Clinical Orthopaedics and Related Research ®

A Publication of The Association of Bone and Joint Surgeons ®

Tumor 246 articles

Articles

Freezing Nitrogen Ethanol Composite May be a Viable Approach for Cryotherapy of Human Giant Cell Tumor of Bone

Po-Kuei Wu MD, Cheng-Fong Chen MD, Jir-You Wang PhD, Paul Chih-Hsueh Chen MD, Ming-Chau Chang MD, Shih-Chieh Hung MD, PhD, Wei-Ming Chen MD

Liquid nitrogen has been used as adjuvant cryotherapy for treating giant cell tumor (GCT) of bone. However, the liquid phase and ultrafreezing (−196° C) properties increase the risk of damage to the adjacent tissues and may lead to perioperative complications. A novel semisolid cryogen, freezing nitrogen ethanol composite, might mitigate these shortcomings because of less-extreme freezing. We therefore wished to evaluate freezing nitrogen ethanol composite as a coolant to determine its properties in tumor cryoablation.

Can Multistate Modeling of Local Recurrence, Distant Metastasis, and Death Improve the Prediction of Outcome in Patients With Soft Tissue Sarcomas?

Florian Posch MD, MSc, Lukas Leitner MD, PhD, Marko Bergovec MD, Angelika Bezan MD, Michael Stotz MD, Armin Gerger MD, MBA, Martin Pichler MD, MSc, Herbert Stöger MD, Bernadette Liegl-Atzwanger MD, Andreas Leithner MD, Joanna Szkandera MD

Exploration of the complex relationship between prognostic indicators such as tumor grade and size and clinical outcomes such as local recurrence and distant metastasis in patients with cancer is crucial to guide treatment decisions. However, in patients with soft tissue sarcoma, there are many gaps in our understanding of this relationship. Multistate analysis may help us in gaining a comprehensive understanding of risk factor-outcome relationships in soft tissue sarcoma, because this methodology can integrate multiple risk factors and clinical endpoints into a single statistical model. To our knowledge, no study of this kind has been performed before in patients with soft tissue sarcoma.

Is There Benefit to Free Over Pedicled Vascularized Grafts in Augmenting Tibial Intercalary Allograft Constructs?

Marco Manfrini MD, Srimanth Bindiganavile MD, Ferhat Say MD, Marco Colangeli MD, Laura Campanacci MD, Massimiliano Depaolis MD, Massimo Ceruso MD, Davide Donati MD

Intercalary reconstruction of tibial sarcomas with vascularized fibula autografts and massive bone allografts is reliable with predictable long-term results. However, inadequate data exist comparing free and pedicled vascularized fibula autografts in combination with a massive bone allograft in patients undergoing intercalary tibia reconstructions.

Can We Estimate Short- and Intermediate-term Survival in Patients Undergoing Surgery for Metastatic Bone Disease?

Jonathan A. Forsberg MD, PhD, Rikard Wedin MD, PhD, Patrick J. Boland MD, John H. Healey MD

Objective means of estimating survival can be used to guide surgical decision-making and to risk-stratify patients for clinical trials. Although a free, online tool () can estimate 3- and 12-month survival, recent work, including a survey of the Musculoskeletal Tumor Society, indicated that estimates at 1 and 6 months after surgery also would be helpful. Longer estimates help justify the need for more durable and expensive reconstructive options, and very short estimates could help identify those who will not survive 1 month and should not undergo surgery. Thereby, an important use of this tool would be to help avoid unsuccessful and expensive surgery during the last month of life.

What is the Incidence of Suicide in Patients with Bone and Soft Tissue Cancer?

Brianna L. Siracuse BS, George Gorgy BA, Jeremy Ruskin MD, Kathleen S. Beebe MD

Patients with cancer in the United States are estimated to have a suicide incidence that is approximately twice that of the general population. Patients with bone and soft tissue cancer often have physical impairments and activity limitations develop that reduce their quality of life, which may put them at high risk for depression, anxiety, and suicidal ideation. To our knowledge, there have been no large studies determining incidence of suicide among patients with bone and soft tissue cancer; this information might allow screening of certain high-risk groups.

What Factors are Associated With Quality Of Life, Pain Interference, Anxiety, and Depression in Patients With Metastatic Bone Disease?

Q. M. J. van der Vliet BSc, N. R. Paulino Pereira MD, S. J. Janssen MD, F. J. Hornicek MD, MS, PhD, M. L. Ferrone MD, J. A. M. Bramer MD, PhD, C. N. van Dijk MD, PhD, J. H. Schwab MD, MS

It would be helpful for the decision-making process of patients with metastatic bone disease to understand which patients are at risk for worse quality of life (QOL), pain, anxiety, and depression. Normative data, and where these stand compared with general population scores, can be useful to compare and interpret results of similar patients or patient groups, but to our knowledge, there are no such robust data.

Are Biopsy Tracts a Concern for Seeding and Local Recurrence in Sarcomas?

Irene Barrientos-Ruiz MD, Eduardo José Ortiz-Cruz MD, PhD, José Serrano-Montilla MD, Daniel Bernabeu-Taboada MD, Jose Juan Pozo-Kreilinger MD

A biopsy is the final step in the diagnosis of sarcomas. Complete resection of the biopsy tract traditionally has been recommended in musculoskeletal oncology guidelines, as that tract is considered potentially seeded with tumor cells. However, to our knowledge, the frequency and implications of contamination of the biopsy tract—specifically with respect to the likelihood of local recurrence—and the factors that affect cell seeding are not well described.

Is It Appropriate to Treat Sarcoma Metastases With Intramedullary Nailing?

Bryan S. Moon MD, Dwayne J. Dunbar MS, Patrick P. Lin MD, Robert L. Satcher MD, Justin E. Bird MD, Valerae O. Lewis MD

Patients with primary bone and soft tissue sarcoma are at risk for skeletal metastases. Although uncommon, these metastases can result in impending or pathologic fractures. Intramedullary nailing traditionally has been an accepted form of palliative treatment for patients with metastatic carcinoma, but we could find no studies that report specifically on intramedullary nailing of metastatic sarcoma lesions.

Are Recently Trained Tumor Fellows Performing Less Tumor Surgery? An Analysis of 10 Years of the ABOS Part II Database

Kyle R. Duchman MD, Benjamin J. Miller MD, MS

The majority of orthopaedic trainees pursue additional subspecialty training at the conclusion of residency. Although national trends indicate that fellowship-trained surgeons are more frequently performing cases in their defined subspecialties, this may not be the case for recently trained tumor fellows. Prior work has established that low tumor case volume is a significant stressor for recently trained tumor fellows. Given the relative rarity of musculoskeletal tumors, it is important for prospective trainees to have clear expectations for the proportion of specialty-specific procedures early during their careers. In addition, knowledge of anticipated specialty case volume is important to optimize fellowship training and to provide guidance for meeting the public health requirements for orthopaedic oncology.

What are the Functional Results, Complications, and Outcomes of Using a Custom Unipolar Wrist Hemiarthroplasty for Treatment of Grade III Giant Cell Tumors of the Distal Radius?

Baichuan Wang MD, PhD, Qiang Wu MD, PhD, Jianxiang Liu MD, PhD, Songfeng Chen PhD, Zhicai Zhang MD, PhD, Zengwu Shao MD, PhD

A giant cell tumor (GCT) of bone presenting in the distal radius is rare, however, when they occur, Campanacci Grade III tumors can present formidable reconstructive challenges. They are associated with a high local recurrence rate with intralesional treatment, therefore approaches to reconstruct the wrist after en bloc resection warrant study.