Clinical Orthopaedics and Related Research ®

A Publication of The Association of Bone and Joint Surgeons ®

Symposium: 2014 Musculoskeletal Tumor Society 10 articles


CT-based Structural Rigidity Analysis Is More Accurate Than Mirels Scoring for Fracture Prediction in Metastatic Femoral Lesions

Timothy A. Damron MD, Ara Nazarian PhD, Vahid Entezari MD, Carlos Brown MD, William Grant EdD, Nathan Calderon MSc, David Zurakowski PhD, Richard M. Terek MD, Megan E. Anderson MD, Edward Y. Cheng MD, Albert J. Aboulafia MD, Mark C. Gebhardt MD, Brian D. Snyder MD, PhD

Controversy continues regarding the appropriate assessment of fracture risk in long bone lesions affected by disseminated malignancy.

Does CT-based Rigidity Analysis Influence Clinical Decision-making in Simulations of Metastatic Bone Disease?

Ara Nazarian PhD, Vahid Entezari MD, Juan C. Villa-Camacho MD, David Zurakowski PhD, Jeffrey N. Katz MD, Mary Hochman MD, Elizabeth H. Baldini MD, Vartan Vartanians MD, Max P. Rosen MD, Mark C. Gebhardt MD, Richard M. Terek MD, Timothy A. Damron MD, Michael J. Yaszemski MD, PhD, Brian D. Snyder MD, PhD

There is a need to improve the prediction of fracture risk for patients with metastatic bone disease. CT-based rigidity analysis (CTRA) is a sensitive and specific method, yet its influence on clinical decision-making has never been quantified.

Is MR-guided High-intensity Focused Ultrasound a Feasible Treatment Modality for Desmoid Tumors?

Raffi S. Avedian MD, Rachelle Bitton PhD, Garry Gold MD, Kim Butts-Pauly PhD, Pejman Ghanouni MD, PhD

MR-guided high-intensity focused ultrasound is a noninvasive treatment modality that uses focused ultrasound waves to thermally ablate tumors within the human body while minimizing side effects to surrounding healthy tissues. This technology is FDA-approved for certain tumors and has potential to be a noninvasive treatment option for extremity soft tissue tumors. Development of treatment modalities that achieve tumor control, decrease morbidity, or both might be of great benefit for patients. We wanted to assess the potential use of this technology in the treatment of extremity desmoid tumors.

Do Mesenchymal Stromal Cells Influence Microscopic Residual or Metastatic Osteosarcoma in a Murine Model?

Megan E. Aanstoos MS, Daniel P. Regan DVM, Ruth J. Rose DVM, Laura S. Chubb BS, Nicole P. Ehrhart VMD

Mesenchymal stromal cells (MSCs) have been shown in rodent models to promote primary and pulmonary metastatic sarcoma growth when injected in the presence of gross tumor. In theory, this would limit their use in a clinical setting after limb salvage treatment for osteosarcoma. Although concerning, these models do not translate to the clinical setting wherein MSCs could be used after primary tumor resection to aid in bone healing and incorporation of tumor endoprostheses. If we can determine whether the use of MSCs in this setting is safe, it might improve our ability to augment bone healing in patients undergoing limb salvage.

How Does the Level of Sacral Resection for Primary Malignant Bone Tumors Affect Physical and Mental Health, Pain, Mobility, Incontinence, and Sexual Function?

Rishabh Phukan BA, Tyler Herzog BS, Patrick J. Boland MD, John Healey MD, Peter Rose MD, Franklin H. Sim MD, Michael Yazsemski MD, PhD, Kathryn Hess BA, Polina Osler BS, MS, Thomas F. DeLaney MD, Yen-Lin Chen MD, Francis Hornicek MD, PhD, Joseph Schwab MS, MD

En bloc resection for treatment of sacral tumors is the approach of choice for patients with resectable tumors who are well enough to undergo surgery, and studies describe patient survival, postoperative complications, and recurrence rates associated with this treatment. However, most of these studies do not provide patient-reported functional outcomes other than binary metrics for bowel and bladder function postresection.

Do Surgical Margins Affect Local Recurrence and Survival in Extremity, Nonmetastatic, High-grade Osteosarcoma?

Todd E. Bertrand MD, Alex Cruz BS, Odion Binitie MD, David Cheong MD, G. Douglas Letson MD

Long-term survival for all patients with osteosarcoma using current aggressive adjuvant chemotherapy and surgical resection is between 60% and 70%. In patients who present with nonmetastatic, high-grade extremity osteosarcoma of bone, limb salvage surgery is favored, when appropriate, over amputation to preserve the limb, because limb salvage may lead to a superior quality of life compared with amputation. However, concern remains that in the attempt to preserve the limb, close or microscopically positive surgical margins may have an adverse effect on event-free survival.

What Are the Risk Factors and Management Options for Infection After Reconstruction With Massive Bone Allografts?

Luis A. Aponte-Tinao MD, Miguel A. Ayerza MD, D. Luis Muscolo MD, Germán L. Farfalli MD

Massive bone allografts have been used for limb salvage of bone tumor resections as an alternative to endoprosthesis, although they have different outcomes and risks. The use of massive bone allografts has been thought to be associated with a high risk for infection, and there is no general consensus on the management of this complication and final outcome. Because infection is such a devastating complication of limb salvage, at times leading to loss of a limb, recognizing the risk factors for infection and the results of treatment is important.

Is Radiation Necessary for Treatment of Non-Hodgkin’s Lymphoma of Bone? Clinical Results With Contemporary Therapy

Ishaq Ibrahim BS, Bryan D. Haughom MD, Yale Fillingham MD, Steven Gitelis MD

Non-Hodgkin’s lymphoma (NHL) of bone is a rare musculoskeletal malignancy accounting for fewer than 7% of bone cancers. Traditionally, we have treated patients who have NHL of bone with chemotherapy and radiation therapy, but the role of radiotherapy in disease management and patient functional outcomes after treatment have not been well studied. We investigated the survival advantage of radiotherapy in a large cohort of patients with NHL of bone and assessed associated patient complications of radiotherapy.

What Is the Outcome of Allograft and Intramedullary Free Fibula (Capanna Technique) in Pediatric and Adolescent Patients With Bone Tumors?

Matthew T. Houdek MD, Eric R. Wagner MD, Anthony A. Stans MD, Alexander Y. Shin MD, Allen T. Bishop MD, Franklin H. Sim MD, Steven L. Moran MD

After bone tumor resection, reconstruction for limb salvage surgery can be challenging because of the resultant large segmental bony defects. Structural allografts have been used to fill these voids; however, this technique is associated with high complication rates. To circumvent the complications associated with this procedure, massive bony allografts have been supplemented with an intramedullary vascularized free fibula. However, few studies have examined the outcomes using this technique in the pediatric and adolescent populations.