G. U. Exner

The influence of tumor- and treatment-related factors on the development of local recurrence in osteosarcoma after adequate surgery : an analysis of 1355 patients treated on neoadjuvant Cooperative Osteosarcoma Study Group protocols

BACKGROUND Local recurrence (LR) in osteosarcoma is associated with very poor prognosis. We sought to evaluate which factors correlate with LR in patients who achieved complete surgical remission with adequate margins. PATIENTS AND METHODS We analyzed 1355 patients with previously untreated high-grade central osteosarcoma of the extremities, the shoulder and the pelvis registered in neoadjuvant Cooperative Osteosarcoma Study Group trials between 1986 and 2005. Seventy-six patients developed LR. RESULTS Median follow-up was 5.56 years. No participation in a study, pelvic tumor site, limb-sparing surgery, soft tissue infiltration beyond the periosteum, poor response to neoadjuvant chemotherapy, failure to complete the planned chemotherapy protocol and biopsy at a center other than the one performing the tumor resection were significantly associated with a higher LR rate. No differences were found for varying surgical margin widths. Surgical treatment at centers with small patient volume and additional surgery in the primary tumor area, other than biopsy and tumor resection, were significantly associated with a higher rate of ablative surgery. CONCLUSIONS Patient enrollment in clinical trials and performing the biopsy at experienced institutions capable of undertaking the tumor resection without compromising the oncological and functional outcome should be pursued in the future.

False-negative magnetic resonance imaging in early stage of Legg-Calvé-Perthes disease.

We report a 7-year 6-month-old boy with Legg-Calvé-Perthes (LCP) disease in whom a magnetic resonance imaging (MRI) was normal during the early symptomatic phase when the 99mTc bone scintigraphy showed segmental hypoperfusion of the femoral head suggestive of bone infarction. Only later in the disease did the MRI also show the typical changes of LCP. The follow-up on this patient with bilateral disease leaves no doubt about the diagnosis of LCP. This sequence of a positive scintigram before positive MRI findings may be the exception, but it is important to realize that MRI is not always the most sensitive way to diagnose or exclude LCP as suggested hitherto by the literature.

Osseous lesions of the distal ulna: atypical location--unusual diagnosis. Report of three cases with similar imaging and different pathologic diagnoses.

Abstract Three cases with destructive bone lesions of the distal end of the ulna caused by different pathologic entities (Ewing’s sarcoma, osteosarcoma, rheumatoid pseudotumoral synovitis) are presented, all with similar clinical and comparable x-ray and magnetic resonance imaging features. Although the distal end of the ulna may be resected without significant functional impairment, careful evaluation of treatment strategies compatible with oncologic standards is warranted.

Muscle Reattachment — Especially the Gluteal Muscles — After Proximal Femoral Resection and Replacement by Tumor Prosthesis

The muscles inserting at the major trochanter (gluteal muscles, external rotators) are major abductors and extensors of the hip and have important functions for locomotion and stabilization against limping.

Chemotherapy of soft tissue sarcomas with Cyclophosphamid or Ifosfamid, Adriamycin and DTIC (CAD or IAD) preoperatively and in patients with metastatic disease : a non randomized pilot study

Soft tissue sarcomas are rare tumors, in localized disease most authors report a five year survival between 40 and 60%. Patients with soft tissue sarcomas mostly present with their primary tumors; they can be rendered disease free clinically by wide resection. Since local recurrences and metastases, especially in grade II and III soft tissue sarcomas over 5 cm in size are a major therapeutic problem, combined modality treatment with radiotherapy and adjuvant chemotherapy is evaluated in prospective studies. Limb sparing procedures without jeopardizing the result may be used, if they are associated with radiotherapy and chemotherapy (Eilber 1980, Consensus Conference 1985, Eilber 1990). Several chemotherapeutic agents, most recently Ifosfamid was added to the list, are found to be effective; among the most promising regimes were Cyclophosphamid, Adriamycin, DTIC (CAD, Blum 1980) and in recent years Ifosfamid, Adriamycin, DTIC (IAD, Elias 1989).

Frozen Homologous Trabecular Bone Allografts: 12-Years’ Experience with Banking and Clinical Use

Frozen homologous trabecular bone (FHTB) is probably the most commonly used allogeneic material for biologic replacement of bone defects [1]. FHTB has been in use at the Klinik Balgrist since 1974. The results in cases of large defects are of interest in comparison with, for example, massive allografts.