R. Boyle

Limb preservation surgery with extracorporeal irradiation in the management of malignant bone tumor: the oncological outcomes of 101 patients

BACKGROUND En bloc resection, extracorporeal irradiation (ECI) and reimplantation have been used selectively at our centers as part of limb preservation surgery of malignant bone tumors since 1996. We report the long-term oncological outcomes. PATIENTS AND METHODS One hundred one patients were treated with ECI at two Australian centers between 1996 and 2011. A single dose of 50 Gy was delivered to the resected bone segments. The irradiated bones were reimplanted immediately as a biological graft. Patients were treated with chemotherapy as per standard protocol. The three main histological diagnoses were Ewings sarcoma (35), osteosarcoma (37) and chondrosarcoma (20). There were nine patients with a range of different histologies. RESULTS There was one local recurrence (2.86%) in Ewings sarcoma and the 5-year cumulative overall survival was 81.9%. There was no local recurrence in osteosarcoma and five distant recurrences. The 5-year cumulative overall survival was 85.7%. The local recurrence rate was 20% (4 of 20) in chondrosarcoma, and the 5-year cumulative overall survival was 80.8%. Limb preservation was achieved in 97 patients. For the 64 patients with disease in the pelvis or lower limb, 53 (82.3%) could walk without aids at the time of last follow-up. CONCLUSIONS This large series of ECI shows an excellent long-term local control. It is a good alternative reconstruction method in selected patients. The overall survival is comparable to other published series.

Case report: periosteal osteosarcoma of the clavicle

Periosteal osteosarcomas are rare and usually affect the meta-diaphyseal region of long bones. We present a case of a periosteal osteosarcoma of the clavicle, a highly unusual site and representing one of only two such cases documented in the English literature. This case illustrates the diagnostic dilemmas in the classification of such tumors, particularly in small biopsy specimens from unusual locations. It emphasizes the importance of radiological and pathological correlation.

Atypical EWSR1 FISH signal patterns in bone and soft tissue tumours:– diagnostic experience with 135 cases

Recurrent Ewing sarcoma breakpoint region 1 (EWSR1) gene rearrangements characterize a select group of bone and soft tissue tumours. In our routine diagnostic practice with fluorescence in‐situ hybridization (FISH), we have occasionally observed EWSR1 gene rearrangements in tumours not associated classically with EWSR1 translocations. This study aimed to review our institutional experience of this phenomenon and also to highlight the occurrence of unusual EWSR1 FISH signals (i.e. 5′ centromeric region or 3′ telomeric region signals) that do not fulfil the published diagnostic criteria for rearrangements.

The effectiveness of robotic hip and knee arthroplasty on patient-reported outcomes: A systematic review and meta-analysis

PurposeThe purpose of the study is to determine the effectiveness of semi-active and active robotic hip and knee arthroplasty on post-operative patient-reported outcomes of function, pain, quality of life and satisfaction with surgery.MethodsPubMed, Medline, Embase and CENTRAL were searched. Included were comparative studies investigating the effectiveness of semi-active or active robotic hip or knee arthroplasty compared to any other surgical intervention on function, pain, quality of life and satisfaction with surgery. Risk of bias and the strength of the evidence were assessed using the Downs and Black tool and the GRADE system, respectively. Relative risks, mean differences and 95% CI were calculated using random-effects models.ResultsFourteen studies involving 1342 patients were included. All studies compared robotic to conventional surgery, with active robotic surgery evaluated in total hip or knee arthroplasty and semi-active robotic surgery in total hip or unicompartmental knee arthroplasty. Most studies presented some risk of bias, and the strength of evidence was rated as low to very low quality. Random-effects meta-analyses showed that post-operative functional outcomes were comparable between active robotic and conventional total hip and knee arthroplasty at the short-, medium- and long-term follow-up. No significant difference in pain, quality of life and satisfaction with surgery were reported in individual studies.ConclusionsThis systematic and meta-analyses indicates that functional outcomes for patients undergoing active robotic total hip and knee arthroplasty were comparable to conventional surgery. Whether semi-active or active robotic hip or knee arthroplasty is effective in improving post-operative pain, quality of life and satisfaction with surgery is unclear.PROSPERO Registration Number: CRD42017059932.

Radiation Therapy as an Alternative Treatment for Desmoid Fibromatosis

AIM To determine the outcome after radiation therapy for desmoid fibromatosis. MATERIALS AND METHODS A retrospective review of 50 patients treated between 1988 and 2016 in a specialised bone and soft tissue tumour clinic. RESULTS The median age at the time of radiation therapy was 36.8 years (range 15.1-69.0) and the median follow-up time was 51 months. Forty-three patients underwent radiation therapy as the definitive treatment with a median dose of 56 Gy (range 30-58.8 Gy). The median dose for the seven patients treated with postoperative radiation therapy was 50.4 Gy (range 48-56 Gy). Eleven patients (22%) developed progressive disease after radiation therapy at a median time of 41 months (range 12-113 months). The recurrences were within the radiation therapy field in four patients and outside the field in seven patients. One patient developed a radiation-induced malignancy 20 years after treatment. CONCLUSIONS Radiation therapy is an alternative treatment in the management of desmoid fibromatosis. It should be considered in patients for whom surgical resection is not feasible, or as adjuvant therapy after surgery with involved margins where any further recurrences would cause significant morbidity.

FISH analysis of selected soft tissue tumors: Diagnostic experience in a tertiary center

Fluorescence in situ hybridization (FISH) is an important ancillary tool for the classification of bone/soft tissue (BST) tumors. The aim of this study was to evaluate the contribution of FISH to the final classification of common BST entities in the molecular pathology department of the Royal Prince Alfred Hospital (RPAH), which is one of the most important referral centers for the management of sarcomas in Australia.

Surgical treatment of meta-diaphyseal osteonecrosis: case report and review of the literature: Images for Surgeons

gastrointestinal bleeding. However, spontaneous perforation is a rare presentation with only one other reported case presenting with spontaneous rupture from an antral GIST. There have been no previous reports on a concurrent presentation of perforation and gastrointestinal haemorrhage in the same setting in a gastric GIST. Urgent surgical resection was indicated here to achieve control of haemorrhage as well as sepsis.

Clinical, functional and radiological outcomes of extracorporeal irradiation in limb salvage surgery for bone tumours.

Aims We present a retrospective review of patients treated with extracorporeally irradiated allografts for primary and secondary bone tumours with the mid‐and long‐term survivorship and the functional and radiographic outcomes. Patients and Methods A total of 113 of 116 (97.4%) patients who were treated with extracorporeally irradiated allografts between 1996 and 2014 were followed up. Forms of treatment included reconstructions, prostheses and composite reconstructions, both with and without vascularised grafts. Survivorship was determined by the Kaplan‐Meier method. Clinical outcomes were assessed using the Musculoskeletal Tumor Society (MSTS) scoring system, the Toronto Extremity Salvage Score (TESS) and Quality of Life‐C30 (QLQ‐30) measures. Radiographic outcomes were assessed using the International Society of Limb Salvage (ISOLS) radiographic scoring system. Results There were 61 (54%) men with a mean age of 22 years (6 to 70) and 52 (46%) women with a mean age of 26 years (3 to 85). There were 23 deaths. The five‐year patient survivorship was 82.3% and the ten‐year patient survivorship was 79.6%. The mean follow‐up of the 90 surviving patients was 80.3 months (2 to 207). At the last follow‐up, 105 allografts (92.9%) were still in place or had been at the time of death; eight (7%) had failed due to infection, local recurrence or fracture. Outcome scores were comparable with or superior to those in previous studies. The mean outcome scores were: MSTS 79% (SD 8); TESS 83% (SD 19); QLQ 82% (SD 16); ISOLS 80.5% (SD 19). Pearson correlation analysis showed a strong relationship between the MSTS and ISOLS scores (r = 0.71, p < 0.001). Conclusion This study shows that extracorporeal irradiation is a versatile reconstructive technique for dealing with large defects after the resection of bone tumours with good functional and radiographic outcomes. Functional outcomes as measured by MSTS, TESS and QLQ‐30 were strongly correlated to radiographic outcomes. Cite this article: Bone Joint J 2017;99‐B:1681‐8

Multifocal low-grade central osteosarcoma: a rare case

Low-grade central osteosarcoma (LGCOS) is a rare variant of osteosarcoma. We present a rare case of multifocal LGCOS located in two distinct skeletal sites, initially noted as incidental findings on imaging for distant traumatic pathology. Both sites seemed small and innocuous on initial imaging, and were quiescent clinically, illustrating the value of close interval multimodal surveillance scanning.

TN06 BONE BANKING

This paper presents an audit of 22 years of bone banking at Royal Prince Alfred Hospital, along with a review of the current literature regarding the use of allograft bone.