The 'other' bone sarcomas: prognostic factors and outcomes of spindle cell sarcomas of bone.

We aimed to identify the incidence, outcome and prognostic factors associated with spindle cell sarcomas of bone (SCSB). We studied 196 patients with a primary non-metastatic tumour treated with the intent to cure. The results were compared with those of osteosarcoma patients treated at our hospital during the same period. The overall incidence of SCSB was 7.8% of all patients with a primary bone sarcoma. The five- and ten-year survival rates were 67.0% and 60.0%, respectively, which were better than those of patients with osteosarcoma treated over the same period. All histological subtypes had similar outcomes. On univariate analysis, factors that were significantly associated with decreased survival were age > 40 years, size > 8 cm, the presence of a pathological fracture, amputation, involved margins and a poor response to pre-operative chemotherapy. Multivariate analyses showed that age > 65 years, amputation and involved margins were all statistically significant prognostic factors. Involved margins and poor response to pre-operative chemotherapy were associated with an increased risk of local recurrence. SCSB has a better prognosis than osteosarcoma when matched for age. Most prognostic factors for osteosarcoma also seem to apply to SCSB. Patients with SCSB should be treated in the same way as patients of the same age with osteosarcoma.

Factors associated with outcome in liposarcomas of the extremities and trunk.

PURPOSE: Liposarcomas are malignant tumors that arise from primitive mesenchymal cells rather than mature adipose tissue. We aimed to evaluate the outcomes of patients with extremities and superficial trunk liposarcomas in relation to some clinicopathological factors. METHODS: Sixty-three surgically treated patients with liposarcoma, with mean age 53 years, were included in this study. The 5-and 10-year survival rates were analyzed with respect to local recurrences, distant metastases and death with the Kaplan-Meier method. Cox models estimated univariate and multivariate hazard ratios for each candidate predictor of interest. RESULTS: The 5-year overall survival was 77.8% (95% CI 65.5-87.3) and the 10-year overall survival was 63.5% (95% CI 50.4-75.3). The 5-and 10-year recurrence-free survival were 60% and 57%, respectively. The 5-and 10-year metastasis-free survival were 86% and 84%, respectively. In univariate analysis factors that were significantly associated with outcomes were grade III tumors, amputation procedures, use of chemotherapy and development of local recurrences. No significant association was observed in multivariate analysis. CONCLUSION: Patients with liposarcoma surviving for 5 years, have also a high probability to be alive at 10 years. The development of metastases is observed within the first 5-years from diagnosis. Metastatic disease after that period is rare. The possibility of local recurrence is not negligible after the 5th year of follow up.

The role of radiation dose in a combined therapeutic protocol for the prevention of heterotopic ossification after total hip replacement.

PURPOSE: To present the results of a prospective study which aimed to evaluate the efficacy of radiation dose in a combined protocol using postoperative radiotherapy (RT) and indomethacin for the prevention of heterotopic ossification (HO) in patients undergoing total hip arthroplasty (THA) and are at high risk for HO development. METHODS: Seventy-one patients with a mean age of 63 years received either a single dose of 7 Gy or a fractionated dose of 10 Gy in 5 fractions of 2 Gy within the 3 postoperative days. Concurrently all patients received 75 mg of indomethacin for 15 days. Patients were analysed for radiographical evidence of HO development and clinically with the Merle d'Aubigné score at 1 year. RESULTS: At 12 months combined RT and indomethacin achieved excellent prophylaxis of HO. The overall radiographical incidence of HO was 7.04% (95% CI 2.33-15.67), while no patient with clinically significant HO (Brooker III-IV) was seen. There was no statistically significant difference between the two RT protocols. In a subgroup of 12 patients with bilateral THA the incidence of HO in the non-irradiated hips was statistically significantly higher compared with the irradiated hips. All patients had improved joint mobility and function during follow up compared with the preoperative period. No statistically significant differences regarding the Merle d'Aubigné score was documented between the 2 RT groups. No acute or late side effects related to RT were noted. CONCLUSION: This study demonstrated the efficacy of combined RT and indomethacin in preventing heterotopic ossification after total hip arthroplasty. Fractionated total dose of 10 Gy seems to offer no further benefit compared to a single dose of 7.0 Gy.

Heterotopic ossification after total hip arthroplasty (THA) in congenital hip disease: comparison of two different prophylactic protocols.

INTRODUCTION: We aimed to evaluate retrospectively the efficacy of combined postoperative radiotherapy and indomethacin compared to indomethacin alone for the prevention of heterotopic ossification (HO) in high-risk patients with congenital disease of hip (CDH) undergoing total hip arthroplasty (THA). MATERIALS AND METHODS: Fifty-five patients received indomethacin alone (Group A), while 44 patients received the combined protocol (Group B). Patients >or=55 years were enrolled in Group B and those younger than 55 years in Group A. Patients were evaluated radiologically for the presence of HO 6 months after the operation. RESULTS: The incidence of HO in Group A was 34.5% (95% confidence interval 22.2-48.6%), while the respective incidence in Group B patients was 27.3% (95% CI 15.0- 42.8%). The difference was not statistically significant (p=0.5). No significant treatment-related side effects were reported. CONCLUSIONS: This is the first study evaluating the impact of HO prophylaxis in an immiscible population of patients with secondary arthritis due to CDH undergoing THA. Further future randomised evidence is required in order to ascertain the observed trend towards improved efficacy of the combined protocol for HO development.

Effect of interlaminar epidural steroid injection in acute and subacute pain due to lumbar disk herniation: a randomized comparison of 2 different protocols.

In order to assess the efficacy of epidural steroid injections (ESI) in acute and subacute pain due to lumbar spine disk herniation, we conducted a randomized trial, comparing 2 different protocols. Fourty patients with radicular pain due to L4-L5 and L5-S1 disc herniation were assigned to receive either 3 consecutive ESI every 24 hours through a spinal catheter (group A) or 3 consecutive ESI every 10 days with an epidural needle (group B). All patients had improved Oswestry Disabilty Index (ODI) and the Visual Analog Scale (VAS) for pain scores at 1 month of follow-up compared to baseline, while no significant differences were observed between the 2 groups. The scores for group B were statistically significant lower at 2 months of follow-up compared to those of group A. The improvement in the scores of group B was continuous since the mean scores at 2 months of follow up were lower compared to the respective scores at 1 month. Protocol B (3 consecutive ESI every 10 days) was found more effective in the treatment of subacute pain compared to Protocol A (3 consecutive ESI every 24 hours) with statistically significant differences in the ODI and VAS scores at 2 months of follow-up.

Use of (99m)Tc-sulesomab for the diagnosis of prosthesis infection after total joint arthroplasty.

This study aimed to evaluate the diagnostic efficacy of antigranulocyte scintigraphy using the antibody fragment (99m)Tc-sulesomab (LeukoScan) for the diagnosis of prosthesis infection in patients with total hip or knee arthroplasty. The results from 19 patients with suspected total joint arthroplasty infection who had undergone a three-phase bone scan and a subsequent examination with (99m)Tc-sulesomab during a 1-year period were reviewed. Twelve patients were shown to have prosthesis infection on culture of aspirated synovial fluid or intra-operative samples. The overall sensitivity, specificity, positive and negative predictive values, and diagnostic accuracy for (99m)Tc-sulesomab were 75%, 86%, 90%, 66% and 79%, respectively, compared with 54%, 83%, 88%, 45% and 63%, respectively, for the three-phase bone scan. This study showed that (99m)Tc-sulesomab had good diagnostic value for the detection of prosthesis infection. The combination of (99m)Tc-sulesomab with other laboratory or imaging examinations may improve diagnostic performance in prosthesis infection and should be investigated further.

Adjuvant chemo-radiotherapy in patients with gastric cancer.

BACKGROUND: The role of adjuvant therapy in gastric cancer has been controversial. AIM: In this study, we report our experience with adjuvant chemotherapy and radiotherapy in patients with non-metastatic gastric cancer. SETTINGS AND DESIGN: Fifty patients were reviewed and assigned to three therapeutic groups. MATERIALS AND METHODS: Twenty patients received radiotherapy with concomitant administration of 5-fluorouracil and leucovorin on the first and last three days of radiotherapy; 20 patients received a five-day cycle 5-fluorouracil and leucovorin followed four to five weeks later by radiotherapy concomitant with the administration of fluorouracil on the first and the last three days of radiotherapy. Four weeks after radiotherapy two more five-day cycles of chemotherapy were administered; 10 patients received three cycles of cisplatin/docetaxel followed by radiotherapy and three additional cycles of chemotherapy after the completion of radiotherapy. STATISTICAL ANALYSIS: Patients were evaluated for treatment-related toxicity, local recurrences, distant metastases and deaths. We also aimed to make any possible comparisons between different chemo-radiation protocols. RESULTS: Within a median follow-up of 21.5 months seven patients developed local recurrence and 17 patients developed distant metastases. The overall death proportion was 42% (95% CI 28.2-56.8%). Despite the limited number of patients, no statistically significant differences in local recurrences, distant metastases and deaths were observed between the three protocols. Acute and long-term treatment-related toxicity was low and no treatment-related deaths were observed. CONCLUSION: Despite variations of chemotherapy, our study demonstrated that combined chemo-radiotherapy for patients with resected gastric cancer can be administered safely, with acceptable toxicity.

Cubital tunnel syndrome due to giant cell tumour of tendon sheaths.

Cubital tunnel syndrome is one of the most common entrapment neuropathies in adults. It is mainly caused by the depression of ulnar nerve from normal structures at the elbow area. Despite the fact that several pathgological entities can be potential mechanisms of the syndrome, the pathogenesis due to benign or malignant neoplasms is extremely rare. In the present report we describe the first case of cubital tunnel syndrome due to giant cell tumour of the tendon sheaths.

Concomitant ipsilateral traumatic dislocation of the hip and knee following high-energy trauma: a case report.

Traumatic dislocation of the hip or knee can occur after high-energy trauma and is often associated with concomitant injuries and secondary complications. Concomitant traumatic dislocation of both hip and knee is rare. We describe a case of combined ipsilateral posterior hip dislocation with a posterior acetabular fracture and a complete open knee dislocation with disruption of the popliteal artery that resulted in amputation.

Multi-focal gliosarcoma: a case report and review of the literature.

Gliosarcoma (GS) is an uncommon malignant brain tumor with biphasic tissue pattern consisted of both glial and sarcomatous components. It usually occurs in adult population of middle age. We report a rare case of multi-focal GS that was initially interpreted as metastases of extra-cranial tumor. The histological examination revealed the biphasic pattern of a GS. The patient was treated with postoperative external radiation therapy and had poor prognosis. To our knowledge this is the second published case of GS with multi-focal presentation. In this study we also review the literature on clinicopathological aspects of GS.

Astrocytoma-like multiple sclerosis.

Multiple sclerosis (MS) may sometimes mimic clinically and radiologically a brain tumor. The initial recognition of such cases is essential as it might avoid a surgical intervention and supplementary treatment. However, even in patients who underwent surgery, the appropriate preparation of the specimen is of crucial importance for the correct pathological diagnosis since tumors and non-neoplastic demyelinating lesions share some common histopathological features. We present such a case of multiple sclerosis presenting with features of an astrocytoma and was treated with surgery and additional radiotherapy.

External radiation therapy for endometrial carcinoma: the University Hospital of Ioannina experience.

PURPOSE OF INVESTIGATION: The aim of our study was to present the experience of our department in the treatment of endometrial cancer with postoperative external beam radiotherapy (EBRT) without intracavitary brachytherapy (BRT) and to evaluate the efficacy of such a method. METHODS: We retrospectively retrieved the medical records of all patients with endometrial cancer treated with surgery and EBRT alone (median dose 50.0 Gy). Thirty-one women (median age: 67 years) of all clinical stages were reviewed and analyzed for recurrences (local or metastases) and late post-radiation side-effects. RESULTS: Within a median follow-up of 17 months one patient developed local recurrence and four developed metastases. Overall survival was 97% and disease-free survival was 87%. Three women developed post-radiation colitis. No other treatment-related late side-effects were observed. CONCLUSION: EBRT without BRT achieved an excellent local control in women with endometrial cancer although some of them were candidates for supplementary BRT.

Primary cerebral gliosarcoma: a case presentation with review of the literature.

In this presentation we describe a rare case of a 42- year-old female with a large right frontal gliosarcoma (GS) treated with gross total resection of the tumor and postoperative external radiotherapy. The patient did not respond to treatment and she died 3 months after the end of radio- therapy. We also present a review of the literature on epidemiology, pathogenesis, clinical presentation, diagnosis and treatment of this uncommon clinical entity.

Recurrent prostate cancer: the role of salvage postoperative external radiotherapy in low risk patients.

PURPOSE: The aim of this study was to present the Ioannina Radiation Therapy Department experience in the treatment of postoperative recurrent prostate cancer with postoperative external beam radiotherapy (EBRT) in initially low-risk patients for recurrence. PATIENTS AND METHODS: The medical records of all patients who underwent salvage postoperative EBRT for either biochemical or clinical local recurrence were reviewed. Primary endpoints were the incidence of clinical and biochemical recurrences, metastases and death. RESULTS: A total of 11 patients with biochemical recurrence were included. Four of them had clinical local recurrence as well. Postoperatively, all patients had pT1-T2N0M0 stage and therefore had low risk for recurrence. However, they were admitted for EBRT with recurrent disease with a mean pre-RT prostatic specific antigen (PSA) of 10 ng/ml. The daily dose of radiotherapy (RT) was 1.8 to 2.0 Gy and the median total dose was 64.8 Gy. All of the patients but one achieved PSA nadir value (<0.5 ng/ml) after RT. With a median follow up of 21 months (range 9-42 months), 5 (45.5%) patients had biochemical failure, 2 (18.18%) developed clinical local recurrence, one (9.1%) developed bone metastases and 2 (18.18%) died. No serious long-term toxicity was observed. CONCLUSION: Despite the small sample size of our study that precluded any further analyses on prognostic factors affecting outcomes after salvage EBRT, we achieved satisfactory results regarding local control of disease, metastases and survival.