Clinical Results following Reconstructive Methods in Pelvic Tumor / 대한정형외과학회잡지

PURPOSE: This study evaluated the results of periacetabular resections in patients with pelvic tumors according to the reconstructive methods. MATERIALS AND METHODS: Twenty-seven patients, who underwent a periacetabular resection with a minimum one year follow up were eligible for this study. There were 20 primary malignant bone tumors, three benign aggressive tumors, three metastatic tumors and one soft tissue sarcoma. According to Enneking's criteria, a type I+II resection was performed in seven patients, type II+III in 17, and type I+II+III in three. The type of reconstructions used were heat treated autogenous bone-THA composite (APC) in 15, a saddle prosthesis in 6, arthrodesis in 2, and a flail hip in 4 patients. The MSTS functional scores and complications according to the type of reconstruction were evaluated. RESULTS: Eleven (46%) of the 27 patients were in the disease free state and 7 (26%) patients showed local recurrences. Eleven (73%) out of 15 patients with APC and 2 (33%) out of 6 patients with a saddle prosthesis had complications including infections, dislocations and loosening. The final average MSTS score was 19.6 (65%) and all reconstructive methods produced similar functional results. CONCLUSION: Reconstructions of the acetabulum with a prosthesis after a periacetabular resection had a relatively high rate of complications. A flail hip might be one suitable reconstructive options after a periacetabular resection.

Parosteal Ossifying Lipoma of Femur: A Case Report

Parosteal lipoma is a rare and generally asymptomatic benign tumor of mature adipose tissue that is located in direct apposition to the external surface of the bone. These tumors are occasionally associated with reactive changes in the underlying bone. The reactive bone formation is generally restricted to the base of the tumor, that is, near the periosteum. We recently experienced a case of parosteal lipoma in the proximal femur, which displayed exuberant bone and cartilage formation, and this led us to a misdiagnosis of chondroblastic osteosarcoma on the initial biopsy. We report here on this case with a special emphasis on making the differential diagnosis from osteosarcoma.

Chondrosarcoma of the Pelvis following Internal Pelvectomy:Functional and Oncological Results / 대한정형외과학회잡지

PURPOSE: We analyzed the nature of primary chondrosarcoma of the pelvis, along with long-term survival, complications, and functional outcomes. MATERIALS AND METHODS: Twenty-five cases of pelvic chondrosarcoma were enrolled. The average age was 40 (range: 17-69) years. The stage was IB in 5, IIB in 20. All of the 25 cases had underwent internal pelvectomy. Twelve cases had resections involving the acetabulum, while 7 involved the iliac wing and 6 involved the pubic bone. Study points were the reconstructive methods according to the extent of resection and the functional results, complications, local recurrence and the metastasis pattern following the clinical factors affecting long-term survival. RESULTS: The 16-year CDF survival of 25 cases following operation was 78.7%. Three (12%) local recurrences and 3 metastases occurred. The MSTS score of the iliac and pubic resection group was 25.3. Of 12 cases with acetabular resection, 6 had prosthetic arthroplasty, 4 had psuedoarthrosis, 1 had arthrodesis, and 1 had excision. Their overall MSTS score was 19.4. There were 2 infections, 1 flap necrosis, 1 screw failure and 2 hip dislocations. Of 11 cases of a high grade (G3), there were 3 metastases and 1 local recurrence. CONCLUSION: The long-term survival rate was good and the pathologic grade had some correlation with prognosis. Because acetabular reconstructions of any kind may involve serious complications, primary pseudoarthrosis can be regarded as an alternative option.

The Primary Malignant Bone Tumors of Distal Tibia: Comparison between Limb Salvage and Amputation / 대한정형외과학회잡지

PURPOSE: The long term survival and indications of limb salvage surgery for primary malignant bone tumors of the distal tibia were evaluated, and the results of the reconstruction method using a pasteurized autograft alone or a pasteurized autograft and living fibular bone graft composite were examined. MATERIALS AND METHODS: From March 1985 to June 2004, 13 cases were considered eligible. The diagnosis included 9 osteosarcomas, 2 chondrosarcomas, 1 parosteal osteosarcoma, and 1 malignant fibrous histiocytoma of the bone. There was 1 case of stage IB, 1 IIA, and 11 IIB according to the Enneking classification. Each case underwent surgery and 10 cases underwent additional chemotherapy. Six cases underwent a below-knee amputation and 7 cases had limb salvage surgery. The reconstruction methods were pasteurized bone alone (5), an additional living fibula bone graft (1) or a living fibula bone graft alone (1). RESULTS: There was no recurrence or metastasis at the final follow up. The MSTS functional score of the limb salvage group and amputation group were 85% and 82% respectively. Two out of 5 cases of reconstruction with pasteurized bone alone achieved bony union at 6 and 9 months after surgery. The remaining 3 cases showed nonunion and fractures of the pasteurized bone that was followed by an additional living fibula graft (2 cases) and cancellous iliac bone graft (1 case). Two cases of primary living fibula grafts are in the course of healing. CONCLUSION: The prognosis was good. Neurovascular invasion by the tumor and the necessity of a radical soft tissue excision indicated an amputation. There was no difference in the functional outcome between the limb salvage group and amputation group. A reconstruction method using pasteurized bone has bio-mechanical and economical benefits. However, primary additional living fibular bone graft is a promising method.

Primary Osteosarcoma in Patients Older than 40 Years of Age

Among the 665 patients who registered at our hospital, we reviewed 39 cases of high grade primary osteosarcoma in patients who were older than 40 yr of age. The aim of this study was to determine if a primary osteosarcoma in older patients has different clinical features, and a poorer prognosis than in younger patients. Two evaluations were performed. In the first, an attempt was made to determine the possible prognostic factors such as gender, location, size, alkaline phosphatase, radiological findings, chemotherapy intensity, chemotherapy-induced tumor necrosis, and surgical margin. The second evaluation involved assessment of whether there were any significant clinical differences between older patients and adoles-cents. According to the results, a primary osteosarcoma in older patients did not reveal any significant prognostic variables. A primary osteosarcoma in older patients showed a poorer prognosis due to relatively unusual locations, common abnormal radiological findings, and a poor response to chemotherapy. Therefore, careful attention should be paid to making an accurate diagnosis and new strategies for more effective treatment, including chemotherapy, must to be developed in order to achieve long term survival in older patients with osteosarcoma.

In Vitro Chemosensitivity Test of Human Soft Tissue Sarcoma Using the HDRA (Histoculture Drug Response Assay) Method / 대한정형외과학회잡지

PURPOSE: To investigate the variation in the chemosensitivity in soft tissue sarcoma (STS), fresh biopsy with sample for culture was tested using the histoculture drug response assay (HDRA)method. MATERIALS AND METHODS: 30 samples of fresh STS were obtained during either biopsy or surgical removal at our hospital between March, 2002 and March, 2004. RESULTS: Drug sensitivity testing by HDRA showed that two drug, Doxorubicin and CDDP, had a significantly higher inhibition rate than BLM, CTX, DTIC, VCR or VP-16 in the thirty STS tested. Doxorubicin showed the highest inhibition rate in the liposarcoma. CDDP shoewd the significant inhibition rate in the synovial sarcoma and malignant fibrous histiocytpma. Depending on the morphological type, round cell sarcoma and pleomorphic sarcoma were more sensitive to Doxorubicin and CDDP than spindle cell sarcoma. In the round cell sarcoma, BLM, CTX, VP-16 and IFS also showed above 30% inhibition rate. CONCLUSION: Drug sensitivity testing in STS should be evaluated with clinical outcome in the future and then HDRA will provide useful information for selection of an anticancer agent for STS because of its ease of evaluation and high predictability.

Osteosarcoma, survivorship following stage and chemotherapeutic regimen: 13 year experience of Korea Cancer Center Hospital / 대한정형외과학회잡지

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.