Teresa Calabrò

Survival of current production tumor endoprostheses: Complications, functional results, and a comparative statistical analysis

Retrospectively analyze outcomes of current‐generation Global Modular Replacement System (GMRS) modular tumor endoprosthesis for the lower limb in primary and secondary implantation procedures.

Protocol of surgical treatment of long bone pathological fractures

Long bone pathological fractures in patients with primary and metastatic bone tumours are difficult to treat and their management may alter the prognosis of the disease and jeopardize survival. The aim of this article was to review the relevant studies reporting on the management of tumour patients with pathological fractures of the long bones, to discuss the most suitable approach in these patients, to highlight specific treatment recommendations, and finally based on this analysis and our clinical practice, to propose a treatment algorithm for decision making and treatment.

Selective embolization with N-butyl cyanoacrylate for metastatic bone disease.

PURPOSE To evaluate the clinical and imaging effect of selective embolization using N-butyl cyanoacrylate (NBCA) as palliation for bone metastases. MATERIALS AND METHODS The procedures and effect of 309 embolizations performed in 243 patients were retrospectively analyzed; 56 patients had repeat embolization at the same location at 1-3 months; 197 patients had embolization for progressive bone metastases after radiation therapy. The mean tumor diameter before embolization was 7.8 cm (range 5-30 cm). In all patients, embolizations were performed under local anesthesia through transfemoral catheterization using NBCA in 33% ethiodized oil. The technical success of embolization was evaluated by angiography after completion of the procedure. The clinical and imaging effect was evaluated at follow-up examinations with a pain score scale and use of analgesics, hypoattenuating areas, tumor size, and ossification. RESULTS In all 309 embolizations, postprocedural angiography showed complete occlusion of metastatic blood supply and greater than 80% devascularization of the lesions. Greater than 50% reduction of pain score and analgesic doses was achieved in 97% of procedures. The mean duration of pain relief was 8.1 months (range 1-12 months). The mean maximal tumor diameter after embolization was 5.5 cm (range 2-20 cm). Variable ossification appeared in 65 patients. Postembolization syndrome, ischemic pain at the site of embolization, paresthesias, skin breakdown, and subcutaneous necrosis were observed in 87 patients. CONCLUSIONS Selective embolization with NBCA is a safe and effective palliative treatment for metastatic bone lesions of various primary cancers; pain relief is temporary.

Prognostic factors in surgical resection of sacral chordoma

The best treatment of sacral chordoma is surgical resection, nowadays associated with optimized radiation therapy. We analysed 1) the oncologic outcome in a large series; 2) the effect of previous intralesional surgery, resection level, tumor volume and margins on survivorship to local recurrence (LR) and 3) the complication rate.

Survival analysis of patients with femoral metastases

Previous studies reported on surgical indications for patients with femoral metastases. However, few studies analyzed the spectrum of femoral metastatic presentation. We performed this study to evaluate the survival of patients with femoral metastases, and clarify the treatment of femoral impending and actual pathological fractures.

Modern Palliative Treatments for Metastatic Bone Disease: Awareness of Advantages, Disadvantages, and Guidance.

Background:Metastatic disease is the most common malignancy of the bone. Prostate, breast, lung, kidney, and thyroid cancer account for 80% of skeletal metastases. Bone metastases are associated with significant skeletal morbidity including severe bone pain, pathologic fractures, spinal cord or nerve roots compression, and malignant hypercalcemia. These events compromise greatly the quality of life of the patients. The treatment of cancer patients with bone metastases is mostly aimed at palliation. Objective:This article aims to present these palliative treatments for the patients with bone metastases, summarize the clinical applications, and review the techniques and results. Methods:It gives an extensive overview of the possibilities of palliation in patients with metastatic cancer to the bone. Results and Discussion:Currently, modern treatments are available for the palliative management of patients with metastatic bone disease. These include modern radiation therapy, chemotherapy, embolization, electrochemotherapy, radiofrequency ablation, and high-intensity focused ultrasound. As such it is of interest for all physicians with no experience with these developments to make palliative procedures safer and more reliable.

Infected Prostheses after Lower-Extremity Bone Tumor Resection: Clinical Outcomes of 100 Patients

BACKGROUND Infection of megaprostheses after bone tumor resection is a major concern; management is challenging. This study evaluated the survivability from such infections, the microbial isolates, treatment tactics, and outcome of megaprosthesis reconstructions. MATERIALS AND METHODS We studied 1,161 patients retrospectively who underwent megaprosthesis reconstruction for limb salvage after a sarcoma from 1983 to 2010. The mean followup was 9 y (range 3-20 y). We evaluated the overall survival of the megaprosthesis reconstructions in patients with infection and the survival with respect to the type of megaprosthesis, site of reconstruction, cemented or cementless fixation, type of tumor, adjuvant treatments, microbial isolate(s), treatment tactics, and outcome. RESULTS The incidence of infection was 8.6%. The most common microbial isolate was Staphylococcus epidermidis (47%). Overall survival with definitive management of infection was 88% at 10 y and 84% at 20 y. Survival was higher for cementless reconstructions and not different with respect to the type of megaprosthesis, site of reconstruction, or adjuvant therapy. Infections resolved completely with one- or two-stage surgery in 75% of patients. The rate of amputation because of infection was 21%. CONCLUSIONS Megaprosthesis reconstructions may be infected in 8.6% of cases. Infections more commonly occur late, caused usually by S. epidermidis. The survival rate is higher with cementless megaprosthesis reconstructions and no different with respect to the type of tumor or megaprosthesis or the adjuvant treatments. One-stage revision is effective for acute post-operative infections; however, two-stage revision surgery is necessary for early and late infections. The rate of amputation because of occurrence or persistence of megaprosthesis infection is 21%.

Resection and reconstruction of pelvic bone tumors.

The objective of this study was to assess outcome and recurrence rate after limb-salvage surgery with reconstruction for pelvic bone tumors and analyze complications and their relationship with surgery. The authors analyzed 129 patients followed for a mean of 6 years (range, 2-19 years). Chondrosarcoma was the most frequent histotype. Thirty-one cases with no acetabular involvement were reconstructed with allograft only. Acetabular resections were reconstructed with allograft prosthetic composite (n=60), allograft only (n=11), trabecular metal components (n=2), prosthesis only (n=10), saddle prosthesis (n=11), and iliofemoral arthrodesis (n=1). Margins were wide (n=94), wide contaminated (n=22), marginal (n=7), and intralesional (n=6). Oncologic outcomes were as follows: 75 patients were continuously disease free, 6 were disease free after treatment of relapse, 13 were alive with disease, 28 were dead of disease, and 5 were dead of other causes. Survival was 66% at 10 years. Local recurrence rate of malignant tumors was 22.1% and was not statistically influenced by margins (P=.140) or site (P=.933). Metastasis rate was 32.8%. Deep infection was observed in 30 (23.6%) cases, with no statistical difference between reconstructions with and without allograft (P=.09). Final external hemipelvectomy was performed in 16 cases. Newer techniques of reconstruction using stemmed acetabular cups or porous metal components combined with allograft are now available. Local control and satisfactory survival is achievable long term in patients with pelvic tumors, but this surgery implies a high rate of complications. Infection is a major complication, not influenced by the use of allografts. Amputation is rarely needed.

Clinically significant thromboembolic disease in orthopedic oncology: an analysis of 986 patients treated with low-molecular-weight heparin.

Thromboembolic risk in orthopedic oncology is high due to several factors. The aim of this study was to assess clinically significant thromboembolic disease in 986 patients operated on with a prosthetic reconstruction of the lower limbs after the resection of bone tumors and prophylactically treated with low‐molecular‐weight heparin (LMWH).

Palliative embolisation for advanced bone sarcomas

PurposeManaging patients with advanced bone sarcomas — namely, recurrent, unresectable and metastatic — is mostly aimed at palliation. The role of embolisation for pain relief for these patients has not been previously reported. We therefore performed this study to emphasise the palliative role of embolisation for pain relief of advanced bone sarcoma patients.Materials and methodsWe retrospectively studied 43 patients with advanced bone sarcomas treated with palliative embolisation with N-2-butyl-cyanoacrylate from 2004 to 2011. All patients had primary treatments including chemotherapy, radiation therapy, radiofrequency thermal ablation, and/or surgery for their advanced sarcomas and were referred for embolisation as end-stage treatment for continuous severe local pain. The effect of embolisation was evaluated with a pain score scale and analgesic use. Mean follow-up was 7 (range, 1–19) months); all patients were dead at the last follow-up.ResultsIn all patients, angiography showed increased pathological vascularisation of the sarcomas; three to six feeding vessels were embolised in each procedure. Almost complete pain relief and >50% reduction in analgesic use was experienced by 36 patients with highly hypervascular sarcomas and sarcomas in the pelvis and shoulder girdle. Moderate pain relief and 50% reduction in analgesic use was experienced by seven patients with spinal and sacral lesions. Within the available follow-up, no patient had recurrent pain with the same intensity as before embolisation. All patients experienced ischaemic pain at the site of embolisation that resolved completely with analgesics. Six patients with advanced pelvic bone sarcomas experienced paraesthesias at the distribution of the sciatic nerve that resolved completely with methylprednisolone.ConclusionsEmbolisation is a safe and effective local palliative treatment for patients with advanced sarcomas, providing optimum pain relief with the least discomfort and the possibility of minor complications only.RiassuntoObiettivoLa gestione dei pazienti con i sarcomi dell’osso in fase avanzata, cioè ricorrenti, non resecabili e metastatici, è volta prevalentemente alla palliazione. Il ruolo dell’embolizzazione nel sollievo dal dolore per questi pazienti non è stato riportato in precedenza. Abbiamo quindi svolto questo studio per enfatizzare il ruolo palliativo dell’embolizzazione nella riduzione del dolore dei pazienti con sarcomi dell’osso in fase avanzata.Materiali e metodiAbbiamo studiato retrospettivamente 43 pazienti con sarcomi dell’osso in fase avanzata trattati con embolizzazione palliativa mediante N-2-butil-cianoacrilato dal 2004 al 2011. Tutti i pazienti sono stati sottoposti ad un trattamento di prima linea che includeva chemioterapia, radioterapia, termoablazione con radiofrequenza e/o chirurgia per sarcomi in fase avanzata, e sono stati successivamente trattati con l’embolizzazione come trattamento finale per il dolore locale severo e continuo. Gli effetti dell’embolizzazione sono stati valutati con una scala del dolore e con l’uso di analgesici. Il follow-up medio è stato di 7 mesi (range 1–19 mesi); tutti i pazienti sono deceduti all’ultimo follow-up.RisultatiIn tutti i pazienti l’angiografia mostrava un aumento della vascolarizzazione patologica del sarcoma; da tre a sei vasi afferenti sono stati embolizzati durante ogni procedura. Trentasei pazienti con sarcomi altamente ipervascolarizzati, sarcomi della pelvi e del cingolo scapolare sono andati incontro ad una quasi completa risoluzione del dolore e ad una riduzione dell’uso di analgesici maggiore del 50%. Nel corso del follow-up nessun paziente ha lamentato la ricomparsa del dolore con intensità pari a quella presente prima dell’embolizzazione. Tutti i pazienti hanno manifestato un dolore di tipo ischemico in sede di embolizzazione che si è completamente risolto con l’assunzione di analgesici. Sei pazienti con sarcomi pelvici dell’osso in fase avanzata hanno lamentato la comparsa di parestesie nel territorio di distribuzione del nervo sciatico che si sono completamente risolte con l’assunzione di metilprednilsolone.ConclusioniL’embolizzazione è un trattamento palliativo locale sicuro ed efficace per i pazienti con sarcomi ossei in fase avanzata, garantendo un’ottimale risoluzione del dolore, un minimo disagio ed una minor incidenza di complicanze.