedic Oncology, Royal Orthopaedic Hospital, Birmingham, United Kingdom
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12
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Palmerini E, Torricelli E, Cascinu S, Pierini M, De Paolis M, Donati D, Cesari M, Longhi A, Abate M, Paioli A, Setola E, Ferrari S. Is there a role for chemotherapy after local relapse in high-grade osteosarcoma? Pediatr Blood Cancer 2019; 66:e27792. [PMID: 31058424 DOI: 10.1002/pbc.27792] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2018] [Revised: 03/26/2019] [Accepted: 04/17/2019] [Indexed: 01/24/2023]
Abstract
BACKGROUND High-grade bone osteosarcoma has a high relapse rate. The best treatment of local recurrence (LR) is under discussion. The aim of this study is to analyze LR patterns and factors prognostic for survival. METHODS LR diagnostic modality (clinical or imaging), pattern of recurrence, and post-LR survival (PLRS) were assessed. RESULTS Sixty-two patients were identified, with median age 21 years (range, 9-75 years), including 11 (18%) ≤15 years, 30 (48%) from 16 to 29 years; 21 (34%) were older. Patterns of relapse were LR only 58%, LR + distant metastases (DM) 42%. Seventy-nine percent of patients relapsed within 24 months, and diagnosis was clinical in 88%. LR treatment was surgery 85%, chemotherapy 55%, chemotherapy + surgery 45%. Surgical complete remission after LR (CR2) was achieved in 60% (LR 86%; LR + DM 23%). With a median follow-up of 43 months (range, 5-235 months), the five-year PLRS was 37%, significantly better for patients with longer LR-free interval (LRFI; ≤24 months 31% vs > 24 months 61.5%, P = 0.03), absence of DM (no DM 56% vs DM 11.5%, P = 0.0001), and achievement of CR2 (no CR2 0% vs CR2 58.5%, P = 0.0001). No difference was found according to age and chemotherapy (LR only: five-year PLRS: 53% without chemotherapy vs 58% with chemotherapy, P = 0.9; LR + DM: five-year PLRS: 25% without chemotherapy vs 9% with chemotherapy, P = 0.7). CONCLUSIONS Early relapse is detected by symptoms in 90% of cases and associated with worse outcome. The achievement of CR2, not age, is crucial for survival. For patients with LR only, better survival was demonstrated, as compared with DM, and no improvement with chemotherapy after surgery was found.
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Affiliation(s)
| | - Elisa Torricelli
- Department of Oncology, University Hospital of Modena and Reggio Emilia, Modena, Italy
| | - Stefano Cascinu
- Department of Oncology, University Hospital of Modena and Reggio Emilia, Modena, Italy
| | - Michela Pierini
- Chemotherapy Unit, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | | | - Davide Donati
- Department of Orthopaedic Oncology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Marilena Cesari
- Chemotherapy Unit, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Alessandra Longhi
- Chemotherapy Unit, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Massimo Abate
- Chemotherapy Unit, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Anna Paioli
- Chemotherapy Unit, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Elisabetta Setola
- Chemotherapy Unit, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Stefano Ferrari
- Chemotherapy Unit, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
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13
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Sambri A, Spinnato P, Bazzocchi A, Tuzzato GM, Donati D, Bianchi G. Does pre-operative MRI predict the risk of local recurrence in primary myxofibrosarcoma of the extremities? Asia Pac J Clin Oncol 2019; 15:e181-e186. [PMID: 31111597 DOI: 10.1111/ajco.13161] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Accepted: 04/23/2019] [Indexed: 02/06/2023]
Abstract
OBJECTIVE The aim of this retrospective study is to analyze and classify magnetic resonance imaging (MRI) features of primary myxofibrosarcoma (MFS) of the extremities and their correlation with patients' prognosis (local recurrence [LR] and sarcoma-specific survival [OS]). METHODS Ninety-four patients with primary MFS of the extremities were included. All MRI were performed with 1.5 Tesla magnet using a standard protocol. The presence of a "tail pattern" was recorded. Myxoid tumor component and contrast enhancement of the tumor were evaluated and graded with semiquantitative method using a newly proposed classification. RESULTS A tail-like pattern was observed in 32% MFS; most of the tumors presented with high myxoid features and high grade of gadolinium (Gd) enhancement. Type 3 myxoid characteristics (P = 0.003) were most often observed in FNCLCC grade 3 tumors. Estimated LR-free survival rate was 70.3% at 3 and 58.4% at 5 years. A higher LR-rate was observed in those tumors presenting a tail-like pattern at MRI (P = 0.039), in those with myxoid features type 2 and 3 (0.047) and in those with Gd enhancement grade 2 or 3 (P = 0.029). A worse OS was observed in Gd enhancement grade 3 (P = 0.013) and in deep tumors (P = 0.031). CONCLUSIONS MFS features on preoperative MRI can be useful in order to identify risk classes of LR and OS. These data may suggest that patients with a tail-like pattern, high Gd enhancement and high myxoid features should be followed up more carefully after surgery.
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Affiliation(s)
- Andrea Sambri
- Department of Orthopedic Oncology, Istituto Ortopedico Rizzoli, Bologna, Italy.,Università degli Studi di Bologna, Bologna, Italy
| | - Paolo Spinnato
- Department of Radiology, Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Alberto Bazzocchi
- Department of Radiology, Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Gian Marco Tuzzato
- Department of Orthopedic Oncology, Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Davide Donati
- Department of Orthopedic Oncology, Istituto Ortopedico Rizzoli, Bologna, Italy.,Università degli Studi di Bologna, Bologna, Italy
| | - Giuseppe Bianchi
- Department of Orthopedic Oncology, Istituto Ortopedico Rizzoli, Bologna, Italy
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14
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Longhi A, Paioli A, Palmerini E, Cesari M, Abate ME, Setola E, Spinnato P, Donati D, Hompland I, Boye K. Pazopanib in relapsed osteosarcoma patients: report on 15 cases. Acta Oncol 2019; 58:124-128. [PMID: 30207179 DOI: 10.1080/0284186x.2018.1503714] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Alessandra Longhi
- Department of Chemotherapy, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Anna Paioli
- Department of Chemotherapy, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Emanuela Palmerini
- Department of Chemotherapy, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Marilena Cesari
- Department of Chemotherapy, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Massimo E. Abate
- Department of Chemotherapy, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Elisabetta Setola
- Department of Chemotherapy, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Paolo Spinnato
- Department of Radiology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Davide Donati
- Orthopedic Surgery, Orthopedic Oncologic Surgery, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Ivar Hompland
- Department of Oncology, Oslo University Hospital, The Norwegian Radium Hospital, Oslo, Norway
| | - Kjetil Boye
- Department of Oncology, Oslo University Hospital, The Norwegian Radium Hospital, Oslo, Norway
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15
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Palmerini E, Longhi A, Donati D, Staals EL. Advances in treatment for tenosynovial giant cell tumors. Expert Opin Orphan Drugs 2018. [DOI: 10.1080/21678707.2018.1549481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
| | - Alessandra Longhi
- Chemotherapy Unit, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Davide Donati
- Orthopaedic Surgery, Musculoskeletal Oncology Department, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Eric L. Staals
- Orthopaedic Surgery, Musculoskeletal Oncology Department, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
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16
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Casadei R, Drago G, Di Pressa F, Donati D. Humeral metastasis of renal cancer: Surgical options and review of literature. Orthop Traumatol Surg Res 2018; 104:533-538. [PMID: 29654934 DOI: 10.1016/j.otsr.2018.03.009] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Revised: 03/15/2018] [Accepted: 03/20/2018] [Indexed: 02/08/2023]
Abstract
INTRODUCTION The humerus is the second most common long bone site of metastatic disease from renal cell carcinomas (RCC) after femur. Surgery has an important role in the treatment of these lesions due to renal cell tumor's resistance to chemotherapy and radiotherapy. HYPOTHESIS Prosthetic replacement is an effective and safe solution in treatment of renal humeral metastasis. MATERIAL AND METHODS Fifty-six patients affected by RCC bone metastases of the humerus that underwent a surgical reconstruction were rewised. Thirty-five lesions were localized on proximal third, 12 on the shaft, 9 on distal third. Among proximal 29 were treated with resection and endoprosthetic replacement and 6 with plate and cement. Six diaphyseal lesions were stabilized with intramedullary nailing, 5 with plate and cement and 1 with an intercalary prosthesis. Regarding distal lesions, 7 elbow prostheses and 2 plates and cement were used. RESULTS The average age was 63years. Metastasis was single in 55% of cases, and in 45% metachronous. A pathologic fracture (PF) occurred in 64% of cases. Only 9% of patients had a mechanical complication, 7% an infection and 5% neurological deficit. A local recurrence occurred in 14% of patients. An implant failure has been observed in 10 patients, 5 for mechanical complications, 2 for infections and 3 for local recurrence; of these 7 were treated with a prosthesis and 3 with plate and cement. The mean value of MSTS score was 64%, 63% and 59% respectively in patients with proximal, diaphyseal and distal humerus metastases. DISCUSSION Solitary and metachronous bone metastases have a longer survival. Disease-free interval>2years is another important prognostic factor. Reconstruction with a modular prosthesis is recommended in proximal and distal third. Instead in diaphyseal lesions a closed reduction and fixation with intramedullary locked nailing are preferred. When surgical indications are correctly followed, good oncologic and functional outcomes are obtained, leading to markedly improvement of patients' quality of life. RETROSPECTIVE STUDY Level of evidence: IV.
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Affiliation(s)
- R Casadei
- Department of Musculoskeletal Oncology, Istituto Ortopedico Rizzoli, Bologna, Italy
| | - G Drago
- Department of Musculoskeletal Oncology, Istituto Ortopedico Rizzoli, Bologna, Italy.
| | - F Di Pressa
- Department of Musculoskeletal Oncology, Istituto Ortopedico Rizzoli, Bologna, Italy
| | - D Donati
- Department of Musculoskeletal Oncology, Istituto Ortopedico Rizzoli, Bologna, Italy
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17
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Sambri A, Bianchi G, Cevolani L, Donati D, Abudu A. Can radical margins improve prognosis in primary and localized epithelioid sarcoma of the extremities? J Surg Oncol 2018; 117:1204-1210. [PMID: 29266231 DOI: 10.1002/jso.24955] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Accepted: 11/14/2017] [Indexed: 11/10/2022]
Abstract
INTRODUCTION Epithelioid sarcoma (ES) has a tendency to locally recur, spread proximally, and metastasize, in particular to lymphnodes and lungs. The aim of this report is to study the role of surgery and the extent of margins required for optimal management of patients with localized epithelioid sarcoma of the extremities. MATERIAL AND METHODS We retrospectively evaluated 77 patients affected by ES of the extremities treated at two different Institutions. RESULTS Twenty-two patients had metastasis at diagnosis. Estimated survival was 65.5% at 5 years and 50.9% at 10 years, with a better prognosis in patients with localized disease at diagnosis (P < 0.001). Among patients with localized disease, a significantly better survival was found in patients with primary tumors in which radical surgical margins were achieved (P = 0.043). Among 47 patients presenting with primary tumors, local recurrence-free rate was 72.9% at 5 years, and 61.9% at 10 years, with a better local control achieved in patients with radical margins were achieved (P = 0.026). DISCUSSION We believe that the best approach to improve both local control and survival is to aim for radical margins in patients with primary tumors. Therefore, the best chance for cure is if the first treatment is the right treatment, which we believe to be radical margins.
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Affiliation(s)
- Andrea Sambri
- Department of Orthopedic Oncology, Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Giuseppe Bianchi
- Department of Orthopedic Oncology, Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Luca Cevolani
- Department of Orthopedic Oncology, Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Davide Donati
- Department of Orthopedic Oncology, Istituto Ortopedico Rizzoli, Bologna, Italy
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Abstract
Little has been written about the specific timing and elements involved in the follow-up of orthopedic oncology patients1,2,7. The experience with bone tumor treatment at the First Clinic of the Istituto Rizzoli started 30 years ago and more than 15,000 patients have been treated to date. The increment of limb salvage surgery is linked with the improvements in imaging and surgical skills and with the availability of new reconstructive techniques. For this purpose it is mandatory to carry out meticulous monitoring of the patients. A large number of patients are still followed up to evaluate the results in terms of oncological and functional status. Based on this experience we developed a time schedule to better respond to the need for adequate patient evaluation.
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Affiliation(s)
- D Donati
- First Orthopedic Clinic, Bologna University, Italy
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19
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Passalacqua R, Bisagni G, Bertusi M, Donati D, Buzzi F, Di Costanzo F, Basurto C, Gori S. Lonidamine in Advanced Colorectal Cancer: A Phase II Study of the Italian Oncology Group for Clinical Research (Goirc). Tumori 2018; 75:277-9. [PMID: 2672481 DOI: 10.1177/030089168907500318] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Twenty-one patients with metastatic colorectal adenocarcinoma, all previously treated with chemotherapy for metastatic disease, were treated with lonidamine (LDN). The major toxicity encountered was muscular (myalgias in 48%) and gastrointestinal (nausea and/or vomiting in 52%). Other toxicities included abdominal pain, somnolence, fever, arthralgia and ototoxicity. In the 14 patients evaluable for response we observed no complete or partial remission, 8 stable disease and 6 progressive disease. LND has no clinically worthwhile activity against colorectal carcinoma refractory to conventional chemotherapy.
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Affiliation(s)
- R Passalacqua
- Medical Oncology Service, Ospedale Maggiore, Parma, Italy
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20
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Bacci G, Longhi A, Ferrari S, Briccoli A, Donati D, De Paolis M, Versari M. Prognostic Significance of Serum Lactate Dehydrogenase in Osteosarcoma of the Extremity: Experience at Rizzoli on 1421 Patients Treated over the Last 30 Years. Tumori 2018; 90:478-84. [PMID: 15656333 DOI: 10.1177/030089160409000507] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Aims The study evaluated the correlation between pretreatment serum lactate dehydrogenase (LDH) levels with the stage of disease and its clinical prognostic value. Methods Pretreatment serum LDH of 1421 patients with osteosarcoma of the extremity were assessed to investigate whether the enzyme correlates with the stage of the tumor. In 860 assessable patients with localized disease, treated according to 10 different protocols of adjuvant (four) and neoadjuvant chemotherapy (six), we also evaluated the correlation between the serum levels of LDH and outcome. Results According to the stage of disease, the rate of high serum level of LDH was significantly higher in 199 patients with metastatic disease at presentation than in 1222 patients with localized disease (36.6% vs 18.8%; P <0.0001). In these patients, the 5-year disease-free survival was 39.5% for patients with high LDH levels and 60% for those with normal values. The 5-year disease-free survival correlated with serum level of LDH at univariate and multivariate analysis, although it lost its significance when histologic response to chemotherapy was also considered in the multivarite analysis. Conclusions Serum LDH has a prognostic value and it should be considered in evaluating the results of therapeutic trials of chemotherapy, as well as defining a category of patients at high-risk of relapse to be treated with a more aggressive regimen.
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Affiliation(s)
- Gaetano Bacci
- Chemotherapy, Department of Musculoskeletal Oncology, Istituto Ortopedico Rizzoli, Bologna, Italy.
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21
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Ferrari S, Mercuri M, Picci P, Bertoni F, Brach del Prever A, Tienghi A, Mancini A, Longhi A, Rimondini S, Donati D, Manfrini M, Ruggieri P, Biagini R, Bacci G. Nonmetastatic Osteosarcoma of the Extremity: Results of a Neoadjuvant Chemotherapy Protocol (IOR/OS-3) with High-dose Methotrexate, Intraarterial or Intravenous Cisplatin, Doxorubicin, and Salvage Chemotherapy Based on Histologic Tumor Response. Tumori 2018; 85:458-64. [PMID: 10774566 DOI: 10.1177/030089169908500607] [Citation(s) in RCA: 64] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Aims and Background From 1986 to 1989, a study for the treatment of nonmetastatic osteosarcoma of the extremity (IOR/OS-2) was carried out at the Rizzoli Institute. The cumulative dose of doxorubicin delivered was 480 mg/m2, and severe heart failure developed in 5 (3%) of the 164 treated patients. The specific aim of the subsequent study was to assess the efficacy of a protocol, similar to IOR/OS-2, but with a reduced cumulative dose of doxorubicin (390 mg/m2). Additional aims were to assess the role of the route of infusion (intraarterial or intravenous) of cisplatin on histologic response of the primary tumor and the use of ifosfamide as salvage chemotherapy in poor responders. Methods The new chemotherapy regimen (IOR/OS-3) was comprised of a preoperative phase with methotrexate (10 g/m2), cisplatin (120 mg/m2 intraarterially or intravenously), and doxorubicin (60 mg/m2). After surgery, the same drugs were administered, with the addition of ifosfamide (10 g/m2) in patients who had a poor histologic response to primary chemotherapy. Results Ninety-five patients entered the study. The rate of good histologic response was 64% with intraarterial cisplatin and 43% with intravenous cisplatin (P = 0.05). The 8-year event-free survival and overall survival were 54% and 61%, respectively, with no significant difference according to the histologic response. No cases of clinical doxorubicin-induced cardiopathy were recorded. Event-free and overall survival did not significantly differ from those achieved with IOR/OS-2 (8-year disease-free and overall survival, respectively 63% and 72%). Conclusions The reduction in the doxorubicin cumulative dose avoided episodes of cardiotoxicity, without consequences on the efficacy of treatment. The addition of ifosfamide was an effective “salvage” therapy for poor responders. A better histologic response with intraarterial cisplatin was observed, but owing to the availability of an effective salvage therapy for poor responders, the advantages in terms of histologic response did not compensate for the cost and discomfort for the patients of this modality of infusion of cisplatin.
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Affiliation(s)
- S Ferrari
- Chemioterapia, I Clinica Ortopedica dell'Università di Bologna, Italy.
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22
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Ferrari S, Meazza C, Palmerini E, Tamburini A, Fagioli F, Cozza R, Ferraresi V, Bisogno G, Mascarin M, Cefalo G, Manfrini M, Capanna R, Biagini R, Donati D, Picci P. Nonmetastatic osteosarcoma of the extremity. Neoadjuvant chemotherapy with methotrexate, cisplatin, doxorubicin and ifosfamide. An Italian Sarcoma Group study (ISG/OS-Oss). Tumori Journal 2018. [DOI: 10.1177/1778.19262] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
| | | | | | - Angela Tamburini
- Ospedale Meyer/Azienda Ospedaliera Universitaria Careggi, Florence
| | | | | | | | | | | | | | | | - Rodolfo Capanna
- Ospedale Meyer/Azienda Ospedaliera Universitaria Careggi, Florence
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23
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Visani J, Staals EL, Donati D. Treatment of chronic osteomyelitis with antibiotic-loaded bone void filler systems: an experience with hydroxyapatites calcium-sulfate biomaterials. Acta Orthop Belg 2018; 84:25-29. [PMID: 30457496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
This is a retrospective study that aims to quantify the problem of chronic osteomyelitis in one of the largest Italian orthopedic centers. Furthermore this study is focused on evaluation of efficacy of bone void filler systems with particular attention to a subgroup of patients treated with PerOssal®. Ninety-seven patients were included in this study between 2008 and 2013 with a minimum follow up of 24 months. A subgroup of 52 patients was treated with curettage plus PerOssal®, another group was treated with curettage only or curettage with other bone void filler systems. Overall we obtained a cure rate of 80,4%, whereas 19,6% had recurrent infection. Looking at the subgroup treated with PerOssal® we found a healing rate of 86,5%, which was significantly higher compared to the other groups. Of the patients with recurrence of infection, those treated with PerOssal® recurred 106 days later than the other patients.
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Biazzo A, Romantini M, De Paolis M, Manfrini M, Donati D. Vascularized fibular autograft as salvage technique in failure of allograft intercalary reconstructions after tumor resections. Acta Orthop Belg 2018; 84:38-46. [PMID: 30457498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Intercalary allografts after diaphyseal resections for bone tumors represent the most frequent option of reconstruction. Main complications are non-unions, fractures and infections. The purpose of the current study was to report our experience with the use of vascularized fibular autograft as rescue technique in failed previous reconstructions after intercalary bone tumor resection of the extremities. Twenty-eight patients were followed over time. Causes of failure were non-union, allograft fracture and infection. Vascularized fibular autograft was used with mechanical support of massive bone allograft in 13 cases. Functional results were excellent in 19 cases, good in 8 and fair in one patient. Among complications we reported 4 non-unions, 2 allograft fractures, 1 non-union with plate breakage, 1 plate breakage, 1 infection, 1 limb shortening and 1 knee varus deformity. The rationale of vascularized fibular autograft is to provide biologic support. The association with massive bone allograft provides mechanical strength and early stability.
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25
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Ballatori E, Roila F, Ruggeri B, De Angelis V, Porzio G, Marchetti P, Basurto C, Ciccarese G, Palladino M, Porrozzi S, Fava S, Grimi E, Calcagno A, De Paoli A, Luoni M, Tocci A, Nuzzo A, Laudadio L, Di Blasio A, Sacco M, Contu A, Olmeo N, Pazzola A, Baldino G, Picece V, Nicodemo M, Cirillo M, Recaldin E, Dazzi C, Cariello A, Giovanis P, Zumaglini F, Rosati G, Manzione L, Bilancia D, Rossi A, Donati D, Maccaferri R, Malacarne P, Labianca R, Quadri A, Pessi M, Cortesi E, Martelli O, Giuliodori L, Silva R, Mari D, Massidda B, Ionta M, Alessandroni P, Baldelli A, Antimi M, Minelli M, Gridelli C, Rossi A, Passalacqua R, Quarta M, Sassi M, Pinaglia D, De Marino E, Giampaolo M, Ciancola S, Lalli A, Di Felice S, Casartelli C. Inappropriate Doses of Chemotherapy in Italian Breast Cancer Patients Enrolled in Clinical Trials. Tumori 2018; 93:540-3. [DOI: 10.1177/030089160709300604] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Aims and background The dose of delivered chemotherapy is important to evaluate the appropriateness of the anticancer treatment. This aspect has been scarcely studied in Italy. About 7 years ago, the Italian Group for Antiemetic Research (IGAR) published a large controlled study on the effectiveness of different antiemetic prophylaxis in patients submitted to moderately emetogenic chemotherapy, where the prescribed chemotherapy was recorded. The aim of our study was to evaluate the incidence of undertreatment and to detect clinical and nonclinical factors able to explain its variability. Methods An observational study on the IGAR databank was performed to evaluate the incidence of undertreatment in the prescription in conditions of clinical trial, where the doses belonged to the eligibility criteria, and to analyze the importance of clinical and nonclinical factors using multifactorial logistic models. Results 317 patients receiving cyclophosphamide, methotrexate, and fluorouracil (CMF) and 224 anthracycline-based chemotherapy were considered. In the CMF-treated patients, 22.4% received full doses, whereas in 53.6% all three drugs of the schedule were down-dosed. In the anthracycline-treated group, 38.6% and 3.4% of patients submitted to chemotherapy containing epirubicin and doxorubicin, respectively, were undertreated. Logistic models showed that undertreatment in CMF-treated patients depended significantly on the geographic area and setting of chemotherapy administration. Although not significant, differences between age class and Karnofsky performance status were also detected. In the epirubicin-treated group, all these factors were significant. Conclusions The undertreatment of cancer patients is a relevant problem, because it could give, in daily clinical practice, worse results than those reported in clinical studies. Considering the setting of a clinical trial where our study was carried out, the incidence of undertreatment is surprisingly high. We do not know whether today, about 8 years after the IGAR study was carried out, the inappropriate dose of chemotherapy is still as frequent as we reported, but surely the topic deserves more attention.
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Affiliation(s)
- Enzo Ballatori
- Department of Internal Medicine and Public Health, University of L'Aquila
| | - Fausto Roila
- Medical Oncology Division, Policlinico Hospital, Perugia
| | | | | | | | | | | | | | | | | | - S. Fava
- Medical Oncology Service, Legnano Hospital, Legnano (Milano)
| | - E. Grimi
- Medical Oncology Service, Legnano Hospital, Legnano (Milano)
| | - A. Calcagno
- Medical Oncology Service, Legnano Hospital, Legnano (Milano)
| | - A. De Paoli
- Medical Oncology Service, Legnano Hospital, Legnano (Milano)
| | - M. Luoni
- Medical Oncology Service, Legnano Hospital, Legnano (Milano)
| | - A. Tocci
- Medical Oncology Service, Legnano Hospital, Legnano (Milano)
| | - A. Nuzzo
- Medical Oncology Division, Hospital Renzetti, Lanciano (Chieti)
| | - L. Laudadio
- Medical Oncology Division, Hospital Renzetti, Lanciano (Chieti)
| | - A. Di Blasio
- Medical Oncology Division, Hospital Renzetti, Lanciano (Chieti)
| | - M. Sacco
- Medical Oncology Division, Hospital Renzetti, Lanciano (Chieti)
| | - A. Contu
- Medical Oncology Service, Sassari
| | - N. Olmeo
- Medical Oncology Service, Sassari
| | | | | | - V. Picece
- Medical Oncology Division, Negrar Hospital, Verona
| | - M. Nicodemo
- Medical Oncology Division, Negrar Hospital, Verona
| | - M. Cirillo
- Medical Oncology Division, Negrar Hospital, Verona
| | - E. Recaldin
- Medical Oncology Division, Negrar Hospital, Verona
| | - C. Dazzi
- Medical Oncology Division, Ravenna
| | | | | | | | | | | | | | - A. Rossi
- Medical Oncology Division, Potenza
| | - D. Donati
- Medical Oncology Division, Arcispedale S. Anna, Ferrara
| | - R. Maccaferri
- Medical Oncology Division, Arcispedale S. Anna, Ferrara
| | - P. Malacarne
- Medical Oncology Division, Arcispedale S. Anna, Ferrara
| | | | | | | | - E. Cortesi
- Medical Oncology Division, La Sapienza University, Rome
| | - O. Martelli
- Medical Oncology Division, La Sapienza University, Rome
| | | | - R.R. Silva
- Medical Oncology Service, Fabriano (Ancona)
| | - D. Mari
- Medical Oncology Service, Fabriano (Ancona)
| | - B. Massidda
- Medical Oncology Department, University of Cagliari, Cagliari
| | - M.T. Ionta
- Medical Oncology Department, University of Cagliari, Cagliari
| | | | | | - M. Antimi
- Medical Oncology Service, Hospital S. Eugenio, Rome
| | - M. Minelli
- Medical Oncology Service, Hospital S. Eugenio, Rome
| | - C. Gridelli
- Medical Oncology B Division, National Cancer Institute, Naples
| | - A. Rossi
- Medical Oncology B Division, National Cancer Institute, Naples
| | | | | | - M. Sassi
- Medical Oncology Service, Foligno (Perugia)
| | | | - E. De Marino
- Medical Oncology Department, Internal Medicine Division, V. Fazzi Hospital, Lecce
| | | | - S. Ciancola
- Medical Oncology Service, Anagni (Frosinone)
| | - A. Lalli
- Medical Oncology Service, Giulianova (Teramo)
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Sambri A, Cadossi M, Giannini S, Pignatti G, Marcacci M, Neri MP, Maso A, Storni E, Gamberini S, Naldi S, Torri A, Zannoli S, Tassinari M, Fantini M, Bianchi G, Donati D, Sambri V. Is Treatment With Dithiothreitol More Effective Than Sonication for the Diagnosis of Prosthetic Joint Infection? Clin Orthop Relat Res 2018; 476:137-145. [PMID: 29389758 PMCID: PMC5919239 DOI: 10.1007/s11999.0000000000000060] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Prosthetic joint infection (PJI) is among the most-severe complications of a total joint arthroplasty. Identification of the causal organism is of paramount importance for successful treatment, and sonication of implants may aid in this identification. Dithiothreitol (DTT) treatment has been proposed as an alternative to sonication to improve diagnosis, reduce costs, and improve reliability of the procedure, but its efficacy remains poorly characterized. QUESTIONS/PURPOSES (1) Are DTT and sonication more sensitive and/or more specific than standard cultures of tissue samples for the diagnosis of PJI? (2) Which test (DTT or sonication) is more sensitive when the clinician does not suspect infection before surgery? (3) Which test (DTT or sonication) is more sensitive when the clinician suspects infection before surgery? METHODS Two hundred thirty-two patients undergoing revision of a knee or hip arthroplasty were prospectively evaluated in this randomized study. Cultures were performed on five tissue samples from each patient and on fluid obtained by prosthesis treatment in patients randomly assigned to sonication (117 patients) or DTT (115 patients). The reference standard against which cultures (on tissue samples and on fluids from sonication or DTT) were compared was the Musculoskeletal Infection Society definition of PJI. RESULTS Cultures on sonication and DTT fluids provided higher sensitivity (89% and 91%, respectively) than those on standard cultures of tissue samples (79%; p < 0.001). Among patients in whom infection was not suspected before surgery, the sensitivity of DTT was greater than that for sonication and cultures on tissue samples (100% versus 70% and 50%; p < 0.001). Among patients in whom infection was suspected before surgery, the sensitivity of DTT and sonication were not greater than that for standard cultures (89% and 94% versus 86%). CONCLUSIONS In this randomized study, we found no difference in sensitivity between DTT and sonication for the detection of PJI, and both of those tests were more sensitive than standard tissue cultures. Thus, cultures of sonication or DTT fluid should be considered important additional tools to standard cultures for definition of PJI and should be considered together with other criteria, especially in settings where infection is not suspected before revision surgery.Level of Evidence Level I, diagnostic study.
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Affiliation(s)
- Andrea Sambri
- A. Sambri, M. Cadossi, S. Giannini, G. Pignatti, M. Marcacci, M. P. Neri, D. Donati, Department of Orthopaedic Surgery, Istituto Ortopedico Rizzoli, Bologna, Italy A. Maso, E. Storni, S. Gamberini, S. Naldi, Unit of Microbiology, Istituto Ortopedico Rizzoli, Bologna, Italy A. Torri, S. Zannoli, M. Tassinari, M. Fantini, V. Sambri, Unit of Microbiology, The Great Romagna Hub Laboratory, Pievesestina, Italy A. Sambri, M. Cadossi, M. Marcacci, D. Donati, V. Sambri, University of Bologna, Bologna, Italy
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Abstract
Introduction Bone metastatic disease is a major cause of pain and decreased quality of life in patients with cancer. In addition to systemic therapy and pain control with narcotic analgesics, standard local treatments include palliation with radiation therapy and surgery. However, 20–30 % of patients do not respond to conventional treatments, increasing the interest in alternative therapies. We present the results of a new minimally invasive technique in the treatment of bone metastases. Methods Twenty-nine patients affected by painful bone metastases were treated with electrochemotherapy (ECT) from July 2009 to July 2011; the mean age was 60 years (range 37–87); 21 patients received a previous ineffective local treatment; the appendicular skeleton was affected in 15 patients while in 14 patients other sites were involved. ECT was performed using the Cliniporator Vitae under fluoroscopy or CT guidance depending on the site of the lesion. Clinical response was assessed using VAS scale and objective tumour response was evaluated according to the MD Anderson criteria for bone metastases. Results All patients well tolerated the procedure and no intraoperative or postoperative complications were observed. At a mean follow-up of 7 months, 24 patients were available for evaluation. 84 % of the patients (20 out of 24) referred improvement of pain ≥50 % with reduction of narcotics consumption. Radiographic evaluation after 3 months in 20 evaluable patients, showed “partial response” in 1 patient, “stable disease” in 17 and “progression” in two cases. Discussion Results reported in this study demonstrated ECT to be safe and feasible in the treatment of painful bone metastases even when other previous treatments were ineffective. Pain and disease progression control was achieved in the majority of the patients with consequent improvement of quality of life. Conclusion ECT should be considered a new feasible tool in the treatment of bone metastases in place or in combination with standard treatments; further developments are required to extend the use of this technique to spine metastases.
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Affiliation(s)
- Giuseppe Bianchi
- Clinica Ortoepdica III, Istituto Ortopedico Rizzoli, Bologna, Italy.
| | - Laura Campanacci
- Clinica Ortoepdica III, Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Mattia Ronchetti
- Oncology Clinical, Research & Development, IGEA S.p.A., via Parmenide 10/a, 41012, Carpi, Modena, Italy
| | - Davide Donati
- Clinica Ortoepdica III, Istituto Ortopedico Rizzoli, Bologna, Italy
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Manfrini M, Bindiganavile S, Say F, Colangeli M, Campanacci L, Depaolis M, Ceruso M, Donati D. Is There Benefit to Free Over Pedicled Vascularized Grafts in Augmenting Tibial Intercalary Allograft Constructs? Clin Orthop Relat Res 2017; 475:1322-1337. [PMID: 27995558 PMCID: PMC5384922 DOI: 10.1007/s11999-016-5196-2] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Accepted: 11/29/2016] [Indexed: 01/31/2023]
Abstract
BACKGROUND Intercalary reconstruction of tibial sarcomas with vascularized fibula autografts and massive bone allografts is reliable with predictable long-term results. However, inadequate data exist comparing free and pedicled vascularized fibula autografts in combination with a massive bone allograft in patients undergoing intercalary tibia reconstructions. QUESTIONS/PURPOSES Among patients undergoing large-segment intercalary allografting, we sought to compare supplemental free vascularized fibular autografts with supplemental pedicled vascularized fibular autografts, in terms of (1) oncologic results, (2) complications associated with surgery, (3) Musculoskeletal Tumor Society (MSTS) scores, and (4) surgical time. METHODS Between 1994 and 2013, we treated 320 patients, younger than 40 years, with tibial sarcomas. Thirty-five patients (11%) underwent amputations. One hundred ninety-five patients (61%) were treated with intraarticular resection of the tibia, which constituted 104 tumor endoprostheses, 63 proximal tibia allograft prosthetic composites, 21 osteoarticular allografts, and seven arthrodeses with allografts. Ninety patients (28%) underwent joint-sparing intercalary reconstruction. Forty-one (13%) of these 90 patients were treated with allografts alone, two (1%) with vascularized fibula grafts, and 47 (15%) with intercalary allografts supplemented by autografts (free fibular autografts, 22 patients, 7%; pedicled fibular autografts, 25 patients, 8%). During the study period, we used free vascularized fibular autografts in association with massive bone allograft for a resection longer than 12 cm with a very small periarticular residual segment. The choice for using a pedicled fibula harvested in the ipsilateral leg initially was for patients having only diaphyseal resections and the indication was later extended to intraepiphyseal osteotomies with a small periarticular residual segment. The goals of this study are to present the long-term results in this group of patients and compare their results based on the type of vascularized fibula harvest. There were 33 male and 14 female patients with mean age of 14 ± 6 years. The median followup was 84 months (range, 7-231 months). No patients were lost to followup before 1 year. Four patients died and were not available for followup after 18 months. The mean tibia resection length was 15 ± 4 cm and mean length of the harvested vascularized fibula was 18 ± 4 cm. RESULTS Overall 5- and 10-year oncologic survival rates in this study were 87% ± 5% and 83% ± 6% respectively. With the numbers available, we observed no difference in survivorship free from death from disease between the study groups (85% ± 8% [95% CI, 174-232 months] of the free vascularized group versus 82% ± 8% [95% CI, 148-206 months] of the pedicled fibula graft group; p = 0.741). At last followup, 40 patients had no evidence of disease and seven had died of disease. Local recurrence was observed in two patients in the supplemental free vascularized fibula group and three patients in the supplemental pedicled vascularized fibula group, whereas metastases was observed in eight patients. With the numbers available, we observed no difference in the proportion of patients experiencing surgical complications between those treated with free vascularized fibula grafts and those treated with pedicled grafts (eight of 22 [36%] versus nine of 25 [36%] respectively; p = 0.605). With the numbers available, we observed no difference in mean MSTS scores between patients treated with free vascularized fibula grafts and those treated with pedicled grafts (24 ± 9 versus 25 ± 8; mean difference, 0.48; 95% CI, 0.54-4.6; p = 0.858). Mean surgical time was longer in the free vascularized fibula and massive bone allograft group at 9.4 ± 1.7 hours compared with that of the pedicled vascularized fibula and massive bone allograft group at 5.7 ± 1.3 hours (mean difference, 3.73 hours; 95% CI, 2.8-4.6 hours; p ≤ 0.001). CONCLUSIONS Intercalary reconstruction of tibia sarcomas with massive bone allografts supplemented with vascularized fibula grafts provide predictable results. Complications occur as expected in a biologic reconstruction, but are salvageable, preserving the original construct. The pedicled fibula can be an alternative to a free contralateral fibula for intraepiphyseal resections. Comparative technical ease, shorter surgical time, avoidance of additional microvascular anastomosis, and avoidance of surgery on the contralateral leg are notable advantages of pedicled vascularized fibula over free fibula grafts to supplement allografts when indicated in intercalary tibia resections. LEVEL OF EVIDENCE Level III, therapeutic study.
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Affiliation(s)
- Marco Manfrini
- Department of Orthopedic Oncology, Unit III, Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136 Bologna, Italy
| | - Srimanth Bindiganavile
- Department of Musculoskeletal Oncology, Manipal Hospital, #98, HAL Airport Road, Bengaluru, 560017 India
| | - Ferhat Say
- Department of Orthopaedics and Traumatology, Faculty of Medicine, Ondokuz Mayıs University, 55139 Samsun, Turkey
| | - Marco Colangeli
- Department of Orthopedic Oncology, Unit III, Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136 Bologna, Italy
| | - Laura Campanacci
- Department of Orthopedic Oncology, Unit III, Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136 Bologna, Italy
| | - Massimiliano Depaolis
- Department of Orthopedic Oncology, Unit III, Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136 Bologna, Italy
| | - Massimo Ceruso
- Department of Hand Surgery, Azienda Ospedaliare-Universitaria Careggi, 50139 Florence, Italy
| | - Davide Donati
- Department of Orthopedic Oncology, Unit III, Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136 Bologna, Italy
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Bianchi G, Sambri A, Cammelli S, Galuppi A, Cortesi A, Righi A, Caldari E, Ferrari S, Donati D. Impact of residual disease after "unplanned excision" of primary localized adult soft tissue sarcoma of the extremities: evaluation of 452 cases at a single Institution. Musculoskelet Surg 2017; 101:243-248. [PMID: 28444540 DOI: 10.1007/s12306-017-0475-y] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Accepted: 04/17/2017] [Indexed: 11/26/2022]
Abstract
BACKGROUND Soft tissue sarcomas are often inappropriately excised; it is, however, still a matter of debate whether the presence of residual disease in the re-excision specimen can affect patients' prognosis. The aim of this study is to investigate the impact of re-excision after unplanned surgery of primary soft tissue sarcomas (STS) of the extremities. PATIENTS AND METHODS We retrospectively evaluated 452 adults with grade 2-3, localized STS (349 primary and 103 unplanned excisions). RESULTS In the re-excision group, a full 43% of the patients had residual tumor. The re-excision group achieved a significantly better outcome in terms of sarcoma-specific survival (SS) (p = 0.002), local recurrence (LR) (p = 0.004) and distant metastasis (DM) (p = 0.028). Residual tumor was associated with a higher risk of DM (p = 0.005). CONCLUSION We confirm that unplanned surgery does not compromise patients' prognosis; scar re-excision guarantees at least the same SS, LR and DM rates compared to STS primarily treated in a referral center. Routine use of radiation therapy after re-excision could improve local control. Distant metastases seem to be negatively affected by the presence of residual tumor, and therefore, the use of CT in deep and large STS is suggested. The main goal is to avoid unplanned surgery by referring suspected lumps (especially deep, large, increasing in size) to a specialist center.
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Affiliation(s)
- G Bianchi
- Orthopedic Oncology Department, Istituto Ortopedico Rizzoli, via Pupilli 1, Bologna, Italy
| | - A Sambri
- Orthopedic Oncology Department, Istituto Ortopedico Rizzoli, via Pupilli 1, Bologna, Italy.
| | - S Cammelli
- Radiation Oncology Center, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - A Galuppi
- Radiation Oncology Center, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - A Cortesi
- Radiation Oncology Center, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - A Righi
- Anatomic Pathology Department, Istituto Ortopedico Rizzoli, Bologna, Italy
| | - E Caldari
- Orthopedic Oncology Department, Istituto Ortopedico Rizzoli, via Pupilli 1, Bologna, Italy
| | - S Ferrari
- Chemotherapy Department, Istituto Ortopedico Rizzoli, Bologna, Italy
| | - D Donati
- Orthopedic Oncology Department, Istituto Ortopedico Rizzoli, via Pupilli 1, Bologna, Italy
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30
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Sambri A, Pignatti G, Romagnoli M, Donati D, Marcacci M, Cadossi M. Intraoperative diagnosis of Staphylococcus aureus and coagulase-negative Staphylococcus using Xpert MRSA/SA SSTI assay in prosthetic joint infection. New Microbiol 2017; 40:130-134. [PMID: 28255603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Accepted: 05/15/2017] [Indexed: 06/06/2023]
Abstract
The aim of this prospective study was to evaluate the performance of the Polymerase Chain Reaction (PCR) tool Xpert MRSA/SA SSTI test (Cepheid, Sunnyvale, CA, USA) on periprosthetic samples from a cohort of patients with suspected prosthetic joint infection (PJI). Seventy adult patients were included in this prospective study. On the basis of the preoperative evaluation, 39 patients were clinically considered to have a PJI, whereas 31 were presumed to suffer from an aseptic mobilization of the implant. Xpert MRSA/SA SSTI identified 4 out of 4 MRSA, 7 out of 7 MSSA, and 14 out of 16 methicillin resistant CoNS. Among the 31 patients not having a PJI, the rapid PCR did not find any bacteria among those identifiable, thus demonstrating an excellent performance in terms of specificity. Statistical analysis of the analytical performance showed a high correlation (p<0.001) between the result of Xpert MRSA/SA SSTI and culture. Xpert MRSA/SA SSTI assay is a novel, yet well known, rapid and accurate method for the identification of different species of staphylococci. The test can be used with peri-operative samples thus dramatically improving the diagnostic sensitivity. In addition, thanks to the very short turnaround time the use of Xpert assay can modify the clinical management of patients suffering from PJI during the ongoing operative procedure.
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Dozza B, Lesci IG, Duchi S, Della Bella E, Martini L, Salamanna F, Falconi M, Cinotti S, Fini M, Lucarelli E, Donati D. When size matters: differences in demineralized bone matrix particles affect collagen structure, mesenchymal stem cell behavior, and osteogenic potential. J Biomed Mater Res A 2017; 105:1019-1033. [PMID: 27943619 DOI: 10.1002/jbm.a.35975] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Revised: 11/21/2016] [Accepted: 12/02/2016] [Indexed: 12/12/2022]
Abstract
Demineralized bone matrix (DBM) is a natural, collagen-based, osteoinductive biomaterial. Nevertheless, there are conflicting reports on the efficacy of this product. The purpose of this study was to evaluate whether DBM collagen structure is affected by particle size and can influence DBM cytocompatibility and osteoinductivity. Sheep cortical bone was ground and particles were divided in three fractions with different sizes, defined as large (L, 1-2 mm), medium (M, 0.5-1 mm), and small (S, <0.5 mm). After demineralization, the chemical-physical analysis clearly showed a particle size-dependent alteration in collagen structure, with DBM-M being altered but not as much as DBM-S. DBM-M displayed a preferable trend in almost all biological characteristics tested, although all DBM particles revealed an optimal cytocompatibility. Subcutaneous implantation of DBM particles into immunocompromised mice resulted in bone induction only for DBM-M. When sheep MSC were seeded onto particles before implantation, all DBM particles were able to induce new bone formation with the best incidence for DBM-M and DBM-S. In conclusion, the collagen alteration in DBM-M is likely the best condition to promote bone induction in vivo. Furthermore, the choice of 0.5-1 mm particles may enable to obtain more efficient and consistent results among different research groups in bone tissue-engineering applications. © 2017 Wiley Periodicals, Inc. J Biomed Mater Res Part A: 105A: 1019-1033, 2017.
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Affiliation(s)
- B Dozza
- Osteoarticolar Regeneration Laboratory, 3rd Orthopaedic and Traumatologic Clinic Prevalently Oncologic, Rizzoli Orthopaedic Institute, via di Barbiano 1/10, Bologna, 40136, Italy.,Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum University of Bologna, via G. C. Pupilli 1, Bologna, 40136, Italy
| | - I G Lesci
- WAPH Technology Corp. 1920 N Commerce Parkway, Weston, Florida, 33326
| | - S Duchi
- Osteoarticolar Regeneration Laboratory, 3rd Orthopaedic and Traumatologic Clinic Prevalently Oncologic, Rizzoli Orthopaedic Institute, via di Barbiano 1/10, Bologna, 40136, Italy
| | - E Della Bella
- Laboratory of Preclinical and Surgical Studies, Rizzoli Orthopaedic Institute, via di Barbiano 1/10, Bologna, 40136, Italy.,Department of Experimental, Diagnostic and Specialty Medicine (DIMES), Alma Mater Studiorum University of Bologna, via G. Massarenti 9, Bologna, 40138, Italy
| | - L Martini
- Laboratory of Preclinical and Surgical Studies, Rizzoli Orthopaedic Institute, via di Barbiano 1/10, Bologna, 40136, Italy
| | - F Salamanna
- Laboratory of Preclinical and Surgical Studies, Rizzoli Orthopaedic Institute, via di Barbiano 1/10, Bologna, 40136, Italy
| | - M Falconi
- Department of Biomedical and Neuromotor Sciences (DIBINEM), Division of Human Anatomy, Alma Mater Studiorum University of Bologna, via Irnerio 48, Bologna, 40126, Italy
| | - S Cinotti
- Cell Culture Centre, Istituto Zooprofilattico Sperimentale della Lombardia e dell'Emilia Romagna (IZSLER), via Bianchi 9, Brescia, 25124, Italy
| | - M Fini
- Laboratory of Preclinical and Surgical Studies, Rizzoli Orthopaedic Institute, via di Barbiano 1/10, Bologna, 40136, Italy
| | - E Lucarelli
- Osteoarticolar Regeneration Laboratory, 3rd Orthopaedic and Traumatologic Clinic Prevalently Oncologic, Rizzoli Orthopaedic Institute, via di Barbiano 1/10, Bologna, 40136, Italy
| | - D Donati
- Osteoarticolar Regeneration Laboratory, 3rd Orthopaedic and Traumatologic Clinic Prevalently Oncologic, Rizzoli Orthopaedic Institute, via di Barbiano 1/10, Bologna, 40136, Italy.,Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum University of Bologna, via G. C. Pupilli 1, Bologna, 40136, Italy
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Donati D, Bianchi C, Pezzi G, Conte L, Hofer A, Chiarucci A. Biogeography and ecology of the genus Turbinicarpus (Cactaceae): environmental controls of taxa richness and morphology. SYST BIODIVERS 2016. [DOI: 10.1080/14772000.2016.1251504] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Davide Donati
- Department of Biological, Geological and Environmental Sciences, University of Bologna, Via Irnerio 42, 40126, Bologna, Italy
| | - Claudia Bianchi
- Department of Biological, Geological and Environmental Sciences, University of Bologna, Via Irnerio 42, 40126, Bologna, Italy
| | - Giovanna Pezzi
- Department of Biological, Geological and Environmental Sciences, University of Bologna, Via Irnerio 42, 40126, Bologna, Italy
| | - Lucia Conte
- Department of Biological, Geological and Environmental Sciences, University of Bologna, Via Irnerio 42, 40126, Bologna, Italy
| | - Anton Hofer
- Jansstrasse 11, CH-3252, Worben, Switzerland
| | - Alessandro Chiarucci
- Department of Biological, Geological and Environmental Sciences, University of Bologna, Via Irnerio 42, 40126, Bologna, Italy
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Palmerini E, Colangeli M, Nanni C, Fanti S, Marchesi E, Paioli A, Picci P, Cambioli S, Donati D, Cevolani L, De Paolis M, Gambarotti M, Ferrari S. The role of FDG PET/CT in patients treated with neoadjuvant chemotherapy for localized bone sarcomas. Eur J Nucl Med Mol Imaging 2016; 44:215-223. [PMID: 27645694 PMCID: PMC5215266 DOI: 10.1007/s00259-016-3509-z] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Accepted: 08/29/2016] [Indexed: 01/14/2023]
Abstract
Purpose The histological response to neoadjuvant chemotherapy is an important prognostic factor in patients with osteosarcoma (OS) and Ewing sarcoma (EWS). The aim of this study was to assess baseline primary tumour FDG uptake on PET/CT, and serum values of alkaline phosphatase (ALP) and lactate dehydrogenase (LDH), to establish whether these factors are correlated with tumour necrosis and prognosis. Methods Patients treated between 2009 and 2014 for localized EWS and OS, who underwent FDG PET/CT as part of their staging work-up, were included. The relationships between primary tumour SUVmax at baseline (SUV1), SUVmax after induction chemotherapy (SUV2), metabolic response calculated as [(SUV1 − SUV2)/SUV1)] × 100, LDH and ALP and tumour response/survival were analysed. A good response (GR) was defined as tumour necrosis >90 % in patients with OS, and grade II-III Picci necrosis (persitence of microscopic foci only or no viable tumor) in patients with Ewing sarcoma. Results The study included 77 patients, 45 with EWS and 32 with OS. A good histological response was achieved in 53 % of EWS patients, and 41 % of OS patients. The 3-year event-free survival (EFS) was 57 % in EWS patients and 48 % OS patients. The median SUV1 was 5.6 (range 0 – 17) in EWS patients and 7.9 (range 0 – 24) in OS patients (p = 0.006). In EWS patients the GR rate was 30 % in those with a high SUV1 (≥6) and 72 % in those with a lower SUV1 (p = 0.0004), and in OS patients the GR rate was 29 % in those with SUV1 ≥6 and 64 % in those with a lower SUV1 (p = 0.05). In the univariate analysis the 3-year EFS was significantly better in patients with a low ALP level (59 %) than in those with a high ALP level (22 %, p = 0.02) and in patients with a low LDH level (62 %) than in those with a high LDH level (37 %, p = 0.004). In EWS patients the 3-year EFS was 37 % in those with a high SUV1 and 75 % in those with a low SUV1 (p = 0.004), and in OS patients the 3-year EFS was 32 % in those with a high SUV1 and 66 % in those with a low SUV1 (p = 0.1). Histology, age and gender were not associated with survival. In the multivariate analysis, SUV1 was the only independent pretreatment prognostic factor to retain statistical significance (p = 0.017). SUV2 was assessed in 25 EWS patients: the median SUV2 was 1.9 (range 1 – 8). The GR rate was 20 % in patients with a high SUV2, and 67 % in those with a low SUV2 (p = 0.02). A good metabolic response (SUV reduction of ≥55 %) was associated with a 3-year EFS of 80 % and a poor metabolic response with a 3-year EFS of 20 % (p = 0.05). In the OS patients the median SUV2 was 2.7 (range 0 – 4.5). Neither SUV2 nor the metabolic response was associated with outcome in OS patients. Conclusion FDG PET/CT is a useful and noninvasive tool for identifying patients who are more likely to be resistant to chemotherapy. If this finding is confirmed in a larger series, SUV1, SUV2 and metabolic response could be proposed as factors for stratifying EWS patients to identify those with high-grade localized bone EWS who would benefit from risk-adapted induction chemotherapy.
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Affiliation(s)
- Emanuela Palmerini
- Chemotherapy, Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136, Bologna, Italy.
| | - Marco Colangeli
- Orthopaedic Surgery, Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136, Bologna, Italy
| | | | - Stefano Fanti
- Nuclear Medicine, Sant' Orsola Hospital, Bologna, Italy
| | - Emanuela Marchesi
- Chemotherapy, Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136, Bologna, Italy
| | - Anna Paioli
- Chemotherapy, Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136, Bologna, Italy
| | - Piero Picci
- Research Laboratory, Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136, Bologna, Italy
| | | | - Davide Donati
- Orthopaedic Surgery, Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136, Bologna, Italy
| | - Luca Cevolani
- Orthopaedic Surgery, Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136, Bologna, Italy
| | | | - Marco Gambarotti
- Surgical Pathology, Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136, Bologna, Italy.,Radiology, Musculoskeletal Oncology Department, Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136, Bologna, Italy
| | - Stefano Ferrari
- Chemotherapy, Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136, Bologna, Italy
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Bellotti C, Capanni C, Lattanzi G, Donati D, Lucarelli E, Duchi S. Detection of mesenchymal stem cells senescence by prelamin A accumulation at the nuclear level. Springerplus 2016; 5:1427. [PMID: 27625981 PMCID: PMC5001959 DOI: 10.1186/s40064-016-3091-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Accepted: 08/17/2016] [Indexed: 01/29/2023]
Abstract
BACKGROUND Human mesenchymal stem cells (MSC), during in vitro expansion, undergo a progressive loss of proliferative potential that leads to the senescent state, associated with a reduction of their "medicinal" properties. This may hampers their efficacy in the treatment of injured tissues. Quality controls on MSC-based cell therapy products should include an assessment of the senescent state. However, a reliable and specific marker is still missing. From studies on lamin-associated disorders, has emerged the correlation between defective lamin A maturation and cellular senescence. FINDINGS Primary cultured hMSC lines (n = 3), were analyzed by immunostaining at different life-span stages for the accumulation of prelamin A, along with other markers of cellular senescence. During culture, cells at the last stage of their life span displayed evident signs of senescence consistent with the positivity of SA-β-gal staining. We also observed a significant increase of prelamin A positive cells. Furthermore, we verified that the cells marked by prelamin A were also positive for p21(Waf1) while negative for Ki67. CONCLUSIONS Overall data support that the detection of prelamin A identifies senescent MSC, providing an easy and reliable tool to be use alone or in combination with known senescence markers to screen MSC before their use in clinical applications.
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Affiliation(s)
- Chiara Bellotti
- Osteoarticular Regeneration Laboratory, 3rd Orthopaedic and Traumatologic Clinic Prevalently Oncologic, Rizzoli Orthopaedic Institute, via di Barbiano 1/10, Bologna, 40036 Italy
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Cristina Capanni
- Institute of Molecular Genetics - Unit of Bologna, CNR-National Research Council of Italy, Bologna, Italy
- Laboratory of Musculoskeletal Cell Biology, Rizzoli Orthopaedic Institute, Bologna, Italy
| | - Giovanna Lattanzi
- Institute of Molecular Genetics - Unit of Bologna, CNR-National Research Council of Italy, Bologna, Italy
- Laboratory of Musculoskeletal Cell Biology, Rizzoli Orthopaedic Institute, Bologna, Italy
| | - Davide Donati
- Osteoarticular Regeneration Laboratory, 3rd Orthopaedic and Traumatologic Clinic Prevalently Oncologic, Rizzoli Orthopaedic Institute, via di Barbiano 1/10, Bologna, 40036 Italy
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Enrico Lucarelli
- Osteoarticular Regeneration Laboratory, 3rd Orthopaedic and Traumatologic Clinic Prevalently Oncologic, Rizzoli Orthopaedic Institute, via di Barbiano 1/10, Bologna, 40036 Italy
| | - Serena Duchi
- Osteoarticular Regeneration Laboratory, 3rd Orthopaedic and Traumatologic Clinic Prevalently Oncologic, Rizzoli Orthopaedic Institute, via di Barbiano 1/10, Bologna, 40036 Italy
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
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Bianchi G, Sambri A, Sebastiani E, Caldari E, Donati D. Is unicondylar osteoarticular allograft still a viable option for reconstructions around the knee? Knee 2016; 23:692-7. [PMID: 27156870 DOI: 10.1016/j.knee.2016.03.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Revised: 01/27/2016] [Accepted: 03/13/2016] [Indexed: 02/02/2023]
Abstract
BACKGROUND Unicondylar osteoarticular allografts (UOAs) represent a possible technique for reconstructing massive bone defects around the knee when only one condyle is affected. The aim of this retrospective study is to evaluate the outcome of UOAs and describe the possible salvage procedures in case of graft failure. METHODS Twenty-five deep-frozen UOAs were implanted at Rizzoli Orthopedic Institute (Bologna, Italy). Twenty-two followed bone tumor resection, two cases were post-traumatic defects and one case followed UOA failure. Mean age at surgery was 33years (range: 15 to 63). Eighteen UOAs were in distal femur, seven in proximal tibia. RESULTS Three patients died (only one because of the tumor). One UOA was removed for chondrosarcoma relapse and one for allograft fracture. Mean overall survival with UOA failure as a primary endpoint was 129months (range 12 to 302), with differences in the femur (85%) and in the tibia (40%) at 150months. Six UOAs had to be converted into knee prostheses due to osteoarthritis after a mean follow-up of 146months. No complications were recorded in UOAs converted into knee prostheses after a mean three year follow-up. Fourteen patients with UOAs still in place at the last follow-up (mean 123months) were radiologically and functionally evaluated: no correlation was found between function and the degree of osteoarthritis. CONCLUSIONS In selected cases, UOAs offer good clinical results and postpone the need for knee prosthesis. Despite short-term encouraging results, longer-term follow-up is needed in order to evaluate the outcome of knee prosthesis after UOA.
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Affiliation(s)
- Giuseppe Bianchi
- Rizzoli Orthopaedic Institute, Via Pupilli 1, 40136 Bologna, Italy
| | - Andrea Sambri
- Rizzoli Orthopaedic Institute, Via Pupilli 1, 40136 Bologna, Italy.
| | - Elisa Sebastiani
- Rizzoli Orthopaedic Institute, Via Pupilli 1, 40136 Bologna, Italy
| | - Emilia Caldari
- Rizzoli Orthopaedic Institute, Via Pupilli 1, 40136 Bologna, Italy
| | - Davide Donati
- Rizzoli Orthopaedic Institute, Via Pupilli 1, 40136 Bologna, Italy
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Errani C, Cocchi S, Ali N, Chehrassan M, Righi A, Gambarotti M, Mavrogenis AF, Vanel D, Donati D. Recurrence After Marginal Excision for Atypical Lipomatous Tumors Versus Lipomas of the Extremities. Orthopedics 2016; 39:e610-4. [PMID: 27322173 DOI: 10.3928/01477447-20160610-02] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Accepted: 11/25/2015] [Indexed: 02/03/2023]
Abstract
This study reviewed the medical records of 90 patients with lipomas (47 patients) and atypical lipomatous tumors (ALT)/well-differentiated liposarcomas (WDL) (43 patients) of the extremities treated from 2006 to 2012. All patients had preoperative biopsy and postoperative histologic analysis of the tumors; surgical margins were marginal in all cases. Histologic sections of the tissue blocks from the excised specimens were re-reviewed for all patients; a consensus with postoperative histologic analysis was confirmed. Molecular chromosome analysis was performed on fluorescence in situ hybridization in tissue sections from the tissue blocks in all cases for the purpose of this study; a ratio greater than 2 was considered to represent murine double-minute 2 (MDM2) amplification consistent with a diagnosis of ALT/WDL. Mean follow-up was 52 months (range, 14-96 months). Local recurrence and metastasis rates and the relationship of patient age and sex with tumor size and location were evaluated. None of the patients with lipomas experienced local recurrence compared with 6 patients (13.9%) with ALT/WDL who experienced local recurrence within a mean of 48 months (range, 33-96 months); this difference was statistically significant. None of the patients in either group experienced metastasis prior to the study period. Local recurrence did not correlate statistically with patient age or sex, or with tumor size or location. [Orthopedics. 2016; 39(4):e610-e614.].
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Bozzetti F, Cozzaglio L, Biganzoli E, Chiavenna G, De Cicco M, Donati D, Gilli G, Percolla S, Pironi L. Quality of Life and Length of Survival in Advanced Cancer Patients on Home Parenteral Nutrition. Nutr Clin Pract 2016. [DOI: 10.1177/0115426503018002176a] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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38
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Gambarotti M, Benini S, Gamberi G, Cocchi S, Palmerini E, Sbaraglia M, Donati D, Picci P, Vanel D, Ferrari S, Righi A, Dei Tos AP. CIC-DUX4 fusion-positive round-cell sarcomas of soft tissue and bone: a single-institution morphological and molecular analysis of seven cases. Histopathology 2016; 69:624-34. [PMID: 27079694 DOI: 10.1111/his.12985] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Accepted: 04/10/2016] [Indexed: 01/17/2023]
Abstract
AIMS Round-cell sarcomas lacking specific translocations represent a diagnostic challenge. The aim of this study was to describe seven cases of CIC-DUX4 fusion-positive sarcomas, including the first reported example arising primarily in bone. METHODS AND RESULTS Patients ranged in age from 15 years to 44 years (median: 33 years). Six cases arose from the soft tissues, and one from the iliac bone. Morphologically, all cases showed an undifferentiated round-cell population with greater atypia and pleomorphism than Ewing sarcoma. Immunohistochemically, all tumours showed focal and weak positivity for CD99, and five of seven showed nuclear and/or cytoplasmic positivity for Wilms tumour 1. Five patients had lung metastases at presentation. All patients received chemotherapy according to Ewing sarcoma protocols. All but one patient (the one with a bone tumour) died of disease after a mean of 14.5 months from the diagnosis (range: 8-20 months). CONCLUSIONS Our series confirms that CIC-DUX4 fusion-positive sarcomas are aggressive tumours with an adverse prognosis, and with clinical, histological and genetic differences from Ewing sarcoma. The best therapeutic approach needs to be investigated.
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Affiliation(s)
| | | | - Gabriella Gamberi
- Department of Pathology, Rizzoli Institute, Bologna, Italy.,Department of Biomedical and Neuromotor Science, University of Bologna, Bologna, Italy
| | | | | | - Marta Sbaraglia
- Department of Pathology, Treviso Regional Hospital, Treviso, Italy
| | - Davide Donati
- Department of Orthopaedic Oncology, Rizzoli Institute, Bologna, Italy
| | - Piero Picci
- Department of Pathology, Rizzoli Institute, Bologna, Italy
| | - Daniel Vanel
- Department of Pathology, Rizzoli Institute, Bologna, Italy
| | | | - Alberto Righi
- Department of Pathology, Rizzoli Institute, Bologna, Italy.
| | - Angelo P Dei Tos
- Department of Pathology, Rizzoli Institute, Bologna, Italy.,Department of Pathology, Treviso Regional Hospital, Treviso, Italy
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39
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Casadei R, De Paolis M, Drago G, Romagnoli C, Donati D. Total elbow arthroplasty for primary and metastatic tumor. Orthop Traumatol Surg Res 2016; 102:459-65. [PMID: 27084091 DOI: 10.1016/j.otsr.2015.12.026] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Revised: 10/05/2015] [Accepted: 12/23/2015] [Indexed: 02/02/2023]
Abstract
BACKGROUND Prostheses can be used in elbow reconstruction in both primary and metastatic lesions. Several authors have reported their experience with different types of implant, but not with modular prostheses. HYPOTHESIS Limb salvage using an elbow prosthesis is effective in obtaining good functional results and reliable local tumor control. MATERIAL AND METHODS Forty-seven patients treated at the Rizzoli Institute for elbow neoplasm from 1990 to 2012 were evaluated. There were 30 primary tumors (64%), 24 bone tumors and 6 soft tissue sarcomas, and 17 bone metastases. Elbow reconstruction used a modular prosthesis in 25 patients and a standard prosthesis in 22. Reconstruction was primary in 30 patients and secondary in 17. RESULTS At last control, 15 (32%) were dead of disease (DOD) at a mean follow-up of 35 months, 12 (25%) were alive with disease (AWD) at a mean follow-up of 29 months, 19 (40%) showed no evidence of disease (NED) at a mean follow-up of 80 months. Early complications were related to unexpected neurological damage, observed in 12 patients (25%): in 5 cases the deficit resolved in a mean 6 months; in the others, no or only partial recovery was observed. Two implants (4%) developed infection: 1 was treated with antibiotic therapy, and the other required implant revision. One implant showing cement extrusion was revised. In 3 patients (6%) radiography showed a radiolucent halo around the stem (2 humeral, 1 ulnar); no measures were taken, as the patients were completely asymptomatic at every follow-up. In 3 patients (6%) partial resorption of the allograft was observed on X-ray, but remained unchanged at last follow-up, without pain or functional impairment. Seven local recurrences (15%) were observed, at a mean of 16 months after surgery; 5 were treated by resection and/or radiotherapy, and 2 by amputation. Mean functional scores on MEPS and MSTS were respectively 84% and 22/30 (73%). CONCLUSIONS Elbow prostheses provided better function in primary than in metastatic tumor. Elbow prosthesis reconstruction after tumor resection is a viable option both for primary and secondary bone neoplasms. TYPE OF STUDY Therapeutic. LEVEL OF EVIDENCE IV, retrospective study.
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Affiliation(s)
- R Casadei
- Department of Musculoskeletal Oncology, Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136 Bologna, Italy.
| | - M De Paolis
- Department of Musculoskeletal Oncology, Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136 Bologna, Italy.
| | - G Drago
- Department of Musculoskeletal Oncology, Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136 Bologna, Italy.
| | - C Romagnoli
- Department of Musculoskeletal Oncology, Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136 Bologna, Italy.
| | - D Donati
- Department of Musculoskeletal Oncology, Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136 Bologna, Italy.
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Vergori A, Masi G, Donati D, Ginanneschi F, Annunziata P, Cerase A, Mencarelli M, Rossetti B, De Luca A, Zanelli G. Listeria meningoencephalitis and anti-GQ1b antibody syndrome. Infection 2016; 44:543-6. [PMID: 26825308 DOI: 10.1007/s15010-015-0862-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Accepted: 11/23/2015] [Indexed: 01/20/2023]
Abstract
We report the first case of Listeria monocytogenes meningoencephalitis associated with anti-GQ1b antibody syndrome in an immunocompetent adult. A prompt diagnosis, made thanks to the multidisciplinary contribution, allowed a combined therapeutic approach leading to final favourable outcome, despite several intercurrent complications.
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Affiliation(s)
- A Vergori
- University Division of Infectious Diseases, Department of Medical Biotechnologies, University of Siena, 53100, Siena, Italy
| | - G Masi
- Department of Medicine, Surgery and Neurosciences, Clinical Neuroimmunology Unit, University of Siena, Siena, Italy
| | - D Donati
- Department of Medicine, Surgery and Neurosciences, Clinical Neuroimmunology Unit, University of Siena, Siena, Italy
| | - F Ginanneschi
- Department of Medicine, Surgery and Neurosciences, Clinical Neuroimmunology Unit, University of Siena, Siena, Italy
| | - P Annunziata
- Department of Medicine, Surgery and Neurosciences, Clinical Neuroimmunology Unit, University of Siena, Siena, Italy
| | - A Cerase
- Unit of Neuroimaging and Neurointervention, University Hospital of Siena, Siena, Italy
| | - M Mencarelli
- University Division of Infectious Diseases, Department of Medical Biotechnologies, University of Siena, 53100, Siena, Italy
| | - B Rossetti
- University Division of Infectious Diseases, Department of Medical Biotechnologies, University of Siena, 53100, Siena, Italy
| | - A De Luca
- University Division of Infectious Diseases, Department of Medical Biotechnologies, University of Siena, 53100, Siena, Italy
| | - G Zanelli
- University Division of Infectious Diseases, Department of Medical Biotechnologies, University of Siena, 53100, Siena, Italy.
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Manfrini M, Donati D, Colangeli M, Campanacci L. Resurfaced Allograft-Prosthetic Composite for Proximal Tibial Reconstruction in Children. JBJS Essent Surg Tech 2016; 6:e4. [PMID: 30237914 DOI: 10.2106/jbjs.st.15.00010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Introduction Reconstruction of the proximal part of the tibia in children with use of an unconstrained tibial component cemented in an allograft-prosthetic composite after proximal tibial resection spares the distal femoral physis and articular cartilage, maintains the bone stock of the tibia, and allows the allograft to be adapted to the small tibial dimension in very young patients. Step 1 Make the Incision Make a longitudinal incision medially or laterally, depending on the side of the biopsy (usually medial), encompassing and encircling the biopsy site. Step 2 Perform the Arthrotomy A parapatellar arthrotomy is performed, and the cruciate ligaments are cut close to the femoral attachment. Step 3 Isolate the Vascular Bundle Retract the medial gastrocnemius muscle and then isolate and protect the popliteal and posterior tibial vessels. Step 4 Perform an Osteotomy of the Tibia Perform an osteotomy of the tibiofibular joint and the tibial shaft at the appropriate level as determined on the basis of the preoperative imaging, and then complete the resection. Step 5 Prepare the Allograft on a Separate Table Cut and prepare the allograft according to the specimen dimensions. Step 6 Prepare the Composite Device Cement the tibial component of an unconstrained total knee prosthesis in the allograft and place the trial device. Step 7 Fix the Composite Device and Suture the Capsule and Ligaments Place the trial composite device and then fix the composite device to the host tibia and suture the capsule and ligaments. Step 8 Postoperative Care Immobilize the knee with an above-the-knee plaster cast, which is worn for six weeks, and then have the patient perform progressive functional rehabilitation. Results The rate of postoperative infection after proximal tibial reconstruction with a resurfaced allograft composite in children has been found to be no higher than that with other reconstructive techniques for the proximal part of the tibia; our series had a 5% rate of deep infection.IndicationsContraindicationsPitfalls & Challenges.
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Affiliation(s)
- Marco Manfrini
- Department of Muscolo-Skeletal Oncology, Rizzoli Orthopedic Institute, Bologna, Italy
| | - Davide Donati
- Department of Muscolo-Skeletal Oncology, Rizzoli Orthopedic Institute, Bologna, Italy
| | - Marco Colangeli
- Department of Muscolo-Skeletal Oncology, Rizzoli Orthopedic Institute, Bologna, Italy
| | - Laura Campanacci
- Department of Muscolo-Skeletal Oncology, Rizzoli Orthopedic Institute, Bologna, Italy
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Nisi C, Moretti A, Donati D, Carandina I, Da Ros L, Bannò E, Frassoldati A. A post-reaction regimen for CRC patients manifesting hypersensitivity to oxaliplatin : an effective alternative not to rule out an important option of treatment. Ann Oncol 2015. [DOI: 10.1093/annonc/mdv340.18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Cesari M, Comandone A, Boglione A, Ferraresi V, Bertulli R, Bielack S, Sundby Hall K, Rocca M, Donati D, Palmerini E, Paioli A, Longhi A, Gambarotti M, Righi A, Picci P, Ferrari S. High-grade bone sarcomas with synchronous metastases in patients older than 40. Results of the European Bone over 40: Sarcoma Study (EURO.B.O.S.S.). Ann Oncol 2015. [DOI: 10.1093/annonc/mdv338.02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Errani C, Facchini G, Rossi G, Vanel D, Righi A, Albisinni U, Donati D. Metachronous osteoblastoma of the spine and osteoid osteoma of the femur. BJR Case Rep 2015; 1:20150256. [PMID: 30363627 PMCID: PMC6180815 DOI: 10.1259/bjrcr.20150256] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Revised: 07/29/2015] [Accepted: 07/30/2015] [Indexed: 12/01/2022] Open
Abstract
Osteoblastoma (OBL) and osteoid osteoma (OO) are usually solitary tumours, only rarely being multicentric. Herein, we report an unusual case in which a typical OBL of the spine was followed by an OO of the femur after a disease-free interval of 5 years. We believe that our unique case represents the first report of a metachronous OBL and an OO, and this presentation may confirm the close correlation between these two rare entities.
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Affiliation(s)
| | | | - Giuseppe Rossi
- Angiographic and Interventional Radiology Service, Rizzoli Institute, Bologna, Italy
| | - Daniel Vanel
- Pathology Service, Rizzoli Institute, Bologna, Italy
| | - Alberto Righi
- Pathology Service, Rizzoli Institute, Bologna, Italy
| | - Ugo Albisinni
- Radiology Service, Rizzoli Institute, Bologna, Italy
| | - Davide Donati
- Orthopaedic Service, Rizzoli Institute, Bologna, Italy
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Righi A, Gambarotti M, Sbaraglia M, Frisoni T, Donati D, Vanel D, Dei Tos AP. Metastasizing tenosynovial giant cell tumour, diffuse type/pigmented villonodular synovitis. Clin Sarcoma Res 2015; 5:15. [PMID: 26052431 PMCID: PMC4458002 DOI: 10.1186/s13569-015-0030-2] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Accepted: 05/21/2015] [Indexed: 01/26/2023] Open
Abstract
Tenosynovial giant cell tumour, diffuse type, also known under a variety of other terms including diffuse pigmented villonodular synovitis, tends to be locally aggressive and not infrequently can show multiple recurrences. The differential diagnosis with the extremely rare and somewhat controversial malignant variant of tenosynovial giant cell tumour, diffuse type, is challenging due to overlapping radiologic features of these two entities. Malignant tenosynovial giant cell tumour is defined by the presence of overtly malignant sarcomatous areas. We describe a very unusual case of a 63-year-old man affected by tenosynovial giant cell tumour, diffuse type of the knee that, despite absence of morphologic evidence of sarcomatous transformation, developed inguinal lymph node metastases following multiple surgical procedures.
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Affiliation(s)
- A Righi
- Department of Pathology, Istituto Ortopedico Rizzoli, Via del Barbiano 1/10, 40136 Bologna, Italy
| | - M Gambarotti
- Department of Pathology, Istituto Ortopedico Rizzoli, Via del Barbiano 1/10, 40136 Bologna, Italy
| | - M Sbaraglia
- Department of Pathology, Treviso Regional Hospital, Treviso, Italy
| | - T Frisoni
- Oncologic Department, Rizzoli Orthopaedic Institute, Bologna, Italy
| | - D Donati
- Oncologic Department, Rizzoli Orthopaedic Institute, Bologna, Italy
| | - D Vanel
- Department of Pathology, Istituto Ortopedico Rizzoli, Via del Barbiano 1/10, 40136 Bologna, Italy
| | - A P Dei Tos
- Department of Pathology, Istituto Ortopedico Rizzoli, Via del Barbiano 1/10, 40136 Bologna, Italy ; Department of Pathology, Treviso Regional Hospital, Treviso, Italy
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Ferrari S, Meazza C, Palmerini E, Tamburini A, Fagioli F, Cozza R, Ferraresi V, Bisogno G, Mascarin M, Cefalo G, Manfrini M, Capanna R, Biagini R, Donati D, Picci P. Nonmetastatic osteosarcoma of the extremity. Neoadjuvant chemotherapy with methotrexate, cisplatin, doxorubicin and ifosfamide. An Italian Sarcoma Group study (ISG/OS-Oss). Tumori 2015; 100:612-9. [PMID: 25688494 DOI: 10.1700/1778.19262] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Based on the results of the ISG/OS-1 study, the MAP regimen (methotrexate [MTX], doxorubicin [ADM] and cisplatin [CDP] with the addition of ifosfamide [IFO] in poor-responder patients) was investigated in patients with nonmetastatic osteosarcoma of the extremity (ISG/OS-Oss study). PATIENTS AND METHODS Compared with the ISG/OS-1 study (cumulative doses: ADM 420 mg/m(2), MTX 120 g/m(2), CDP 600 mg/m(2), IFO 30 g/m(2)), the ISG/OS-Oss study reduced the number of MTX cycles from 10 to 5 (cumulative MTX dose: 60 g/m(2)) in order to diminish treatment duration and toxicity. RESULTS From January 2007 to June 2011, 171 patients (median age 16 years, 60% males) were registered. The limb salvage rate was 94% and the good pathologic response rate 51% (these figures were 92% and 48%, respectively, in the ISG/OS-1 study). At a median follow-up of 39 months (range, 4-80), the 5-year overall survival rate was 80% (95% CI, 73%-87%) and the event-free survival was 50% (95% CI, 39%-59%). For comparison, the 5-year overall and event-free survival rates in ISG/OS-1 were 73% (95% CI, 65%-81%) and 64% (95% CI, 56%-73%), respectively. CONCLUSIONS This study confirms that in nonmetastatic osteosarcoma of the extremity, conservative surgery in more than 90% and a good pathologic response rate of 50% can be expected with primary chemotherapy based on the MAP regimen. The response and resection rates in the ISG/OS-Oss study are in the same range as those of the previous study, whereas the event-free survival is lower than that previously achieved. Since the only difference between the two studies was the cumulative dose of postoperatively given MTX, our data support the importance of the cumulative dose of MTX in the MAP regimen.
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Pierini M, Lucarelli E, Duchi S, Prosperi S, Preve E, Piccinini M, Bucciotti F, Donati D. Characterization and cytocompatibility of a new injectable multiphasic bone substitute based on a combination of polysaccharide gel-coated OSPROLIFE(®) HA/TTCP granules and bone marrow concentrate. J Biomed Mater Res B Appl Biomater 2015; 104:894-902. [PMID: 25952003 DOI: 10.1002/jbm.b.33441] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Revised: 03/20/2015] [Accepted: 04/14/2015] [Indexed: 12/28/2022]
Abstract
The purpose of this study was to examine the in vitro cytocompatibility of a novel injectable multiphasic bone substitute (MBS) based on polysaccharide gel-coated OSPROLIFE(®) hydroxyapatite (HA)/tetracalcium phosphate (TTCP) granules combined with bone marrow concentrate (BMC). Polysaccharide gel-coated granules loaded in syringe were combined with BMC diluted in ionic crosslinking solution. The product was then maintained in culture to investigate the cytocompatibility, distribution, and osteogenic differentiation function of cells contained in the BMC. The in vitro cytocompatibility was assessed after 0, 24, and 96 h from the injectable MBS preparation using the LIVE/DEAD(®) staining kit. The results highlighted that cells remained viable after combination with the polysaccharide gel-coated granules; also, viability was maintained over time. The distribution of the cells in the product, observed using confocal microscopy, showed viable cells immersed in the polysaccharide gel formed between the granules after ionic crosslinking. The mesenchymal stromal cells (MSC) contained in the injectable MBS, the basic elements for bone tissue regeneration, were able to differentiate toward osteoblasts, producing an osteogenic matrix as evidenced by alizarin red-s (AR-S) staining. In conclusion, we found that the injectable MBS may have the potential to be used as a bone substitute by applying a "one-step" procedure in bone tissue engineering applications. © 2015 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 104B: 894-902, 2016.
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Affiliation(s)
- Michela Pierini
- Osteoarticular Regeneration Laboratory, 3rd Orthopaedic and Traumatologic Division, Rizzoli Orthopaedic Institute, Bologna, 40136, Italy.,Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum University of Bologna, Bologna, 40123, Italy
| | - Enrico Lucarelli
- Osteoarticular Regeneration Laboratory, 3rd Orthopaedic and Traumatologic Division, Rizzoli Orthopaedic Institute, Bologna, 40136, Italy
| | - Serena Duchi
- Osteoarticular Regeneration Laboratory, 3rd Orthopaedic and Traumatologic Division, Rizzoli Orthopaedic Institute, Bologna, 40136, Italy.,Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum University of Bologna, Bologna, 40123, Italy
| | - Susanna Prosperi
- Eurocoating Spa, Research and Development Department, Pergine Valsugana, 38057, Trento, Italy
| | - Eleonora Preve
- Eurocoating Spa, Research and Development Department, Pergine Valsugana, 38057, Trento, Italy
| | - Marzio Piccinini
- Eurocoating Spa, Research and Development Department, Pergine Valsugana, 38057, Trento, Italy
| | - Francesco Bucciotti
- Eurocoating Spa, Research and Development Department, Pergine Valsugana, 38057, Trento, Italy
| | - Davide Donati
- Osteoarticular Regeneration Laboratory, 3rd Orthopaedic and Traumatologic Division, Rizzoli Orthopaedic Institute, Bologna, 40136, Italy.,Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum University of Bologna, Bologna, 40123, Italy
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Palmerini E, Benassi MS, Quattrini I, Pazzaglia L, Donati D, Benini S, Gamberi G, Gambarotti M, Picci P, Ferrari S. Prognostic and predictive role of CXCR4, IGF-1R and Ezrin expression in localized synovial sarcoma: is chemotaxis important to tumor response? Orphanet J Rare Dis 2015; 10:6. [PMID: 25613038 PMCID: PMC4320838 DOI: 10.1186/s13023-014-0222-5] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2014] [Accepted: 12/30/2014] [Indexed: 01/01/2023] Open
Abstract
Background Synovial sarcoma (SS) is a rare tumor, with dismal survival when metastatic. The role of adjuvant chemotherapy is debated. New prognostic and predictive factors are needed. Methods We reviewed patients with localized SS; SS18-SSX fusion transcript presence was confirmed by FISH and RT-PCR. Expression of CXCR4, IGF-1R and Ezrin were evaluated by immunohistochemistry. Results Tumor samples from 88 SS patients (45 female; 43 male) with median age 37 years (range 11–63) were selected. The size of the lesion was > 5 cm in 68% of patients and 34% of cases presented biphasic histotype. All patients underwent surgery, 56% adjuvant radiotherapy (RT), 65% adjuvant chemotherapy. A positive stain for IGF-1R was detected in 55 patients, with nucleus expression in 21 patients. CXCR4 was expressed in 74 patients, nuclear pattern in 31 patients. 80 SS were positive to Ezrin, 48 had cytoplasmatic location, 32 membrane location. With a median follow-up of 6 years (1–30 years), the 5-year overall survival (OS) was 70% (95% CI 60–81). 5-year OS was 63% (95% CI 41-85%) for patients with positive IGF-1R/nuclear expression, and 73% (95% CI 61-85%; P = 0.05) in negative patients. 5-year OS was 47% (95% CI 27-66%) in patients with positive CXCR4/nuclear staining, and 86% (95% CI 76-96%, P = 0.0003) in negative cases. No survival difference was found according to Ezrin expression. By multivariate analysis, nuclear expression of CXCR4 and IGF-1R was confirmed independent adverse prognostic factor for SS patient survival linked to the use of chemotherapy. Conclusions Our findings have important potential implications demonstrating that together with clinical prognostic factors such as radiotherapy and age, CXCR4 and IGF-1R negatively influences survival in patients with localized SS. We believe that further studies addressed to the effects of CXCR4 and IGF-1R inhibitors on cell viability and function are needed to plan new and more appropriate SS treatments.
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Traina F, Errani C, Toscano A, Pungetti C, Fabbri D, Mazzotti A, Donati D, Faldini C. Current concepts in the biopsy of musculoskeletal tumors: AAOS exhibit selection. J Bone Joint Surg Am 2015; 97:e7. [PMID: 25609446 DOI: 10.2106/jbjs.n.00661] [Citation(s) in RCA: 93] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND A musculoskeletal tumor biopsy can involve fine needle aspiration, core needle biopsy, or incisional biopsy. Controversy regarding the diagnostic yield of these biopsy techniques continues. The purpose of this article is to summarize the current concepts in the biopsy of musculoskeletal tumors. METHODS We performed a literature review of clinical articles reporting on the biopsy of bone and soft-tissue primary tumors. Clinical articles were excluded on the basis on abstract content if they represented case reports, review or opinion articles, or technique descriptions. Eighteen of the thirty-nine articles that remained were excluded because the results did not indicate the diagnostic accuracy of the various biopsy techniques. Thus, twenty-one articles with diagnostic data on the biopsy of bone and soft-tissue tumors were included in this review. RESULTS Core needle biopsy appeared to be more accurate than fine needle aspiration, and incisional biopsy appeared to be more accurate than both of these techniques, but the differences did not reach significance. Incisional biopsy was more expensive than the percutaneous biopsy methods. In deep musculoskeletal tumors, incorporation of ultrasonography or computed tomography for guidance is easy and safe and can be useful for increasing the accuracy of the biopsy. Advantages of a percutaneous technique compared with an incisional one are the low risk of contamination and the minimally invasive nature. Certain anatomic locations and histologic types were associated with diagnostic difficulty. Vertebral tumors had the lowest diagnostic accuracy regardless of the biopsy technique. Myxoid, infection, and round cell histologies were associated with the lowest diagnostic accuracy. CONCLUSIONS The current literature has not clarified the optimal biopsy technique for the diagnosis of bone and soft-tissue tumors. However, core needle biopsy is usually preferable to incisional biopsy because of the low risk of contamination and the low cost. In addition, the use of imaging guidance increases the diagnostic accuracy of musculoskeletal biopsies and reduces the risk of complications. If the result of a percutaneous biopsy is nondiagnostic, a small incisional biopsy should be performed. LEVEL OF EVIDENCE Diagnostic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Francesco Traina
- Orthopaedic Service, Istituti Ortopedici Rizzoli, Via Pupilli 1, Bologna 40136, Italy. E-mail address for F. Traina: . E-mail address for C. Errani: . E-mail address for A. Toscano: . E-mail address for C. Pungetti: . E-mail address for D. Fabbri: . E-mail address for A. Mazzotti: . E-mail address for D. Donati: . E-mail address for C. Faldini:
| | - Costantino Errani
- Orthopaedic Service, Istituti Ortopedici Rizzoli, Via Pupilli 1, Bologna 40136, Italy. E-mail address for F. Traina: . E-mail address for C. Errani: . E-mail address for A. Toscano: . E-mail address for C. Pungetti: . E-mail address for D. Fabbri: . E-mail address for A. Mazzotti: . E-mail address for D. Donati: . E-mail address for C. Faldini:
| | - Angelo Toscano
- Orthopaedic Service, Istituti Ortopedici Rizzoli, Via Pupilli 1, Bologna 40136, Italy. E-mail address for F. Traina: . E-mail address for C. Errani: . E-mail address for A. Toscano: . E-mail address for C. Pungetti: . E-mail address for D. Fabbri: . E-mail address for A. Mazzotti: . E-mail address for D. Donati: . E-mail address for C. Faldini:
| | - Camilla Pungetti
- Orthopaedic Service, Istituti Ortopedici Rizzoli, Via Pupilli 1, Bologna 40136, Italy. E-mail address for F. Traina: . E-mail address for C. Errani: . E-mail address for A. Toscano: . E-mail address for C. Pungetti: . E-mail address for D. Fabbri: . E-mail address for A. Mazzotti: . E-mail address for D. Donati: . E-mail address for C. Faldini:
| | - Daniele Fabbri
- Orthopaedic Service, Istituti Ortopedici Rizzoli, Via Pupilli 1, Bologna 40136, Italy. E-mail address for F. Traina: . E-mail address for C. Errani: . E-mail address for A. Toscano: . E-mail address for C. Pungetti: . E-mail address for D. Fabbri: . E-mail address for A. Mazzotti: . E-mail address for D. Donati: . E-mail address for C. Faldini:
| | - Antonio Mazzotti
- Orthopaedic Service, Istituti Ortopedici Rizzoli, Via Pupilli 1, Bologna 40136, Italy. E-mail address for F. Traina: . E-mail address for C. Errani: . E-mail address for A. Toscano: . E-mail address for C. Pungetti: . E-mail address for D. Fabbri: . E-mail address for A. Mazzotti: . E-mail address for D. Donati: . E-mail address for C. Faldini:
| | - Davide Donati
- Orthopaedic Service, Istituti Ortopedici Rizzoli, Via Pupilli 1, Bologna 40136, Italy. E-mail address for F. Traina: . E-mail address for C. Errani: . E-mail address for A. Toscano: . E-mail address for C. Pungetti: . E-mail address for D. Fabbri: . E-mail address for A. Mazzotti: . E-mail address for D. Donati: . E-mail address for C. Faldini:
| | - Cesare Faldini
- Orthopaedic Service, Istituti Ortopedici Rizzoli, Via Pupilli 1, Bologna 40136, Italy. E-mail address for F. Traina: . E-mail address for C. Errani: . E-mail address for A. Toscano: . E-mail address for C. Pungetti: . E-mail address for D. Fabbri: . E-mail address for A. Mazzotti: . E-mail address for D. Donati: . E-mail address for C. Faldini:
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Traina F, Errani C, Toscano A, Pungetti C, Fabbri D, Mazzotti A, Donati D, Faldini C. Current concepts in the biopsy of musculoskeletal tumors. J Bone Joint Surg Am 2015; 97:e7. [PMID: 25723000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND A musculoskeletal tumor biopsy can involve fine needle aspiration, core needle biopsy, or incisional biopsy. Controversy regarding the diagnostic yield of these biopsy techniques continues. The purpose of this article is to summarize the current concepts in the biopsy of musculoskeletal tumors. METHODS We performed a literature review of clinical articles reporting on the biopsy of bone and soft-tissue primary tumors. Clinical articles were excluded on the basis on abstract content if they represented case reports, review or opinion articles, or technique descriptions. Eighteen of the thirty-nine articles that remained were excluded because the results did not indicate the diagnostic accuracy of the various biopsy techniques. Thus, twenty-one articles with diagnostic data on the biopsy of bone and soft-tissue tumors were included in this review. RESULTS Core needle biopsy appeared to be more accurate than fine needle aspiration, and incisional biopsy appeared to be more accurate than both of these techniques, but the differences did not reach significance. Incisional biopsy was more expensive than the percutaneous biopsy methods. In deep musculoskeletal tumors, incorporation of ultrasonography or computed tomography for guidance is easy and safe and can be useful for increasing the accuracy of the biopsy. Advantages of a percutaneous technique compared with an incisional one are the low risk of contamination and the minimally invasive nature. Certain anatomic locations and histologic types were associated with diagnostic difficulty. Vertebral tumors had the lowest diagnostic accuracy regardless of the biopsy technique. Myxoid, infection, and round cell histologies were associated with the lowest diagnostic accuracy. CONCLUSIONS The current literature has not clarified the optimal biopsy technique for the diagnosis of bone and soft-tissue tumors. However, core needle biopsy is usually preferable to incisional biopsy because of the low risk of contamination and the low cost. In addition, the use of imaging guidance increases the diagnostic accuracy of musculoskeletal biopsies and reduces the risk of complications. If the result of a percutaneous biopsy is nondiagnostic, a small incisional biopsy should be performed.
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