Comparison of such three in vitro inactivation methods as alcohol inactivation, irradiation inactivation, and liquid nitrogen inactivation for the treatment of femur osteosarcoma in children / 中华实用儿科临床杂志

Objective:To retrospectively analyze the clinical effects and complications of alcohol inactivation, irradiation inactivation, and liquid nitrogen inactivation in the treatment of femur osteosarcoma in children, in an attempt to provide a theoretical basis for clinical selection of in vitro inactivation methods of tumor bone segment. Methods:The clinical data of 93 children with femur osteosarcoma admitted to the Department of Bone and Soft Tissue, the Affi-liate Cancer Hospital of Zhengzhou University from January 2008 to December 2017 were retrospectively analyzed, and 40 children, including 21 males and 19 females, aged 8-18 (13.65±2.87) years, who were treated with in vitro inactivation and replantation of autogenous tumor bone segment, were screened.Among these children, there was alcohol inactivation in 15 cases, irradiation inactivation in 12 cases, and liquid nitrogen inactivation in 13 cases.A comparison was drawn on these 3 inactivation methods with respect to bone healing time, bone healing rate, tumor recurrence rate, infection rate, fracture or fixation failure rate, and revision rate. Results:All those 40 children were subject to valid medical followed-up, with the alcohol inactivation group for (102.60±16.55) months, the irradiation inactivation group for (59.33±6.39) months, and the liquid nitrogen inactivation for (36.85±6.49) months.The difference in follow-up time of 3 groups was statistically significant ( P<0.05). Compared with other 2 groups, the index of bone healing time, bone healing rate, infection rate and revision rate in the alcohol inactivation group were unfavorable, which showed a significant difference (all P<0.05); However, there was no significant difference in the recurrence rate, fracture rate or fixation failure rate compared with other 2 groups (all P>0.05); There was no significant difference in all above indexes between the irradiation group and the liquid nitrogen group (all P>0.05). Conclusions:Three in vitro inactivation methods for the treatment of tumor bone segment are safe and reliable.The alcohol inactivated bone has a long healing time and more complications.Both irradiation inactivation and liquid nitrogen inactivation are clinical options, but irradiation inactivation requires professional equipment, which may limit the clinical application.

Efficacy and safety of apatinib in advanced sarcoma: an open-label, nonrandomized, single-center study of 45 patients.

Sarcoma is a rare tumor with more than 50 histologic subtypes. Patients with advanced sarcoma have a poor prognosis. The aim of this study was to evaluate the efficacy and safety of apatinib, an oral vascular endothelial growth factor receptor-2 inhibitor, as salvage treatment for advanced bone and soft tissue sarcomas. From May 2017 to July 2018, a prospective, open-label, nonrandomized, clinical trial of apatinib was carried out in selected patients with advanced sarcoma. After apatinib dosing, progression-free survival (PFS), overall survival (OS), objective response rate, disease control rate, and treatment-related adverse events (AEs) were reviewed and evaluated. Patients were administered apatinib for at least 1 month. Median follow-up time was 6.00 months (1-13 months). The median PFS was 7.88 months, with the longest PFS of 13 months observed in a patient with epithelial sarcoma. The 3-month PFS rate was 66.44%. The median OS was 11.64 months with significant differences observed based on disease subtypes. Four patients achieved a partial response, and 36 patients achieved stable disease. The objective response rate was 8.88% (4/45), and the disease control rate was 88.89% (40/45). The most common grade 3/4 treatment-related AEs were hypertension (12.50%), hand-foot syndrome (6.67%), diarrhea (12.50%), fatigue (6.25%), and proteinuria (14.29%). One drug-related severe AE of thrombocytopenia (21×10/l) occurred 2 months after therapy. Apatinib treatment in our study exhibited objective efficacy in PFS, OS, and manageable toxicity in patients with advanced sarcoma. This result supports future randomized controlled trials to further define apatinib activity in stage IV sarcomas.

Experience of pedicled flaps for defect reconstruction after resection of sarcoma around extremities joint in 103 cases / 中华显微外科杂志

Objective To investigate the clinical effect of using pedicled flap to reconstruct skin and soft tis-sue defect after resection of sarcoma around extremities joint. Methods Retrospectively analysis 103 cases of sar-coma around extremities joint who was treated from June, 2012 to June, 2017 and used the pedicled fasciocutaneous flaps or pedicled musculocutaneous flaps to reconstruct the defect after sarcoma resection. There were 61 males and 42 females, with a mean age of 52.3 (14-82 ) years old. Among these patients, there were 32 initial diagnosis, 30 had been resected in other units, and 41 recurrent tumor. There were 13 patients that tumor around wrist:reconstructed by radial wrist upper branch fasciocutaneous flap, dorso-ulnar flap based on supracarpal perforator, and posterior in-terosseous artery flap. Eight patients with tumor around elbow: reconstructed by lateral arm flap and media arm flap. Eight patients with tumor around shoulder: reconstructed by latissimus dorsi musculocutaneous flap and lateral tho-racic flap. Fourteen patients with tumor around hip: rectus femoris musculocutaneous flap, tensor fascia lata musculo-cutaneous flap, and posterior thigh fasciocutaneous flap. Sixteen patients that tumor around knee:reconstructed by an-terolateral low leg flap, and sural calf fasciocutaneous flap. Forty-four patients that tumor around ankle: reconstructed by saphenous neuro-veno-fasciocutaneous flap, sural neuro-veno-fasciocutaneous flap, lateral supramalleolar flap, and medial plantar flap. The defect area after tumor resection were:3 cm ×4 cm-18 cm×25 cm. After surgery, observe the situation and fitness of flap, complication, joint mobility, and tumor recurrence and metastasis. Results Allflaps survived except 6 died or partial died, with a survival rate of 94.2％, of which dead flap were replaced by a new flap or covered by free skin graft. Infection occurred in 4 cases (2 in donor site and 2 in recipient site), were cured by dressing and antibiotic. Except for 12 cases dropped, all rest 91 cases were followed-up by 33 months on average (1-5 years), flaps' shape and texture were good, without swollen and fester, and fit well. Superficial sensibility of direct fasciocuta-neous flaps and musculocutaneous flaps were normal, protective sensation of reverse fascial flaps were recovered. The mobility of affected joint show no difference compared with the other side. No ulcer occurred on flaps of plantar and but-tocks, that helps normal sit position and gait. There were 17 recurrences and 32 metastasis occurred, 21 patients died so far. There was a statistical difference between recurrent cases with first shot(10.3％) second widely resection(11.5％) and recurrent resection(30.6％)(P<0.05). Conclusion Using pedicled flap to reconstruct skin defect after the resection of sarcoma around extremities joint, can get good clinical result, with simple and reliable operation. It is worth to popularize.

Preliminary application of pedicled vascularized fibular periosteum transplantation for union promotion of irradiated tibia sarcoma section autograft in children / 中华显微外科杂志

Objective To investigate the clinical effect of irradiated-host bone ends' union after transplantation of pedicled vascularized fibular periosteum in the treatment of Children's tibia sarcoma.Methods From June,2016 to December,2016,there were 5 children of tibia sarcoma,which were 2 boys and 3 girls,aged of 9-15 years (mean,12 years).They were treated by the re-transplantation of extracorporal irradiated segmental autograft,and used ipsilateral pedicled vascularized fibular periosteum cover the ends of irradiated-host bone to shorten the bone union time of irradiated tibia autograft and prevent nonunion.Patients were 3 cases of osteosarcoma,1 of Ewing's sarcoma,and 1 of relapse of Langerhans's cell histocytosis in tibia.The length of resect bone was 14.0-20.0 cm (mean,17.2cm),constitute of 2 osteoarticular resections and 3 intercalary resections.The method of inactivation of bone segment was intraoperative extracorporal irradiation.Regular followed-up were done postoperative.The X-ray and CT were applied to observe the function of affect limb.The bone union time and complication were record.Results All patients were followed-up of 12-18 months (mean,14.2 months).Eight ends of irradiated-host bone in 5 patients healed completely in 7.8 (6-10) months postoperative.The region of ends were covered by periosteum and showed excellent osteogenic power.There was no leg length discrepancy occurred in patients who received intercalary inactivation because of the preservation of growth plate.But the other 2 osteoarticular inactivated patients suffered leg length discrepancy of 1.0 cm and 1.5 cm respectively because of the inactivation of growth plate.At the follow-up of 12 months post-operation,the mean MTSS of affect limb was 25.8(22-28),and the mean of MTSS％ was 86％(73％-93％).Conclusion Transplantation of pedicled vascularized fibular periosteum can promote effectively healing of irradiated tibia bone after replantation in Children,with simple operation and less complications.

Reconstruction with massive allograft bone for osteosarcoma of the middle tibia with limb salvage / 中国组织工程研究

BACKGROUND:There are many complications of limb salvage surgery in patients with osteosarcoma of the middle tibia, and the limb salvage surgery is one of the current difficulties in clinical treatment. OBJECTIVE:To evaluate the clinical efficacy of reconstruction with massive al ograft bone for osteosarcoma of the middle tibia by retrospectively reviewing relevant cases. METHODS:Seven patients with osteosarcoma of the middle tibia were treated. And we analyzed their clinical data retrospectively. Al patients completed the formal preoperative adjuvant chemotherapy and we confirmed that there was no distant metastasis before surgery. Al patients received large al ogeneic bone transplantation and internal fixation, and the gastrocnemius muscle flap coveraged graft bone in surgery. The average length of al ogeneic bone was 12.5 cm. Five patients received postoperative adjuvant chemotherapy completely, and two patients received partly. RESULTS AND CONCLUSION:The fol ow-up period was 18-36 months. One patient had local tumor recurrence at 1 year after transplantation, and died of lung metastases after amputation. One patient survived after resection of lung metastases that occurred at 1.5 years after transplantation. One patient died of lung metastases at 2 years after transplantation. The rest four patients were tumor-free. The mean Musculoskeletal Tumor Society (MSTS) score was 26.5, the mean International Society of Limb Salvage (ISOLS) graft score was 31. Among four underage patients, one had leg length deformities, with limb shortening 2 cm. There were no postoperative infections and pathological fractures. Using large al ogeneic bone for the repair of bone defects after tumor surgery of the middle tibia can have a good clinical efficacy under the premise of strict indications. Using gastrocnemius muscle flap to cover the bone graft during surgery is an effective measure to reduce postoperative complications.

Use of gluteus maximus adipomuscular sliding flaps in the reconstruction of sacral defects after tumor resection.

BACKGROUND: While performing sacrectomy from a posterior approach enables the en bloc resection of sacral tumors, it can result in deep posterior peritoneal defects and postoperative complications. We investigated whether defect reconstruction with gluteus maximus (GLM) adipomuscular sliding flaps would improve patient outcomes. METHODS: Between February 2007 and February 2012, 48 sacrectomies were performed at He Nan Cancer Hospital, Zhengzhou City, China. We retrospectively examined the medical records of each patient to obtain the following information: demographic characteristics, tumor location and pathology, oncological resection, postoperative drainage and complications. Based on the date of the operation, patients were assigned to two groups on the basis of closure type: simple midline closure (group 1) or GLM adipomuscular sliding reconstruction (group 2). RESULTS: We assessed 21 patients in group 1 and 27 in group 2. They did not differ with regards to gender, age, tumor location, pathology or size, or fixation methods. The mean time to last drainage was significantly longer in group 1 compared to group 2 (28.41 days (range 17-43 days) vs. 16.82 days (range 13-21 days, P < 0.05)) and the mean amount of fluid drained was higher (2,370 mL (range 2,000-4,000 mL) vs. 1,733 mL (range 1,500-2,800 mL)). The overall wound infection rate (eight (38.10%) vs. four (14.81%), P < 0.05) and dehiscence rate (four (19.05%)] vs. three (11.11%), P < 0.05) were significantly higher in group 1 than in group 2. The rate of wound margin necrosis was lower in group 1 than in group 2 (two (9.82%) vs. three (11.11%), P < 0.05). CONCLUSIONS: The use of GLM adipomuscular sliding flaps for reconstruction after posterior sacrectomy can significantly reduce the risk of infection and improve outcomes.

Open vertebroplasty in the treatment of spinal metastatic disease.

BACKGROUND: Metastatic spine tumors can cause vertebral body (VB) osteolysis, microfractures, and/or compression fractures, and requires restabilization of the VB. Curative or curettage surgery, such as vertebrectomy and reconstruction, is currently the main method of treatment. In certain situations however, such as a patient's poor condition, multi-level involvement, or a limited life expiration, major surgery is not recommended. OBJECTIVE: To evaluate a new method of open vertebroplasty (OVP) in the treatment of VB metastasis and to investigate the indications for, limitations of, and the result of this new procedure. METHODS: Between May 2007 and May 2010, the authors treated 18 patients with VB metastasis disease by OVP. Patients consisted of 12 men and 6 women with a mean age of 53 years. All patients suffered severe back pain preoperatively (mean VAS score of 6.82). Spinal cord compression resulted in eight and isolated radicular compression occurred in three of the 18 patients. In these 18 patients, 28 vertebral levels were treated: three levels in 3 patients; two levels in 4 patients; and one level in the remaining 11 patients. OVP was used accompanied by vertebral fixation or medullary compression. RESULTS: The mean duration of the OVP procedure was 37 min. Blood loss ranged from 50 to 150 ml. In all patients, pain improved within seven days after the intervention, and the mean VAS score decreased to 2.31. Patients who suffered from neurological dysfunction preoperatively improved in Frankel degree (the result of spinal cord decompression). Most patients reached an excellent score, according to the Modified MacNab Criteria. Postoperative radiography revealed cement leaks into pulmonary veins in one case. After OVP or PVP, all patients underwent radiotherapy or chemotherapy. CONCLUSIONS: OVP has a comprehensive application in metastasis spinal column disease, being easily performed and accompanied by few complications. Importantly, this procedure allows decompression of the spinal cord and consolidation of the VB, thus stabilizing the vertebral column. Results from the clinic demonstrate that patients experience pain relief and neural function recovery following the OVP procedure.