Gideon Flusser

The complexity of management of pregnancy-associated malignant soft tissue and bone tumors.

Objective: The incidence of musculoskeletal tumors during pregnancy is very low. The aim of this study was to summarize our experience in treating a large cohort of pregnant patients diagnosed with these rare tumors. Methods: Women diagnosed with musculoskeletal tumors during pregnancy or immediately after delivery were identified retrospectively in our database between 1996 and 2006. Relevant maternal and neonatal data were collected. Results: Twenty patients, 8 with bone sarcomas (BS) and 12 with soft tissue sarcomas (STS) were identified. Two women were treated by wide excision of mass during pregnancy. In all other cases oncological treatment was delayed until delivery or termination of pregnancy. Vaginal delivery was possible in 9 patients, cesarean section was performed in 7, spontaneous abortion occurred in 1, and 3 underwent termination of pregnancy. Three newborns were premature, but normal growth and development were observed. Different techniques of fertility preservation were used in our patients. Five patients with BS and 5 patients with STS received preoperative chemotherapy, with different grades of toxicity. The degree of tumor necrosis tended to correlate with dose-intensity of chemotherapy. Seven patients with BS received adjuvant chemotherapy. Two patients with STS received adjuvant chemotherapy, two – radiotherapy, and four – both modalities. Median disease-free survival was 15.1 months, median overall survival – 25.4 months. Conclusions: Musculoskeletal tumors diagnosed during pregnancy, or after delivery, do not appear to have a significant impact on the prognosis. A multidisciplinary team should tailor the oncological approach individually.

Cryosurgery in fibrous dysplasia: Good result of a multimodality protocol in 16 patients

The indications for surgical treatment of x8e ber dysplasia are: chronic pain, increasing swelling and deformity, imminent fracture, the development of malignancy and cosmetic considerations (Feintuch 1973, De Smet et al. 1981, Yabut et al. 1988, Simpson et al. 1989). To reduce the rate of local recurrence, we used cryosurgery as an adjuvant treatment to curettage, cementing and/or bone grafting in 16 patients with monostotic x8e brous dysplasia for the last 11 years. The indication for the operation was pain or imminent fracture.

Gemcitabine in bone sarcoma resistant to Doxorubicin-based chemotherapy.

Subjects and Methods: Seven patients with progressive localized or metastatic chemo-resistant osteosarcoma were treated by gemcitabine.The protocol included gemcitabine 1000 mg/m2/w for 7 consecutive weeks, followed by 1 week rest. If no progression was observed,maintenance by gemcitabine 1000 mg/m2/w for 3 weeks every 28 days was given until failure was clinically or radiologically evident. Results. The true objective response rate was 0%. However, disease stabilization and clinical benefit response were observed in five patients (70%) for 13–96 weeks. Discussion. Postponing the inevitable death with a relatively non-toxic treatment, is, in our opinion, an important issue especially in young patients.Thus it may be justified and warranted to investigate the activity of gemcitabine in a larger group of patients with bone sarcomas.

Periosteal Ewing's Sarcoma: Report of Two New Cases and Review of the Literature

Background. The origin of Ewings sarcoma in a periosteal location is rare and not clearly documented. Other malignant bone tumors appear to have a somewhat better prognosis when confined between periosteum and bone. Is it the same for periosteal Ewings sarcoma? Methods. We describe two new cases and comprehensively review the literature consisting of 18 documented cases since the condition was first described in 1986 (S.M. Bator.Cancer 58:1781– 4). Results. Periosteal Ewings sarcoma differs from the other forms of Ewings sarcoma in terms of sex predominance, location of tumor, surgical stage at presentation and typical imaging studies. Eighteen out of the 20 patients were reported to be alive with no evidence of disease. Conclusions. It seems that the prognosis of this rare variant of Ewings sarcoma family of tumors might be better but the small number of cases precludes such a firm conclusion.