Marcelo de Toledo Petrilli

Computed tomography-guided percutaneous trephine removal of the nidus in osteoid osteoma patients: experience of a single center in Brazil

Objective To report the results of computed tomography (CT)-guided percutaneous resection of the nidus in 18 cases of osteoid osteoma. Materials and Methods The medical records of 18 cases of osteoid osteoma in children, adolescents and young adults, who underwent CT-guided removal of the nidus between November, 2004 and March, 2009 were reviewed retrospectively for demographic data, lesion site, clinical outcome and complications after procedure. Results Clinical follow-up was available for all cases at a median of 29 months (range 6–60 months). No persistence of pre-procedural pain was noted on 17 patients. Only one patient experienced recurrence of symptoms 12 months after percutaneous resection, and was successfully retreated by the same technique, resulting in a secondary success rate of 18/18 (100%). Conclusion CT-guided removal or destruction of the nidus is a safe and effective alternative to surgical resection of the osteoid osteoma nidus.

Sarcoma de Ewing: epidemiologia e prognóstico dos pacientes tratados no Instituto de Oncologia Pediátrica, IOP-GRAACC-UNIFESP

OBJECTIVE: To outline the epidemiological profile and prognosis for Ewings sarcoma in the Brazilian population. Material and METHODS: The medical records of 64 patients with intraosseous Ewings sarcoma who were treated at the Pediatric Oncology Institute, IOP-GRAACC-Unifesp, between 1995 and 2010, were retrospectively evaluated. RESULTS: The statistical analysis on the data obtained did not correlate factors such as sex, trauma, pathological fracture and time taken for case diagnosis with the treatment outcome. Factors such as initial metastasis, lung metastasis, tumor site, age, recurrence and type of surgery showed results corroborating what has been established in the literature. CONCLUSION: The prognosis in cases of Ewings sarcoma was mainly influenced by the presence of metastases at the time of diagnosis.

O uso de espaçadores com antibiótico no tratamento das infecções em endopróteses de joelho

OBJCTIVE: The aim of this study is to evaluate the use of cement spacers impregnated with antibiotics for the treatment of infections in the nonconventional endoprostheses of the knee. METHODOLOGY: We have treated seven patients since 2004 (of which six were submitted to surgery in our service and one patient had been submitted to a primary tumor surgery in another removal service) with deep infection in knee tumor prosthesis. All patients were submitted to endoprosthesis removal and reconstructed with antibiotic cement spacer. All patients were monitored both clinically and by lab tests as for monitoring the evolution, being considered able for reviews after 6 (six) months without infections signs. RESULTS: We have noted a small predominance of infectious processes on the prosthesis inserted on proximal tibia as compared with distal femur (57.1% x 42.9%). The mean follow-up time of patients was 68.2 months. During the follow up, one patient died as a result of the root disease. Six patients out of seven were regarded as cured and one persisted with infection signs and symptoms. CONCLUSION: The results obtained up to date have motivated us to continue using this method of treatment.

Total knee arthroplasty with computer-assisted navigation: an analysis of 200 cases,

Objective to evaluate the results from surgery with computer-assisted navigation in cases of total knee arthroplasty. Method a total of 196 patients who underwent total knee arthroplasty with computer-assisted navigation were evaluated. The extension and flexion spaces (gaps) were evaluated during the operation and the alignment after the operation was assessed. The Knee Society Score (KSS) questionnaire for assessing patients function was applied preoperatively and postoperatively after a mean follow-up of 22 months. Results in all, 86.7% of the patients presented good alignment of the mechanical axis (less than 3° of varus or valgus in relation to the mechanical axis) and 96.4% of the patients presented balanced flexion and extension gaps. Before the operation, 97% of the patients presented poor or insufficient KSS, but after the operation, 77.6% presented good or excellent KSS. Conclusion the navigation system made it possible to achieve aligned and balanced implants, with notable functional improvement among the patients. It was found to be useful in assessing, understanding and improving knowledge in relation to performing arthroplasty procedures.

Fifteen Years' Experience of the Brazilian Osteosarcoma Treatment Group (BOTG): A Contribution from an Emerging Country.

PURPOSE Little information is available regarding the tumor features, prognostic factors, and treatment results in children and adolescents and young adults (AYAs) with osteosarcoma diagnosed in developing countries. We reviewed the results of three observational cohorts of osteosarcoma patients treated in an emerging country. METHODS A total of 604 patients below the age of 30 years with high-grade osteosarcoma were prospectively enrolled in the Brazilian Osteosarcoma Treatment Group (BOTG) studies III, IV, and V. Gender, age, time from onset of symptoms to diagnosis, primary tumor site, presence or absence of metastases at diagnosis, tumor size, type of surgery (limb-sparing or amputation), treatment protocol, and histological response were correlated with survival. RESULTS The estimated 5-year overall survival and event-free survival (EFS) rates for the 553 eligible patients were 49% and 39% respectively; of the 390 non-metastatic patients included in the total, overall- and event-free survival were 59% and 48% respectively. Metastases at diagnosis, primary tumor site, type of surgery, and histological response were significant predictors of overall survival and EFS in univariate and multivariate analysis, whereas tumor size and treatment protocol lost prognostic significance in multivariate analysis. CONCLUSION We report on the outcome of three consecutive studies for the treatment of osteosarcoma carried out in Brazil over 15 years. Although the survival rates presented are below those reported in current literature, it represents the result of a favorable experience gathered from the national collaborative work.

Extraskeletal Osteosarcoma of the Hand in an Adolescent: A Case Report

Extraskeletal osteosarcoma (ESOS) is a well-defined and rare soft-tissue neoplasm characterized by osteoid production with no association with bone1. It represents 1% of all soft-tissue sarcomas and 4% to 5% of all osteosarcomas1-3. ESOS mainly arises in the deep soft tissue of the lower limbs and is extremely uncommon in young people. The median age of affected patients in most series has been in the fifth to seventh decades of life; the number of reported pediatric cases is low3-9. The prevalence of ESOS in the upper extremity is between 15% and 23%; 7% of these cases have occurred in the hand1,3,4,10,11. Previous series, primarily including patients treated with surgery alone, have reported five-year survival rates ranging from 24% to 50%, with high rates of distant metastasis2,4,12-14. Several reports have found no difference in overall or event-free survival between patients treated with resection and those treated with amputation5,6. Uncertainty remains as to whether ESOS should be treated with use of neo or adjuvant chemotherapy5-7,15. We report the clinical and pathological findings of an unusual case of an ESOS arising from the hypothenar muscles of the left hand in an eighteen-year-old woman. The patient was informed that data concerning the case would be submitted for publication, and she provided consent. An eighteen-year-old woman presented with a rapidly enlarging, painless mass of the left hand. The patient had noticed the mass four months earlier. She reported no injury to the hand or prior history of radiation therapy. She denied any health problems and family history of cancer. Physical examination confirmed a firm, immobile, painless mass, …

EWINg'S SARCOmA: EPIDEmIOLOgY AND PROgNOSIS FOR PATIENTS TREATED AT THE PEDIATRIC ONCOLOgY INSTITuTE, IOP-gRAACC-uNIFESP

Objective: To outline the epidemiological profile and prognosis for Ewings sarcoma in the Brazilian population. Material and Methods: The medical records of 64 patients with intraosseous Ewings sarcoma who were treated at the Pediatric Oncology Institute, IOP-GRAACC-Unifesp, between 1995 and 2010, were retrospectively evaluated. Results: The statistical analysis on the data obtained did not correlate factors such as sex, trauma, pathological fracture and time taken for case diagnosis with the treatment outcome. Factors such as initial metastasis, lung metastasis, tumor site, age, recurrence and type of surgery showed results corroborating what has been established in the literature. Conclusion: The prognosis in cases of Ewings sarcoma was mainly influenced by the presence of metastases at the time of diagnosis.

Contaminação do trajeto de biópsia em sarcomas primários ósseos

Resumo Objetivo Determinar a incidencia da contaminacao do trajeto de biopsia nos pacientes com sarcomas primarios osseos, bem como as caracteristicas clinicas que influenciaram neste desfecho. Metodo Foram avaliados retrospectivamente os laudos anatomopatologicos de pacientes tratados pelo Servico de Oncologia Ortopedica do Departamento de Ortopedia e Traumatologia dessa instituicao. Resultado Dentre os 148 pacientes incluidos no presente estudo, apenas um apresentou contaminacao por celulas neoplasicas em seu trajeto de biopsia. Conclusao O procedimento de biopsia ossea em pacientes com sarcomas primarios osseos apresenta grande seguranca no quesito contaminacao quando feito em centros especializados no tratamento dessas patologias.Objective To determine the incidence of contamination of the biopsy pathway in patients with primary bone sarcomas, as well as the clinical characteristics that influenced this outcome. Materials and Methods The anatomopathological reports of the patients who were treated by the Orthopedic Oncology Sector of the Orthopedic and Traumatology Department of this institution were retrospectively evaluated. Results Of the 148 patients included for evaluation in the present study, only 1 presented contamination by neoplastic cells in his biopsy pathway. Conclusion The bone biopsy procedure in patients with primary bone sarcomas presents great safety regarding pathway contamination when performed in specialized centers that treat this type of pathology.

Epidemiological characteristics of patients with pelvic tumors submitted to surgical treatment

Objective Describe the epidemiological profile of patients with primary or secondary neoplastic lesions in the pelvis who required a surgical procedure such as hemipelvectomy. Methods This study retrospectively evaluated 69 patients located in the database of a São Paulo educational institution, subject to surgical hemipelvectomy treatment between January 1990 and December 2013. All patients had previous diagnosis of bone tumor (primary or metastatic) in the pelvis (ilium, ischium, pubis, and/or sacrum). Results Analyzing the data obtained in this study, it was observed that these are partly similar to those found in the literature, with primary bone malignancies as the main diagnosis; general injuries affecting the pelvic area I (pelvic bone) and its most frequent complication, infection. The differences are mainly due to rarity of the bone tumors evaluated in this study, and the type of surgical procedure in question, which is even more unusual. Conclusion Building a picture that conveys the reality of each diagnosis and that indicates which characteristics of these patients would better resemble an absolute or relative indication for the realization of hemipelvectomy is harder by the rarity of these cases.

Postural assessment of patients with non-conventional knee endoprosthesis

Objective: To investigate the correlation between the sagittal and frontal alignment and possible postural asymmetries found in patients submitted to total knee stent placement for osteosarcoma. Methods: Twenty two individuals were divided into two groups according to tumor location: femur group (13 patients) and tibia group (nine patients), who were evaluated through postural analysis software (SAPO). Results: No statistically significant difference was found between groups, supporting previous result showing that both groups present the same postural asymmetries. Conclusion: We conclude that both groups have the same postural imbalances, especially the knee of the affected limb that presents hyperextension and center of gravity shifted anteriorly and laterally to the non-affected limb, indicating changes in weight bearing and influencing the gait pattern and balance. Level of Evidence II, Prospective Comparative Study.