Isobe Y

Limiting Factors of Limb Salvage Operation for Musculoskeletal Sarcoma

Based on the therapeutic results of 158 musculoskeletal sarcomas treated by limb salvage operation, the limiting factors were analyzed. As a result, we concluded that the Surgical Staging System advocated by Enneking is not satisfactory as an indicator of surgical procedures in the treatment of musculoskeletal sarcoma. Also, the Functional Evaluation System does not adequately determine the appropriateness of the limb salvage operation. Therefore, in this analysis, a different standard was applied.

Results of Alumina-Ceramic Endoprostheses Used for Bone Tumor Cases

Alumina-ceramic endoprostheses were applied to ten cases of bone tumors in the following categories: osteosarcomas (four cases), malignant fibrous histiocytomas (two), parosteal osteosarcomas (two), chondrosarcoma (one), and extended giant cell tumor (one). Of these, three cases were evaluated as excellent and one as good. In three cases, revision occurred because of breakage and loosening of the prosthesis. Additionally, three cases were lost due to patient death or local recurrence. The alumina-ceramic showed fragility and less affinity to the bone than had been expected. From these results, we conclude that alumina-ceramic endoprostheses have a limited indication for use with low-malignant bone tumors that only require small amounts of bone and soft tissue resection.

Functional Evaluation of Limb Salvage Operation for Malignant Bone and Soft Tissue Tumors Using the Evaluation System of the Musculoskeletal Tumor Society

A total of 158 cases of bone and soft tissue sarcomas treated by limb salvage operations were evaluated using the evaluation system of the Musculoskeletal Tumor Society. They overall rating was 41% excellent, 31% good, 17% fair, and 11% poor. From the viewpoint of the value “satisfactory” for the categories “excellent” and “good,” soft tissue sarcomas were found to be better than bone sarcomas, high-malignant tumors were better than low-malignant ones, intracompartmental tumors were better than extracompartmental ones, and smaller soft tissue sarcomas were better than larger ones. To make this functional evaluation system more useful, recurrent cases should be excluded as failures, and more emphasis should be placed on the factor of functional activity. To determine the successfulness of the limb salvage operation itself, a new evaluation system was tried. Under this sytem, 78% of the cases were rated as satisfactory, while 24 (15%) were rated as poor.

Role of Electroradiography in the Evaluation of Preoperative Treatment for Primary Malignant Bone Tumors

Patients with primary malignant bone tumors usually need preoperative chemotherapy for the treatment of micrometastasis. If the preoperative chemotherapy is not effective, the period of preoperative treatment becomes meaningless, and the best opportunity for limb saving is lost. This makes it highly important to determine the effects of the drug treatment as early as possible. Unfortunately, it is extremely difficult to evaluate the early response of bone lesions to the treatment using conventional radiograms. Consequently, we have recently taken a special interest in electroradiography which makes it possible to detect the extraskeletal mass shadow of a bone lesion in fine detail since it is relatively easy to obtain electroradiographic images. Therefore, we have been comparatively evaluating the effects of preoperative treatment using conventional radiograms, CAT scans, isotope bone scans, and electroradiography.