Tag Archive | osteosarcoma

What’s New in Orthopaedic Oncology

Every month, JBJS publishes a Specialty Update—a review of the most pertinent and impactful studies published in the orthopaedic literature during the previous year in 13 subspecialties. Here is a summary of selected findings from studies cited in the December 16, 2015 Specialty Update on orthopaedic oncology:

Malignant Primary Bone Tumors

  • A study comparing the efficacy of surgery versus radiation in 465 patients with Ewing sarcoma managed with standardized chemotherapy found lower local failure rates with surgery, but no significant differences in event-free survival, overall survival, or distant metastasis.1
  • A study of 30 long-term survivors of Ewing sarcoma after limb salvage found that, at a mean follow-up of 16 years, 83% of patients were performing athletic activity regularly. Those with pelvic and femoral resections with no reconstruction exercised more hours per week than those with endoprosthetic pelvic reconstruction.2
  • A survival and relapse analysis of 45 locally recurrent osteosarcomas identified a recurrent tumor that was ≥5 cm and metastatic disease at presentation as independent risk factors. Most recurrences were in soft tissues. Early detection and resection with wide negative margins are crucial for optimal outcomes.3
  • A long-term outcome study of 30 patients with recurrent sacral chordoma treated surgically found survival of 89% at two years, 56% at five years, and 19% at ten years. Wide resection gave the best chance of long-term survival, and complete resection of local recurrence gave the best chance of disease control.4

Benign Bone Tumors

  • A study investigating pulmonary metastasis risk factors in 167 patients with giant cell tumor of bone identified local recurrence as the strongest independent predictor of metastasis. Younger patients also had higher metastatic rates.
  • A multicenter study of clinical presentation and outcomes in 126 operatively treated patients with chondroblastoma of the extremities found a local recurrence rate of 4.8% over a minimum two-year follow-up. Findings suggested that local recurrence may be more common in patients with open physes.
  • An investigation of 195 patients with multiple hereditary exostosis found that seven (3.6%) had intraosseous chondroid lesions. Five of those patients developed chondrosarcomas.
  • Curettage, high-speed burring, and bone grafting without other adjuvants in 31 patients with an aneurysmal bone cyst resulted in only one recurrence (3.2%).5

Bone Metastasis and Reconstruction

  • In a study of 125 patients, CT-based structural rigidity analysis of femora to detect impending pathologic fractures had higher sensitivity, specificity, and predictive values than the Mirels classification.6
  • In 111 patients who underwent hemicortical allograft reconstruction of a remaining defect after hemicortical resection of a bone tumor, all of the host bone fractures healed without surgeons having to remove the allograft. The authors recommended hemicortical resections with allograft reconstructions for low- to intermediate-grade tumors.
  • Five-year revision-free survival of conventional total femoral replacements in 40 patients with primary malignant bone tumors was 48%. The most common mechanism of failure was soft-tissue insufficiency.7

References

  1. DuBois SG, Krailo MD, Gebhardt MC, Donaldson SS, Marcus KJ, Dormans J, Shamberger RC, Sailer S, Nicholas RW, Healey JH, Tarbell NJ, Randall RL, Devidas M, Meyer JS, Granowetter L, Womer RB, Bernstein M, Marina N, Grier HE. Comparative evaluation of local control strategies in localized Ewing sarcoma of bone: a report from the Children’s Oncology Group. Cancer. 2015 Feb1;121(3):467-75. Epub 2014 Sep 23.
  2. Hobusch GM, Lang N, Schuh R, Windhager R, Hofstaetter JG. Do patients with Ewing’s sarcoma continue with sports activities after limb salvage surgery of the lower extremity? Clin Orthop Relat Res. 2015 Mar;473(3):839-46.
  3. Takeuchi A, Lewis VO, Satcher RL, Moon BS, Lin PP. What are the factors that affect survival and relapse after local recurrence of osteosarcoma? Clin Orthop Relat Res. 2014 Oct;472(10):3188-95. Epub 2014 Jul 1.
  4. Xie C, Whalley N, Adasonla K, Grimer R, Jeys L. Can local recurrence of a sacral chordoma be treated by further surgery? Bone Joint J. 2015 May;97-B(5):711-5.
  5. Wang EH, Marfori ML, Serrano MV, Rubio DA. Is curettage and high-speed burring sufficient treatment for aneurysmal bone cysts? Clin Orthop Relat Res. 2014Nov;472(11):3483-8. Epub 2014 Jul 22.
  6. Damron TA, Nazarian A, Entezari V, Brown C, Grant W, Calderon N, Zurakowski D,Terek RM, Anderson ME, Cheng EY, Aboulafia AJ, Gebhardt MC, Snyder BD. CT-based structural rigidity analysis is more accurate than Mirels scoring for fracture prediction in metastatic femoral lesions. Clin Orthop Relat Res. 2015 Jul 14.
  7. Sevelda F, Schuh R, Hofstaetter JG, Schinhan M, Windhager R, Funovics PT. Total femur replacement after tumor resection: limb salvage usually achieved but complications and failures are common. Clin Orthop Relat Res. 2015Jun;473(6):2079-87. Epub 2015 Apr 2.

What’s New in Primary Bone Tumors

Every month, JBJS publishes a Specialty Update—a review of the most pertinent and impactful studies published in the orthopaedic literature during the previous year in 13 subspecialties. Here is a summary of selected findings from studies cited in the December 17, 2014 Specialty Update on primary bone tumors:

Chondrosarcoma

–MicroRNA-145, an inhibitor of cell growth, was expressed at abnormally low levels in chondrosarcoma, lending credence to the hypothesis that underexpression of microRNA-145 plays a role in cancer development.

–Osteoclasts enhance the ability of chondrosarcoma to invade bone, but that invasion that can be partially halted by zoledronic acid.

–There is increased activity of the glycolysis-associated enzyme lactate dehydrogenase-A (LDHA) in chondrosarcoma.

–Density and location of new blood-vessel formation may be an important prognostic factor in chondrosarcoma.

–Conditional survival in patients with chondrosarcoma improves with each year of survival, but even patients who survive ten years after diagnosis cannot be considered cured.

Chordoma

–Variants of T transcription factor play a role in the pathophysiology of familial and sporadic chordoma.

–In patients with primary sarcomas of the spine, proton radiation plus surgery yielded local control rates of 85% at eight years.

Osteosarcoma

–Expression of the glucose transporter Glut-1 correlated with worse outcomes in patients with osteosarcoma.

–Secondary malignant neoplasms were found in 2.1% of long-term survivors of osteosarcoma.

–Use of fluorescence-guided surgery in a mouse model of osteosarcoma allowed reduction in the amount of residual tumor and improved disease-free survival.

–Among patients with high-grade osteosarcoma with soft-tissue extension, four parameters—tumor location, intracapsular extension, Huvos grade, and alkaline phosphatase level—may help predict which individuals will eventually develop metastases.

–In 45 patients with local recurrence but no metastases, the 10-year survival rate was 13%; most local recurrences were in soft tissue, not bone.

–Mid-therapy PET imaging may be useful to physicians in assessing response to chemotherapy.

Ewing Sarcoma

–Twenty-one percent of Ewing sarcoma samples had deletions of the STAG2 gene, and patients with STAG2 deletions had more aggressive tumors.

Soft-Tissue Sarcoma

–Among patients who also had surgery, intensity-modulated radiation therapy (IMRT) was associated with a lower local recurrence rate compared to conventional external-beam radiation.

–Six-month progression-free survival was 58% among 91 patients in a phase-II clinical trial of a hypoxia-activated cytotoxic agent (TH-302) used with doxorubicin.

–In a follow-up protocol comparison, radiography was noninferior to CT in terms of overall survival rate and disease-free survival.

–Ninety-five percent of 867 soft-tissue sarcoma patients who developed a recurrence did so within 8.6 years, raising questions about the usefulness of following patients beyond 10 years.

Reconstruction

–Due to high complication rates, intercalary allograft reconstruction after tumor resection should be reserved for defects of 15 cm or less, and plate-and-screw fixation should be used rather than intramedullary-nail fixation.

–Thirty-six patients who received frozen orthotopic autograft during reconstruction demonstrated a 10-year autograft survival rate of 80%.

–Patients who underwent pelvic reconstruction had a higher infection rate (26%), compared with those who did not undergo pelvic reconstruction (15%).