Application of pasteurized tumor-bearing bone replantation for primary malignant bone tumor of extremities / 中国修复重建外科杂志

Objective: To assess the effectiveness of the pasteurized tumor-bearing bone replantation in treatment of primary malignant bone tumor of extremities. Methods: Between February 2012 and June 2016, 13 patients with primary malignant bone tumor of extremities were treated with pasteurized tumor-bearing bone replantation after extensive excision. There were 8 males and 5 females, aged from 11 to 27 years, with an average of 17.4 years. Tumors were located at the mid-upper humerus in 2 cases, the mid-upper femur in 2 cases, the mid-lower femur in 6 cases, the mid-upper tibia in 2 cases, and the middle tibia in 1 case. According to Enneking staging system, 3 patients were classified as stage ⅠB, 5 patients as stage ⅡA, and 5 patients as stage ⅡB. There were 11 cases of osteosarcoma and 2 cases of chondrosarcoma. The disease duration ranged from 3 to 8 months, with an average of 4.8 months. The length of the tumor-bearing bone ranged from 8 to 16 cm, with an average of 12.5 cm. Postoperative follow-up was conducted regularly to evaluate the status of inactivated bone and complications. The limb function was assessed by the Musculoskeletal Tumor Society 93 (MSTS-93) scoring system. Results: All 13 patients were followed up 26-79 months, with an average of 50.5 months. Eleven patients survived without tumors. Two patients had local soft tissue recurrence and underwent amputation, 1 had lung metastasis after amputation and died. All patients had no complications of bone resorption, shortening, and internal fixation disorder. The nonunion of osteotomy occurred in 4 cases. Among them, 3 cases were successfully healed after autologous iliac bone grafting, and 1 case was treated conservatively. The healing time of metaphyseal osteotomy end was 10-15 months (mean, 12.6 months), the healing rate was 90.9% (10/11); the healing time of diaphyseal osteotomy end was 12-21 months (mean, 17.0 months), the healing rate was 72.7% (8/11); and the total healing rate of osteotomy end was 81.8% (18/22). One case had inactivated bone fracture and 1 case had incision dehiscence and infection after operation. At last follow-up, the MSTS-93 score of affected limb ranged from 21 to 28, with an average of 25.3. Conclusion: The procedure of the pasteurized tumor-bearing bone replantation is an effective, simple, and economic way in repair of massive segmental bone defect to save limb function for primary malignant bone tumor of extremities.

Development of Conventional Osteosarcoma after 13 Years Continuous Disease-free Survival of Periosteal Osteosarcoma / 대한정형외과학회잡지

Periosteal osteosarcoma is a rare variant of osteosarcoma and has represented 1-2% of all osteosarcomas. Most local recurrences or progression to metastatic disease occurred within the first 3 years after presentation and lung metastasis is more common than bony metastasis. We describe a periosteal osteosarcoma of tibia patient who developed conventional osteosarcoma of proximal humerus after 13 years from the completion of treatment.

Pathologic Fracture of Primary Malignant Bone Tumor: Survival, Limb Salvage, Local recurrence / 대한정형외과학회잡지

PURPOSE: This study analyzes the indication, survival rate, local recurrence and limb salvage possibility of primary malignant bone tumors that have had pathologic fractures. MATERIALS AND METHODS: Eighteen cases that received preoperative chemotherapy and surgery were eligible for this study. Primary tumors were osteosarcoma (13) , Ewing's sarcoma (2) and MFH (3) . Primary locations were femur (10) , humerus (6) , and tibia (2) . Fractures were classified into three grades. Grade I (10) was mild displacement, II (5) was moderate but intracompartmental, III (3) was extracompartmental. Average follow-up was 40 months. RESULT: Limbs were salvaged in 16 cases, 2 cases had amputation. Union was acquired in 7 (7/10) cases for grade I and 4 (4/6) cases for grade II. Two cases with severe displacement both ended in non-union. There were two local recurrences. The actual survival rate of the 13 cases with osteosarcoma was 33% in 80 months, showing significantly lower results compared to 238 contemporary cases of IIB (P=0.04) . CONCLUSION: Conservative external immobilization and preoperative chemotherapy for pathologic fracture of primary malignant bone tumor was good initially in the care of amputation. Local recurrence rate was 11 percent and survival rate was significantly worse.

Results of Limb Salvage Surgery in Primary Malignant Bone Tumors / 대한정형외과학회잡지

Limb salvage operation in primary malignant bone tumors is increasing recently, according to the improvement of diagnostic methods, surgical technique and adjuvant chemotherapy. The purpose of this study is to obtain the interim results of survival rate and the functional grade of the limb in primary malignant bone tumors treated by limb salvage operation. Between 1985 to 1993, 63 primary malignant bone tumors treated by limb salvage operations. Tumor prosthesis arthroplasty was performed in 49 patients, resection arthrodesis in 9 patients, and IM nailing with cement molding in 5 patients. Autoclave autograft was combined in 2 patients. Adjuvant chemotherapy and postoperative radiotherapy were performed in selected patients. The average follow-up period was 50 months(ranged 12 months to 116 months). In the cases of osteosarcoma, estimated survival rate was 61.9% based on Kaplan-Meier survival plot. In the parosteal sarcoma, the survival rate was 87.5% and 80% in chondrosarcoma patients. According to functional grading by Enneking, 66% was excellent, 20% was good, 11% was fair and one patients was poor. Complications occurred in 16 patients:wound infection was developed in 6 patients, local recurrence in 4, peroneal nerve palsy in 2 patients and femoral stem loosening in 2 patients. Fracture in resection arthrodesis and pulmonary metastasis were also occurred. Reoperation was performed in 10 patients at average 31 months after initial operation. Revision tumor persthesis arthroplasty was performed in one patient due to local recurrence and in 2 patients due to femoral stem loosening. Three amputations were done due to recurrence of tumor. IM nailing with cement molding was performed in one patient due to deep infection and repeated arthrodesis was done in a fracture patients. Scheduled custom-made tumor prosthesis arthroplasty was performed within a year in 2 patients treated with IM nailing with cement molding. In conclusion, with the careful preoperative assessment, adjuvant chemotherapy and skillful surgical technique, limb salvage operation would provide the primary malignant bone tumor patients for longer survival and better quality of life.

Clinical Observation in the Primary Malignant Bone Tumors / 대한정형외과학회잡지

A total 73 cases of primary malignant bone tumors was reviewed and analysed clinically at the department of orthopaedic surgery, Kosin medicsl center, Pusan, Kores for 11 years from January, 1975 to December, 1985. The results were obtained as follows ; l. In the 73 cases of primsry malignant bone tumors, osteogenic sarcoma was the most common primary malignant bone tumor (57%) and followed by chondrossrcoma (10%), multiple myeloma (8%). 2. Average survival times according to each primary malignant bone tumors was more than 3 years in chondrosarcoma, reticulum cell sarcoma, and synovial sarcoma, 28 months in osteogenic sarcoma, and 7 months in Ewings sarcoma. Ewings sarcoma had the worse prognosis and the slowly progressing tumors-chondrosarcoma, reticulum cell sarcoma and synovial sarcoma are needed long term follow up. 3. In osteogenic sarcoma, the prognosis was better when developed in their 3rd decsde than when developed in their 2nd decade. 4. There is a slight difference in average survival time on the location of the site, for example when tumor is located in the distal femur, the prognosis was worst. 5. There is no difference in the prognosis. The mode of treatment did not effect to their prognosis. 6. It was clear that the tumors which had not been responded to chemotherapy or radiation therapy had poorer prognosis. Chondrosarcoma, fibrosarcoma and synovisl sarcoma were considered as slowly progressed tumors, and so it may be benefit to the patients that chemotherapy and/or radiotherapy were prescribed.