ABSTRACT
The authors discuss 18 cases of acute capsuloligamentous lesions of the external compartment of the knee submitted to surgical treatment. The results obtained by separately studying the progression of the various types of anatomical lesions revealed a relationship between the entity of the lesion and the results. Positive results were as follows: 100% in isolated lesions of the EC, 70% in lesions of the EC and ACL, 40% in lesions of the EC + ACL + PCL. In grade I distorsion trauma surgery is not indicated; in grade II lesions treatment is based on an objective examination in narcosis, and surgery should be performed when dynamic tests are positive; in grade III lesions surgery is always indicated. An objective examination in narcosis (rarely arthroscopy) is thus of essential importance to therapeutic indications.
Subject(s)
Knee Injuries/surgery , Ligaments, Articular/injuries , Acute Disease , Adolescent , Adult , Female , Follow-Up Studies , Humans , Knee Injuries/epidemiology , Knee Injuries/etiology , Ligaments, Articular/surgery , Male , Middle AgedABSTRACT
Osteosarcoma associated with Paget's disease is very malignant and has an extremely severe prognosis. This is also related to the usually advanced age of the patient and to the consequent impossibility of carrying out suitable chemotherapy. The case presented here is exceptional because of the young age of the patient, which allowed us to use a neoadjuvant chemotherapy protocol.
Subject(s)
Bone Neoplasms/diagnostic imaging , Humerus/diagnostic imaging , Osteitis Deformans/diagnostic imaging , Osteosarcoma/diagnostic imaging , Adult , Amputation, Surgical , Bone Neoplasms/complications , Bone Neoplasms/therapy , Combined Modality Therapy/methods , Fractures, Spontaneous/diagnostic imaging , Fractures, Spontaneous/etiology , Fractures, Spontaneous/therapy , Humans , Humeral Fractures/diagnostic imaging , Humeral Fractures/etiology , Humeral Fractures/therapy , Humerus/surgery , Male , Osteitis Deformans/complications , Osteitis Deformans/therapy , Osteosarcoma/complications , Osteosarcoma/therapy , Tomography, X-Ray ComputedABSTRACT
The relationship between dose-intensity and outcome was retrospectively analyzed in 125 patients with osteosarcoma of the extremities treated at our institution with neoadjuvant chemotherapy between 1986 and 1988. Before surgery, chemotherapy was performed with high-dose methotrexate (HDMTX) i.v. followed by cisplatinum (CDP) i.a. and adriamycin (ADM) i.v. Postoperative chemotherapy was tailored according to the necrosis induced by preoperative treatment. Patients who were "good responders" had 31-weeks of chemotherapy with the same drugs utilized preoperatively, while "poor responder" patients received a longer treatment (40 weeks) in which ifosfamide and etoposide (VP-16) were added to HDMTX, CDP and ADM. At a median follow-up of 2 years (1-3 years) 100 patients (80%) remained continuously disease-free and 25 patients relapsed: 24 with lung metastases and 1 with local recurrence. According to the real dose-intensity received, calculated as a percentage of the dose intensity projected by the protocol, the continuously disease-free survival was 87% in the 82 patients who received 80% or more of the scheduled dose-intensity and only 65% for the 43 patients who received less than 80% of the projected dose-intensity. This difference is highly significant (P less than 0.01). These results suggest that in neoadjuvant chemotherapy of osteosarcoma the real dose-intensity delivered is a determinant of treatment outcome and therefore every effort should be made to avoid reductions of doses and delays of cycles of chemotherapy in these patients.
Subject(s)
Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Bone Neoplasms/drug therapy , Osteosarcoma/drug therapy , Adolescent , Adult , Antineoplastic Combined Chemotherapy Protocols/administration & dosage , Arm , Bone Neoplasms/surgery , Child , Child, Preschool , Cisplatin/administration & dosage , Clinical Protocols , Colorectal Neoplasms/surgery , Combined Modality Therapy , Dose-Response Relationship, Drug , Doxorubicin/administration & dosage , Drug Administration Schedule , Female , Humans , Leg , Male , Methotrexate/administration & dosage , Preoperative Care , Retrospective StudiesSubject(s)
Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Chemotherapy, Adjuvant , Sarcoma, Ewing/drug therapy , Amputation, Surgical , Biopsy , Clinical Trials as Topic , Combined Modality Therapy , Disease-Free Survival , Follow-Up Studies , Humans , Recurrence , Sarcoma, Ewing/radiotherapy , Sarcoma, Ewing/surgery , Time FactorsABSTRACT
Between March, 1983 and June, 1986, 32 patients with localized high grade osteosarcoma of the extremities who refused chemotherapy before surgery (neoadjuvant chemotherapy), were immediately operated on and treated with a protocol of adjuvant chemotherapy. This was performed with adriamycin, methotrexate, cisplatinum, bleomycin, cyclophosphamide and dactinomycin. At a median follow-up of 40 months (12-57), 20 patients (63%) remained continuously disease-free. These results appear to be better than the results achieved in our institution in 108 patients treated between 1980 and 1982 with an adjuvant chemotherapy protocol in which only adriamycin and methotrexate were employed. They also seem comparable to the results obtained in 127 contemporary patients treated with neoadjuvant chemotherapy in which the same drugs were used (methotrexate i.v., cisplatinum i.a. preoperatively; adriamycin- methotrexate- cisplatinum or adriamycin -bleomycin -cyclophosphamide-dactinomycin postoperatively, depending on the degree of necrosis achieved by preoperative treatment). These data seem to indicate that the improved survival with neoadjuvant chemotherapy compared to a previous group of patients treated with adjuvant chemotherapy may be related to the improved effectiveness of the agents used rather than the sequence of treatment.
