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Διεθνείς Δημοσιευσεις - Ογκολογικά θέματα


Free vascularised tissue transfer and brachytherapy for soft-tissue sarcomas of the extremities.

First Department of Orthopaedics, Athens University Medical School, Attikon General University Hospital, Athens, Greece. This e-mail address is being protected from spambots. You need JavaScript enabled to view it

SUMMARY: We reviewed the medical files of nine patients with localised soft-tissue sarcomas of the extremities treated with surgical resection, free vascularised tissue transfer, and computerised after-loading iridium-192 high dose rate brachytherapy over a period of 8 years. All patients had external beam radiation therapy in fractions with a total dose of 48-52 Gy, followed by surgery at approximately 4-5 weeks post-irradiation. Surgical treatment included wide resection of the primary tumour in six patients, and marginal resection in three patients. Microsurgical reconstruction of the soft-tissue defect used a free vascularised musculocutaneous flap that included the gracilis flap in five patients, the latissimus dorsi flap in four patients, and the radiovolar flap in one patient. Postoperative brachytherapy dose ranged from 12 to 24 Gy. Adjuvant chemotherapy was administered in five patients with large tumours and marginal resection. At a mean follow-up of 36 months, eight patients were still alive with no evidence of local recurrence or distant metastases; all these patients had good cosmetic and functional outcomes. Two patients died with lung metastases; one of these patients had local tumour recurrence. Wound healing problems and seroma formations were observed in two patients. Intramedullary nailing was required in one patient for a pathological fracture. Tumour resection for soft-tissue sarcomas combined with microsurgical reconstruction of the soft-tissue defect, preoperative external beam radiation and high dose rate brachytherapy results in a high degree of local control with acceptable complications.

PMID: 18687428 [PubMed - in process]

Bone Tumors

 

Pathological fractures in primary bone sarcomas.

First Department of Orthopaedics, Athens University Medical School, Athens, Greece. This e-mail address is being protected from spambots. You need JavaScript enabled to view it

Pathological fractures in patients with primary bone sarcomas should not be considered an absolute indication for amputation. Initial fracture management should include cast immobilisation or external fixation avoiding tumour-cell dissemination. The extent of fracture displacement and the type of fracture stabilisation may affect the outcome of patients with primary bone sarcomas presenting with pathological fractures. Patients with high-grade primary bone sarcomas should be treated by neo-adjuvant chemotherapy, and limb-salvage surgery. Pathological fractures in chemo-resistant primary bone sarcomas are a relative contraindication for limb salvage surgery.

PMID: 18061185 [PubMed - indexed for MEDLINE]

 

Prognostic value of bax, bcl-2, and p53 staining in primary osteosarcoma.

First Department of Orthopaedic Surgery, KAT Hospital, University of Athens, Athens, Greece. This e-mail address is being protected from spambots. You need JavaScript enabled to view it

BACKGROUND AND OBJECTIVES: To investigate the immunohistochemical expression of three apoptosis-related genes (bax, bcl-2, and p53) and apoptosis (TUNEL) in patients with primary osteosarcoma, and examine potential correlations between gene expression and clinicopathological characteristics in these patients. MATERIALS AND METHODS: Thirty-five primary osteosarcoma specimens and 18 tissue specimens deriving from non-malignant osseous lesions were immunohistochemically stained for bax, bcl-2, and p53 proteins, while apoptosis was investigated by the TUNEL method. The results were statistically analyzed. RESULTS: P53, bax, and bcl-2 protein expression was observed in 22 (62.9%), 29 (82.9%), and 18 (51.4%) osteosarcoma patients, respectively. Non-specific positive TUNEL staining (+/-) was observed in two primary osteosarcoma cases (5.7%). None of the benign controls expressed any of the genes studied. None of the apoptosis-related genes studied was able to predict overall or disease-free survival in our group of patients. Nevertheless, increased bax/bcl-2 protein expression ratio was associated with a decreased 4-year survival and disease free survival (P = 0.0229 and P = 0.0370, respectively). Furthermore, all the patients who were bax(+)/bcl-2(-)/p53(+) relapsed within the 4-year follow-up period (P = 0.0385). CONCLUSIONS: The increased apoptotic rate as determined by an elevated bax/bcl-2 protein expression ratio or by the bax(+)/bcl-2(-)/p53(+) protein expression pattern, appears to identify groups of osteosarcoma patients with unfavorable prognosis. 2007 Wiley-Liss, Inc

PMID: 18161867 [PubMed - indexed for MEDLINE]


Free vascularised tissue transfer and brachytherapy for soft-tissue sarcomas of the extremities.

First Department of Orthopaedics, Athens University Medical School, Attikon General University Hospital, Athens, Greece. This e-mail address is being protected from spambots. You need JavaScript enabled to view it

SUMMARY: We reviewed the medical files of nine patients with localised soft-tissue sarcomas of the extremities treated with surgical resection, free vascularised tissue transfer, and computerised after-loading iridium-192 high dose rate brachytherapy over a period of 8 years. All patients had external beam radiation therapy in fractions with a total dose of 48-52 Gy, followed by surgery at approximately 4-5 weeks post-irradiation. Surgical treatment included wide resection of the primary tumour in six patients, and marginal resection in three patients. Microsurgical reconstruction of the soft-tissue defect used a free vascularised musculocutaneous flap that included the gracilis flap in five patients, the latissimus dorsi flap in four patients, and the radiovolar flap in one patient. Postoperative brachytherapy dose ranged from 12 to 24 Gy. Adjuvant chemotherapy was administered in five patients with large tumours and marginal resection. At a mean follow-up of 36 months, eight patients were still alive with no evidence of local recurrence or distant metastases; all these patients had good cosmetic and functional outcomes. Two patients died with lung metastases; one of these patients had local tumour recurrence. Wound healing problems and seroma formations were observed in two patients. Intramedullary nailing was required in one patient for a pathological fracture. Tumour resection for soft-tissue sarcomas combined with microsurgical reconstruction of the soft-tissue defect, preoperative external beam radiation and high dose rate brachytherapy results in a high degree of local control with acceptable complications.

PMID: 18687428 [PubMed - in process]

Current treatment concepts for neuromas-in-continuity.

First Department of Orthopaedics, Athens University Medical School, Athens, Greece. This e-mail address is being protected from spambots. You need JavaScript enabled to view it

SUMMARY: A neuroma-in-continuity is a neuroma that results from failure of the regenerating nerve growth cone to reach peripheral targets. It occurs within an intact nerve in response to internally damaged fascicles, resulting in a distal portion of the nerve that no longer functions properly. Management of neuromas-in-continuity is challenging. Chemical methods, and microsurgical techniques including fascicular ligation, and burying into muscle and bone have been reported to prevent neuroma-in-continuity formation. The purpose of this article is to present novel techniques for neuroma-in-continuity management, and to discuss the related literature.

PMID: 18715561 [PubMed - in process]

Current concepts for management of soft tissue sarcomas of the extremities.

First Department of Orthopaedics, ATTIKON University Hospital, University of Athens, School of Medicine, Athens, Greece. This e-mail address is being protected from spambots. You need JavaScript enabled to view it

Wide resection and limb-salvage surgery remain the gold standard for the management of patients with soft tissue sarcomas of the extremities. Innovations in understanding tumor biology and limb-salvage techniques have led amputation rates to decline. Radiation therapy and novel chemotherapy agents and dosing regimens are supplementing oncology-related surgical treatment. A multidisciplinary team approach with input from oncologists, pathologists, radiation oncologists, and orthopaedic and plastic surgeons is necessary for the management of patients with soft tissue sarcomas of the extremities.

PMID: 18851808 [PubMed - indexed for MEDLINE]

 

Skeletal osteochondromas revisited.

Department of Microbiology and Immunology, Baxter Laboratory in Genetic Pharmacology, Stanford University, 269 Campus Drive, Stanford, California 94305, USA.

Skeletal osteochondromas or osteocartilaginous exostoses represent the most common of all benign bone tumors and 10% to 15% of all bone tumors. Osteochondromas are solitary or multiple, pedunculated or sessile exophytic outgrowths from the bone surface that are composed of cortical and medullary bone with an overlying hyaline cartilage cap. Marrow and cortical continuity with the underlying parent bone defines the lesion. Osteochondromas usually occur in children or adolescents between 10 and 15 years, and increase in size throughout childhood, ranging from 1 to 10 cm. After adolescence and skeletal maturity, osteochondromas usually exhibit no further growth. In adults, growth or imaging alterations of an osteochondroma suggest the rare diagnosis of malignant transformation; however, extensive growth of osteochondromas without histological evidence of malignancy has been reported

PMID: 19226005 [PubMed - in process]

Metastatic malignant melanoma of the conjunctiva: a case report.

Academic Unit of Trauma & Orthopaedic Surgery, Leeds General Infirmary, Leeds School of Medicine, Leeds, LS1 3EX, UK. This e-mail address is being protected from spambots. You need JavaScript enabled to view it .

ABSTRACT: BACKGROUND: Malignant melanoma of the conjunctiva is an extremely rare non-cutaneous neoplasm with infrequent skeletal metastatic spread. CASE PRESENTATION: We present the case of a 54 year old female Caucasian patient with osseous metastases originating from a malignant melanoma of her right conjunctiva. Metastatic deposits were identified in the left humeral diaphysis and left tibial metaphysis. Clinical, radiological and scintigraphic evaluation necessitated prompt stabilisation of both long bones. Following reamed intramedullary nailing and post-operative radiotherapy she remains asymptomatic six months post-operatively. CONCLUSION: This unusual pattern of metastatic spread to the appendicular skeleton of an extremely rare melanomatous lesion requires diagnostic vigilance as well as a multidisciplinary approach for accurate diagnosis, staging and management. Due to the poor prognosis, treatment goals should be directed to palliation of symptoms and prolongation of the quality of life.

PMID: 19193228 [PubMed - in process]

PMCID: PMC2642788