Functional Outcome in Sarcomas Treated With Limb-Salvage Surgery or Amputation

Purpose.In all patients treated at the Centre for Bone and Soft Tissue Sarcomas of Aarhus the functional outcome is prospectively evaluated by use of the Enneking system for the functional evaluation after surgical treatment of tumours of the musculoskeletal system. This system has been accepted by the Musculoskeletal Tumour Society and the International Symposium on Limb Salvage.Patients/methods.In the present study the functional outcome after limb-salvage surgery (89 patients) and amputation (58 patients) was compared. In the limb-salvage group the treatment was surgery alone in 50% and surgery combined with either radiotherapy in 39% or chemotherapy in 11%. Inclusion criteria were: Deep seated extremity sarcomas, age >14 years, more than 1 year post-treatment follow-up time and alive at the end of the study. Median age was 49 years (range 14–88 years). Median tumour diameter was 8 cm (range 1–20 cm), median follow-up time was 4.8 years (range 1–11 years). Wilcoxon andχ2-tests were used for statistical analyses.Results.The two groups were comparable according to age, sex, size of tumour, type of tumour, location of tumour, as well as post-treatment follow-up time. The functional scores were significantly higher after limb-salvage surgery as compared to amputation, the median scores being 85 and 47, respectively (p<0.001). A similar difference was observed if the Enneking scores were subdivided into general health-related scores and extremity-related scores. No association was found between functional scores and the following factors by use of univariate analysis: size of tumour, radiation therapy, localization of tumour and surgical margin.Discussion.We conclude that this study indicates that limb-salvage surgery is associated with a better functional outcome than that observed after amputation. However, whether this also indicates a difference in quality of life needs further studies.

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Can Orthopedic Oncologists Predict Functional Outcome in Patients with Sarcoma after Limb Salvage Surgery in the Lower Limb? A Nationwide Study

Sarcoma ◽

10.1155/2014/436598 ◽

2014 ◽

Vol 2014 ◽

pp. 1-11 ◽

Cited By ~ 7

Author(s):

Sjoerd Kolk ◽

Kevin Cox ◽

Vivian Weerdesteyn ◽

Gerjon Hannink ◽

Jos Bramer ◽

...

Keyword(s):

Functional Outcome ◽

Limb Salvage ◽

Lower Limb ◽

Salvage Surgery ◽

Limb Salvage Surgery ◽

Toronto Extremity Salvage Score ◽

Patient Reported ◽

Functional Scores ◽

Mri Scans ◽

Preoperative Status

Accurate predictions of functional outcome after limb salvage surgery (LSS) in the lower limb are important for several reasons, including informing the patient preoperatively and, in some cases, deciding between amputation and LSS. This study aimed to elucidate the correlation between surgeon-predicted and patient-reported functional outcome of LSS in the Netherlands. Twenty-three patients (between six months and ten years after surgery) and five independent orthopedic oncologists completed the Toronto Extremity Salvage Score (TESS) and the RAND-36 physical functioning subscale (RAND-36 PFS). The orthopedic oncologists made their predictions based on case descriptions (including MRI scans) that reflected the preoperative status. The correlation between patient-reported and surgeon-predicted functional outcome was “very poor” to “poor” on both scores (r2values ranged from 0.014 to 0.354). Patient-reported functional outcome was generally underestimated, by 8.7% on the TESS and 8.3% on the RAND-36 PFS. The most difficult and least difficult tasks on the RAND-36 PFS were also the most difficult and least difficult to predict, respectively. Most questions had a “poor” intersurgeon agreement. It was difficult to accurately predict the patient-reported functional outcome of LSS. Surgeons’ ability to predict functional scores can be improved the most by focusing on accurately predicting more demanding tasks.

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Functional Outcome of Limb Salvage Surgery by Megaprosthesis for Malignant Bone Umours-Mid and Long Term Follow Up

International Journal of Current Research and Review ◽

10.31782/ijcrr.2020.122335 ◽

2020 ◽

Vol 12 (23) ◽

pp. 189-194

Author(s):

Manish R Shah ◽

Manisha M Shah ◽

Aditya K. Agrawal ◽

Malkesh D Shah ◽

Sarvang M Desai

Keyword(s):

Functional Outcome ◽

Limb Salvage ◽

Salvage Surgery ◽

Limb Salvage Surgery ◽

Long Term Follow Up

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Custom Mega Prosthesis in Metachronous Osteosarcoma

Annals of the National Academy of Medical Sciences (India) ◽

10.1055/s-0040-1712748 ◽

2017 ◽

Vol 53 (02) ◽

pp. 073-078

Author(s):

MV Natarajan ◽

Mohamed Sameer M ◽

Upasana Upadhyay ◽

MD Kumar

Keyword(s):

Functional Outcome ◽

Limb Salvage ◽

Salvage Surgery ◽

Primary Tumour ◽

Skeletal Metastases ◽

Limb Salvage Surgery ◽

Excellent Functional Outcome ◽

Conventional Osteosarcoma ◽

Diagnostic Modalities

ABSTRACT Background: The objective of the current study was to determine the incidence, clinical and pathologic characteristics, and outcome of patients with conventional osteosarcoma who developed metachronous tumours and treated by limb salvage surgery with Custom Mega Prosthesis. Methods: Among 1198 osteosarcoma patients who were treated with limb salvage surgery and implantation of custom mega prosthesis, 6 patients were found to have metachronous lesions. The absence of pulmonary metastases was conﬁrmed by chest radiographs and computed tomography while radionuclide bone scan and biopsy were used to conﬁrm the absence of skeletal metastases. The patients were treated by limb salvage surgery with custom mega prosthesis for the metachronous tumour and functional outcome was evaluated by MSTS scores. Results: Index primary tumours involved the femur (n=3) and the tibia (n=3) and were treated with limb salvage surgery using endoprosthetic reconstruction. Single metachronous tumours developed in the all of these patients with the interval between identiﬁcation of the primary tumour to development of the metachronous tumours varying from 18 months to 41 months. All metachronous tumours were treated with neoadjuvant chemotherapy and limb salvage surgery. We obtained excellent functional outcome for primary tumours and good functional outcome for metachronous tumours. Two patients succumbed to disease due to pulmonary and cerebral metastasis during follow-up. Conclusions: With advances in survival rate in the multidrug chemotherapy era in the post tumoursresection period, advanced diagnostic modalities help in diagnosing metachronous osteosarcoma. It should be recognized as important sequelae in long-term survivors. Meticulous follow-up is required to permit early detection and successful therapeutic intervention. Limb salvage surgery has provided consistent good results in metachronous osteosarcoma patients.

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Does neo-adjuvant chemotherapy increase the risk of infection after limb salvage surgery for bone tumors?

Journal of Clinical Oncology ◽

10.1200/jco.2007.25.18_suppl.20532 ◽

2007 ◽

Vol 25 (18_suppl) ◽

pp. 20532-20532

Author(s):

S. Sankaranarayanan ◽

V. Sokolovskiy ◽

V. Voloshin ◽

M. Aliev ◽

V. Zubikov ◽

...

Keyword(s):

Adjuvant Chemotherapy ◽

Limb Salvage ◽

Bone Tumors ◽

Salvage Surgery ◽

Limb Salvage Surgery ◽

Team Approach ◽

Group A ◽

Neo Adjuvant Chemotherapy ◽

Group B

20532 Background: Neo-adjuvant chemotherapy is commonly used to eradicate the micro metastases and to prepare the patient for limb-salvage surgery. It helps the surgeon to get good oncological margin intraoperatively. Methods: Between the period of 1992 - 2005, 321 patients underwent limb salvage surgery for bone tumors at the Department of General Oncology (Bone & Soft tissue tumors), N. N. Blokhin Russian Cancer Research Center & Moscow Regional Clinical Research Institute, Moscow, Russian Federation. 230/321 patients (Group A) received neo-adjuvant chemotherapy. The course of chemotherapy ranges from 2 to 11 cycles. 95/321 patients (Group B) did not receive neo-adjuvant chemotherapy. The histological diagnoses were: 155 - High grade osteosarcoma, 38 - Giant cell tumor, 36 - Malignant fibrous histiocytoma, 29 - Chondrosarcoma, 25 - Periosteal osteosarcoma, 21 - Metastasis from other organs and 17 - Ewing's tumor. Results: In Group A, 27 patients (11.7%) and in Group B, 7 (7.3%) had infection of endoprosthetic bed. Suppression of the immune system by chemotherapeutic agents is the main reason for the higher incidence of infection in Group A. All the 27 patients in Group A and 2 patients in Group B had revisional endoprosthetic replacement. In group A 7/27 and in Group B none of the 7 patients died of post operative infection. The follow-up ranged from 1 - 13 years (mean follow-up 6 years). Discussion: In our opinion, it has a major disadvantage, i.e. it increases the risk of postoperative infection. How best to combine this drug is still unknown. In the future, therapy for bone tumors should be enhanced by advances in pharmacology, immunology, and molecular genetics that will lead to more efficacious, specific and less toxic treatments. An interdisciplinary team approach is needed in order to advance the goal of local tumor control, limb salvage with optimum extremity function, minimal morbidity and improved long term survival. No significant financial relationships to disclose.

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Massive autoclaved allografts and autografts for limb salvage surgery A1-8 year follow-up of 23 patients

Acta Orthopaedica Scandinavica ◽

10.3109/17453679708996184 ◽

1997 ◽

Vol 68 (4) ◽

pp. 392-395 ◽

Cited By ~ 43

Author(s):

Naohiro Asada ◽

Hiroyuki Tsuchiya ◽

Katsuhiko Kitaoka ◽

Yoshihiko Mori ◽

Katsuro Tomita

Keyword(s):

Limb Salvage ◽

Salvage Surgery ◽

Limb Salvage Surgery

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Limb Salvage Surgery without Radiation Therapy for Soft Tissue Sarcomas of the Foot

Foot & Ankle Surgery: Techniques, Reports & Cases ◽

10.1016/j.fastrc.2021.100096 ◽

2021 ◽

pp. 100096

Author(s):

Keiko Hayakawa ◽

Seiichi Matsumoto ◽

Keisuke Ae ◽

Taisuke Tanizawa ◽

Yuki Funauchi ◽

...

Keyword(s):

Radiation Therapy ◽

Soft Tissue ◽

Limb Salvage ◽

Salvage Surgery ◽

Soft Tissue Sarcomas ◽

Limb Salvage Surgery

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Demography and Short Term Functional Outcome of Soft Tissue Sarcoma Treated with Limb Salvage Surgery

Journal of College of Medical Sciences-Nepal ◽

10.3126/jcmsn.v16i4.31050 ◽

2020 ◽

Vol 16 (4) ◽

pp. 238-245

Author(s):

Suresh Pandey

Keyword(s):

Soft Tissue ◽

Soft Tissue Sarcoma ◽

Functional Outcome ◽

Limb Salvage ◽

Negative Correlation ◽

Salvage Surgery ◽

Demographic Data ◽

Functional Score ◽

Limb Salvage Surgery ◽

Positive Correlation

Background: Limb salvage surgery with or without radiotherapy and/or chemotherapy is the mainstay of treatment of Soft Tissue Sarcoma (STS). Though, many studies are found regarding the demographics and result of such malignancy from other parts of the world, such data is not available from our country. This study aimed to analyze the demographic data and functional outcome of STS treated with limb salvage surgery. Methods: It is a retrospective review of 16 cases of soft tissue sarcoma of extremities and trunk managed with limb salvage surgery followed by adjuvant radiotherapy and/or chemotherapy in indicated cases from 2012 to 2017. Demographic data and functional score after 2 years of surgery were analysed and presented. Results: There were 14 male and 2 female cases of STS with mean age of 32.88 years. The most common STS was liposarcoma (37.5%) followed by rhabdomyosarcoma (25%) and synovial sarcoma (18.8%). Extremity and lower limb were the most common sites. Mean MSTS functional score at the last follow up was 24.56 (81.83%) with range from 19-29 (63.33%-96.66%). There were good to excellent results in 13 cases (81.25%) and moderate result in 3 cases (18.75%) according to MSTS functional score. There was positive correlation of MSTS with age, radiotherapy, chemotherapy and negative correlation with grade of tumor. Conclusions: This study showed good to excellent functional results in 81.25% of cases as per Musculoskeletal Tumor Society Score (MSTS) with positive correlation with radiotherapy, chemotherapy, age and negative correlation with grade of tumor.

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Clinical and Functional Outcomes using the Kyocera Modular Limb Salvage System for Lower Extremity Reconstruction

10.21203/rs.3.rs-37321/v1 ◽

2020 ◽

Author(s):

Donnel Alexis Ting Rubio ◽

Katsuhiro Hayashi ◽

Norio Yamamoto ◽

Toshiharu Shirai ◽

Akihiko Takeuchi ◽

...

Keyword(s):

Aseptic Loosening ◽

Limb Salvage ◽

Functional Outcomes ◽

Salvage Surgery ◽

Valgus Deformity ◽

Limb Salvage Surgery ◽

Superficial Infection ◽

Prosthesis Survival ◽

Tumor Group

Abstract Background: Segmental metallic endoprostheses are widely used and important in reconstructive procedures of the lower limb. Most of the currently available endoprostheses are made in Europe or the United States of America and are too large for Asian knees. The Japanese Musculoskeletal Oncology Group developed a tumor prosthesis better suited for Asian skeletal anatomy, the Kyocera Modular Limb Salvage System (KLS).Methods: We performed a retrospective review of the records of patients who underwent reconstruction using KLS implants. Thirty-five patients fulfilled the inclusion criteria, 20 having undergone limb salvage surgery for tumor and 15, joint arthroplasty. Functional outcomes were evaluated using the revised Musculoskeletal rating scale for the tumor group and the Japanese Orthopedic Association Knee Score for the arthroplasty group. Complications and survivorship of the implants were also assessed.Results: At the latest follow-up, in the tumor group, 13 were alive with no evidence of recurrence, 6 died of disease, and 1 was alive with evidence of disease. The average MSTS scores on latest follow-up were 63 for the proximal femur, 67 for the distal femur, and 92 for the proximal tibia. The mean prosthesis survival was 28 months. Complications include 4 cases of aseptic loosening, 2 deep infections, 1 superficial infection, 1 valgus deformity, 2 periprosthetic fractures, 2 incidences of excessive polyethylene wear, and 2 local tumor recurrences. In the arthroplasty group, 1 patient had a persistent low grade infection on the latest follow-up. The post-operative JOA score was 61(mean). Complications included 3 cases of aseptic loosening, 2 deep infections, 2 implant failures, 1 superficial infection, 1 valgus deformity, and 1 soft tissue defect.Conclusion: Early results of the KLS implant system are encouraging, with comparable clinical outcomes to other systems in the literature. A longer follow-up study with increased numbers of patients is necessary to further validate the functional outcomes and prosthesis survival using the KLS system for limb salvage surgery.

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