Reconstruction with Unconventional Endoprostheses after Resection of Primary Distal Femoral Bone Tumors: Implant Survival and Functional Outcomes / Reconstrução com endoprótese não convencional após ressecção de tumores ósseos primários de fêmur distal: sobrevida do implante e resultados funcionais

Abstract Objective To evaluate the survival time, the failure rate and its causes, and the functional results of cemented endoprostheses, with a polyethylene body, used after resection of primary bone tumors of the distal femur. Methods A retrospective study including 93 primary and 77 review procedures performed between 1987 and 2014. Survival was obtained by the Kaplan Meyer analysis, and the risk factors for implant failure were assessed through the Cox proportional risk model. The causes of endoprosthesis failure were classified according to Henderson et al. into five types: soft-tissue failure, aseptic loosening, structural fracture, infection, and tumor recurrence. The functional evaluation was performed using the functional classification system of the Musculoskeletal Tumor Society (MSTS) of bone sarcomas of the lower extremity, Brazilian version (MSTS-BR). Results Osteosarcoma was the most common diagnosis; 64.5% of the patients were younger than 20 years of age; the mean follow-up was of 124.3 months. The failure rate of the primary implant was of 54.8%, and the mean survival was of 123 months. The estimated survival of the primary implant was of 63.6%, 43.5%, 24.1%, and 14.5% in 5, 10, 15, and 20 years respectively. The most common cause of failure was type 2 (37.3%). Age ≤ 26 years and right side were risk factors for failure. The mean MSTS-BR score was of 20.7 (range: 14 to 27). Conclusion The results obtained for the failure rate and survival of the implant are in accordance with those of the literature, so the procedure herein studied is adequate and yields satisfactory functional results, even in the long term.

Resumo Objetivo Avaliar o tempo de sobrevida, a taxa de falha e suas causas, e os resultados funcionais de endopróteses cimentadas, com corpo em polietileno, empregadas após ressecção de tumores ósseos primários do fêmur distal. Métodos Estudo retrospectivo, que incluiu 93 procedimentos primários e 77 de revisão, realizados entre 1987 e 2014. A sobrevida foi obtida pela análise de Kaplan Meyer, e os fatores de risco para falha do implante foram avaliados por meio do modelo de riscos proporcionais de Cox. As causas de falha da endoprótese foram classificadas segundo Henderson et al. em cinco tipos: falha de partes moles, soltura asséptica, fratura estrutural, infecção e recorrência do tumor. A avaliação funcional foi realizada por meio do sistema de classificação funcional da Musculoskeletal Tumor Society (MSTS) para sarcomas ósseos da extremidade inferior, versão brasileira (MSTS-BR). Resultados Osteossarcoma foi o diagnóstico mais comum; 64,5% dos pacientes tinham menos de 20 anos; e o seguimento médio foi de 124,3 meses. A taxa de falha do implante primário foi de 54,8%, e a sobrevida média foi 123 meses. A estimativa de sobrevida do implante primário foi de 63,6%, 43,5%, 24,1%, 14,5% em 5, 10, 15 e 20 anos, respectivamente. A causa de falha mais comum foi a do tipo 2 (37,3%). Idade ≤ 26 anos e lado direito foram fatores de risco para falha. A pontuação média no MSTS-BR foi de 20,7 (variação: 14 a 27). Conclusão Os resultados obtidos para a taxa de falha e o tempo de sobrevida do implante estão de acordo com os da literatura, de forma que o procedimento estudado é adequado e apresenta resultados funcionais satisfatórios, inclusive em longo prazo.

Evaluación funcional y calidad de vida en megaprótesis implantadas por tumores musculoesqueléticos en miembro inferior / Functional evaluation and quality of life in megaprostheses implanted by musculoskeletal tumors in the lower limb

Resumen: Introducción: La resección amplia es el tratamiento quirúrgico de elección en los tumores malignos musculoesqueléticos, que con frecuencia asientan en la pelvis y en los miembros inferiores. La reconstrucción mediante megaprótesis se ha impuesto en los últimos años como primera opción en la cirugía de preservación de la extremidad. Material y métodos: Estudio retrospectivo descriptivo serie de casos, incluye 30 pacientes intervenidos entre 2011 y 2019 de tumores musculoesqueléticos de pelvis y miembro inferior. En todos ellos valoramos la tasa de complicaciones y los resultados funcionales mediante el índice MSTS (Musculoskeletal Tumor Society). Resultados: Se realizó un seguimiento de 40.8 meses (12-101.7). En nueve pacientes (30%) se realizaron resecciones y reconstrucciones pélvicas, a 11 pacientes (36.7%) se les implantaron megaprótesis de cadera por afectación femoral, en tres de los pacientes (10%) se realizó resección del fémur completo y en siete pacientes (23.3%) reconstrucción protésica de la rodilla. El resultado funcional medio de la escala MSTS fue de 72.5% (rango: 40-95%) y la tasa de complicaciones de 56.7% (17 pacientes), siendo la recurrencia tumoral (29%) la principal complicación. Conclusión: La reconstrucción mediante megaprótesis ofrece buenos resultados funcionales a los pacientes dentro de la cirugía de resección radical, permitiendo realizar una vida relativamente normal.

Abstract: Introduction: Radical resection is the surgical treatment of choice in musculoskeletal malignancies, which often settle in the pelvis and lower limbs. Megaprothesis reconstruction has been imposed in recent years as the gold standard in limb preservation surgery. Material and methods: Descriptive retrospective study series of cases, including 30 patients operated between 2011 and 2019 of musculoskeletal pelvic and lower limb tumors at our institution that underwent limb-sparing reconstruction with the megaprosthesis. Functional results according to the MSTS (Musculoskeletal Tumor Society) index and complication rate were analyzed. Results: The average follow-up was 40.8 months (12-101.7). Nine patients (30%) underwent pelvic resections and reconstructions, 11 patients (36.7%) underwent hip reconstruction with megaprothesis due to femoral involvement, in three patients (10%) complete femur resection was performed, and seven patients (23.3%) underwent prosthetic reconstruction of the knee. The mean MSTS score was 72.5% (range: 40-95%), and the complication rate was 56.7% (17 patients), being de tumoral recurrence (29%) the main complication. Conclusion: Tumor megaprothesis give satisfying functional results, allowing the patients to realize a relatively normal life after a lower limb-sparing surgery.

Analysis of Postural Stability and Daily Energy Expenditure to Manage Tumor Patients' Functional Expectation

BACKGROUND: Advances in surgical techniques, implant technology, radiotherapy, and chemotherapy have increased the recovery chances of patients with bone sarcomas. Accordingly, patients' expectations on life quality have also increased, highlighting the importance of objective evaluation of the functional results of reconstruction. METHODS: Thirteen patients with distal femoral endoprosthesis, who had been followed for an average of 2.9 years were evaluated. Postural stability, daily energy expenditure, muscle power, and range of motion were the four parameters analyzed in this study. The Musculoskeletal Tumor Society (MSTS) score and Toronto Extremity Salvage Score (TESS) were used to assess postoperative function and examine correlations with other parameters. RESULTS: Patients had sedentary activities in 84% of their daily lives. They exhibited a slower speed in the walk across test and a higher sway velocity in the sit-to-stand test (p = 0.005). MSTS scores were significantly correlated with the daily energy expenditure and walking speed. CONCLUSIONS: Objective functional results acquired from various clinics will provide significant data to compare reconstruction techniques, rehabilitation protocols, and surgical techniques. In this way, it will be possible to satisfy the expectations of patients that increase in relation to enhanced recovery.

Current status of photodynamic therapy for unresectable hilar cholangiocarcinoma / 中国肿瘤临床

Hilar cholangiocarcinoma is a rare biliary malignant tumor derived from the biliary epithelial cell. The primary current treat-ments for hilar cholangiocarcinoma include surgery and chemotherapy, as well as radiation and photodynamic therapies (PDT). A com-plete resection with negative margins is the only treatment with the potential for cure and the only way to maximize survival. Howev-er, over half of the patients in the advanced stage of hilar cholangiocarcinoma lost the chance for surgery. Radiotherapy and chemo-therapy can prolong patient survival;however, these lack reliable data. Most patients who cannot be treated surgically undergo biliary stenting to relieve the biliary obstruction. The PDT is a new method to treat various malignant tumors. Several clinical studies have shown its local tumor ablation capability. Thus, PDT has broad application prospects in the treatment of unresectable hilar cholangio-carcinoma.

The Failure of Polyethylene Lock of MUTARS(R) Distal Femur Tumor Endoprostheses: A Case Report / 대한골관절종양학회지

The guidelines for the treatment of massive bone defects caused by bone resection due to tumors have changed from amputation to limb salvaging surgery. Limb salvaging surgery using endoprotheses is a well-established procedure. However, Aseptic loosening, infection, and mechanical defect remain significant problems. Among them, we experienced the case with a breakage of polyethylene lock of MUTARS(R) distal femur tumor Endoprostheses.