ABSTRACT
PURPOSE: Soft tissue sarcomas have a wide variety of manifestation and its course is still unpredictable in many cases. This study altlempts to analyze the meaningful prognostic factors and to find optimal treatment strategies for each clinical stage. MATERIALS AND METHODS: From May 1985 to Mar. 1997, 432 soft tissue sarcomas were enlisted and 319 cases were eligible for this retrospective study. Staging followed AJCC classification and there were 34 stage I, 69 stage II, 151 stage III and 64 cases of stage IV. For stage I and II, operation was a major tool. Radiotherapy and chemotherapy were added for each situation. Intensive chemotherapy and surgery were done for stage III and IV. Metastasectomy was added in feasible cases. RESULTS: Actual survival rate for the 319 cases was 50% at 152 months. Disease free survival for stage I, II, III was 84%, 41%, and 38%, respectively. The stage itself had a statistical significance (P<0.00001). In univariate analysis, surgical margin in stage II and local recurrence in stage III had statistical significance. Multivariate study revealed the local recurrence as the only meaningful factor in stage I, II, III. An aggressive treatment for stage IV and I, II, III with late metastasis group had significant gain on survival. CONCLUSIONS: The stage itself predicts the course of soft tissue sarcomas. Evaluation of sound surgical margin to prevent the local recurrence is necessary.
Subject(s)
Classification , Disease-Free Survival , Drug Therapy , Metastasectomy , Neoplasm Metastasis , Radiotherapy , Recurrence , Retrospective Studies , Sarcoma , Survival RateABSTRACT
PURPOSE: Although survival of osteosarcoma patient has markedly improved, cases of non-responders to chemotherapy and late-relapsers are still perplexing. Our strategy was to analyze the impact of chemotherapy and surgery on the survival for each stage, and to evaluate long-term survival and find prognostic factors within the same stage. MATERIALS AND METHODS: From May 1985 to Feb. 1999, 461 osteosarcomas were enlisted at our department and among them 348 cases were evaluable. There were 1 IB, 4 IIA, 302 IIB, and 41 IIIB. Two hundred and fifty-five (IIA/IIB:4/251) out of 348 cases followed our protocol of chemotherapy and surgery. Two hundred and ten cases had neoadjuvant chemotherapy and 45 had adjuvant only. RESULTS: Eleven year event free survival of the neoadjuvant group was 56.7%. On univariate analysis for 210 neoadjuvant cases, age (90%), local recurrence, pathologic fracture, location and size were statistically significant. But multivariate one revealed age, type of surgery, local recurrence and pathologic response as useful factors. There were 12 local recurrences (5.7%) and 100 metastasis among 255 stage II and their average onset from treatment was 17.8 month. Survival after metastasis was 5.6% at 55 months and the aggressively treated group made gains in survival (P<0.0001). Survival of 41 stage III was 0% at 64 months and this group also had an advantage in survival through intensive chemotherapy and surgery for primary and metastatic lesions (p=0.04). CONCLUSION: Long-term survival of the treated 255 stage II group was 55% at 14 years. For stage II: age, local recurrence and pathologic response were meaningful prognostic factors. Aggressive surgery and chemotherapy were necessary to improve the survival of stage III and stage II with late metastasis group.
Subject(s)
Humans , Disease-Free Survival , Doxorubicin , Drug Therapy , Fractures, Spontaneous , Korea , Neoplasm Metastasis , Osteosarcoma , Recurrence , Survival RateABSTRACT
Thirty-one distal femoral and nine proximal tibial primary bone tumor patients who had prosthetic replacements were reviewed retrospectively. Average follow-up was thirty-eight months(range: 12- 109 months). There were thirty-two(osteosarcoma: 29, chondrosarcoma: 3) stage IIB lesions and eight 1B lesions(giant cell tumor). Twenty-nine patients were surviving at final follow-up. Overall prosthetic survival was 81%, 27% at 2 and 5 year respectively. Eleven prostheses were revised. The causes of revisions were infection(7), metal failure(2), fracture of host bone(1), and loosening(1). Eight revisions were successful, one was fair, and two patients needed an amputation. Prognostic factors which were analyzed for survival of prostheses were age, sex, location of primary lesion, percent of bone resected, and stage. Only the location of primary lesion showed statistical significance and diabolic pattern of survival curve was noted between two groups in resection length(40%). Average functional score was 26. The tibial side had worse prosthetic survival and a major threat to this procedure was due to infection.
Subject(s)
Humans , Amputation, Surgical , Chondrosarcoma , Follow-Up Studies , Knee Joint , Knee , Prostheses and Implants , Prosthesis Failure , Retrospective Studies , SarcomaABSTRACT
We developed the 166Ho-chitosan, the new radiation synovectomy agent. Holmium is the more practical isotope based on its longer half-life. And chitosan, is ideal and suitable particles based on its soluble and biodegradable characteristics. We investigated the biocompatibility of the 166Ho-chitosan complex to evaluate the suitability as a radiation synovectomy agent. In vitro stability test, the 166Ho-chitosan complex suspension in saline was stored at room temperture and 37degrees C for 25 days and decay rate was of determined by ITLC(Instant Thin Layer Chromatography). In vivo stability test, the 166Ho-chitosan complex was injected into rabbit joints and followed by gamma camera imaging to quantify extra-articular leakage. Biodistribution study, the 166Ho-chitosan complex was injected into rabbit joints. After 48 hours heart, liver, urinary bladder, spleen, lung, brain, kidney, blood were extracted and radioactivities were measured. In vitro stability test, there was no significant change of radioactivity and no leakage problem indicating the prepared 166Ho-chitosan complex is sufficiently stable. In vivo stability tests revealed that more than 98% of the 166Ho-chitosan remained in joint over a 2 days period. The mean retention percentage of 166Ho-chitosan in knee were 99.9%, 99.9%, 99.8%, 99.7% at 2 h, 6 h, 1 day and 2 days, respectively. A biodistribution study of the rabbits revealed that leakage to heart, liver, urinary bladder, spleen, lung, brain, kidney, blood is 0.71, 1.5, 0.50, 1.5, 0.25, 0.26, 0.81, 0.065(% Injected Dose x 10-3/gram), respectively. The 166Ho-chitosan complex shows less leakge than any other radiation synovectomy agents. Our results indicate that 166Ho-chitosan have the biocompatibility and the suitability as a radiation synovectomy agent.
Subject(s)
Rabbits , Brain , Chitosan , Half-Life , Heart , Holmium , Joints , Kidney , Knee , Liver , Lung , Radioactivity , Radionuclide Imaging , Spleen , Urinary BladderABSTRACT
OBJECTIVES: To evaluate the efficacy and safety of radiation synovectomy with Dy-165 HMA in chronic rheumatoid synovitis of the knee METHODS: Two hundred thirty six knees of 212 patients with rheumatoid arthritis and persistent synovitis of the knee were treated with the intraarticular injection of 250~300 mCi of Dy-165 HMA which was prepared by KAERI. Efficacy was assessed by the following parameters: visual analog scale of the knee pain while walking and resting, circumference of the knee, range of motion of the knee. The final global assessment was classified as good, fair or poor. Estra-articular leakage of Dy-165 HMA was determined by blood pool and urine radioactivity and scintigraphic evaluation of liver, groin, and knee joints. RESULTS: l) The optimum radiation dose was 260mCi. 2) The mean follow up periods were 50.4(24-112) weeks. 3) Forty four percent of the knees showed good results, 32% fair results, and 24% shwoed good results. 4) In knees with stage I radiographic changes, 81% showed improvement, of which 54% showed good results. In knees with stage II changes, 78% showed improvement including 39% of the patients with good results. There was a direct correlation between the radiographic stage and response to treatment. 5) The mean period of improvement for the 180 knees that reponded to treatment was 41.4(24-106) weeks. Ten of the 180 knees with improvement relapsed after the mean period of 64(28-80) weeks. 6) Leakage of radioactivity from the injected joint was minimal. 7) Adverse reactions were rare(radiation burn : 4, transient postinjection "flare" : 14). CONCLUSIONS: The optimum radiation dose in Korean was somewhat less than of other foreign reports. Dy-165 HMA radiation synovectomy is a safe and useful therapy for chronic synovitis of the knee joint.
Subject(s)
Humans , Arthritis, Rheumatoid , Burns , Dysprosium , Follow-Up Studies , Groin , Injections, Intra-Articular , Joints , Knee Joint , Knee , Liver , Radioactivity , Range of Motion, Articular , Synovitis , Visual Analog Scale , WalkingABSTRACT
Between 1987 and 1994, the authors analysed 29 patients who underwent limb sparing resection for shoulder girdle neoplasms. Follow up averaged 24 months. Primary bone and soft tissue malignancy were 23 cases, metastatic carcinoma 3, aggressive giant cell tumor 2, aneurysmal bone cyst 1. By Enneking's criteria, stage IIB 23 cases, stage III 3, stage I 2. The surgical margins were: wide(20), marginal(7), and intralesional(2). In 4 cases with S2345B resections(by Musculoskeletal Tumor Society classification), shoulder fusion were done with Ender nail and bone cement. Among twenty patients with S345A(3), S34A(6), S345B(11) resections, arthroplasty with Ender nail and bone cement were done in 11 cases, endoprothesis and its combination with bone cement in 4, vascu- larized fibula graft in I, shoulder fusion with fibula graft in 1, combination of autoclaved bone and endoprothesis were done in 3 cases. Four patients with S12B, no reconstruction were done. For one patient with S45A, segmental resection and reconstruction with autogenous pasteurized bone were done. Oncologic results are CDF 14, DOD 5, NED 3, AWD 7 cases. Complications were local recur- rence 3(10.3%), distal fragment loosening 1, subluxation of humeral head 1, graft site fracture 1, and infection in 1 case. MSTS functional scores for the whole 29 cases were 22.5(75% of normal). S2345B with fusion was 20(67%). For S345A(3) and S34A(6) score was 23.2(77%). For S345B(11), score was 21.7(72%). For S12B(4) and S45A(1), score was 25.8(86%). Although functional results are depend on the extent of bone and soft tissue resection, reconstruction of soft tissue seems to be important. The options for reconstruction of bony defect(endoprothesis complex, living fibula graft or IM nail and cement as a prothesis) did not affect functional outcome.