1,721,012 research outputs found
Side effects of radiation in musculoskeletal oncology
No full textRadiation therapy is applied for systemic effects to patients with bone and soft tissue tumors and for local effects that facilitate the surgical procedure. However, while it remains an essential treatment of cancers, radiation therapy is associated with unwanted complications. The purpose of this review is to summarize information regarding the complications of radiation in musculoskeletal oncology and their management. Because preoperative radiotherapy is associated with an increased risk of wound complications and postoperative radiation is associated with an increased risk of postradiation fractures, the physician requires additional information in deciding on the best method of treatment, and such information is provided in this revie
Successful treatment of aggressive aneurysmal bone cyst of the pelvis with serial embolization
No full textIntralesional surgery is most commonly used for aneurysmal bone cysts. Rarely is en bloc resection used for active, aggressive, recurrent lesions and those located in expendable bones. However, persistence or recurrence of aneurysmal bone cysts is common. The clinical behavior of aneurysmal bone cysts is more aggressive in younger patients. Selective embolization is used as the primary treatment for aneurysmal bone cysts in surgically difficult anatomical locations and as an adjuvant to surgical treatment to reduce intraoperative blood loss and facilitate curettage.
This article describes a 3-year-old boy with an aggressive aneurysmal bone cyst of the pelvis involving the right ischiopubic rami that achieved curative treatment with 3 embolizations with N-2-butyl-cyanoacrylate. Biopsy was diagnostic; however, the clinical course was misleading. Twenty days after the first embolization, despite complete occlusion of the feeding vessels, the patient experienced severe pain, increased size of the lesion, and lateral subluxation of the right hip. Based on the imaging and histological diagnosis, intralesional hemorrhage was assumed, and repeat embolization was performed. After the second embolization, the patient experienced perineal skin necrosis from normal vessel embolization; it was treated with wound dressing changes and healed uneventfully. A third embolization was performed because of a persistent lesion. Six years after treatment, the patient was symptom free, and imaging showed complete ossification of the cyst.
Selective catheterization and occlusion of the feeding arteries with the appropriate embolic agent provide tumor devascularization, size reduction, pain relief, and induction of new bone formation. Multiple procedures are often necessary, and complications may occur
Impact of the COVID-19 pandemic on patients suffering from musculoskeletal tumours
Get PDFBackground The aim of the current study was to evaluate the impact of the coronavirus disease (COVID-19) pandemic on musculoskeletal tumor service by conducting an online survey of physicians.
Methods The survey was conducted among the members of the ISOLS (International Society of Limb Salvage) and the EMSOS (EuropeanMusculo-Skeletal Oncology Society). The survey consisted of 20 questions (single,multiple-response, ranked): origin and surgical experience of the participant (four questions), potential disruption of healthcare (12 questions), and influence of the COVID-19 pandemic on the particular physician (four questions). A matrix with four different response options was created for the particular surgical procedures).
Results One hundred forty-nine physicians from five continents completed the survey. Of the respondents, 20.1% and 20.7% stated that surgery for life-threatening sarcomas were stopped or delayed, respectively. Even when the malignancy was expected to involve infiltration of a neurovascular bundle or fracture of a bone, still 13.8% and 14.7% of the respondents, respectively, stated that surgery was not performed. In cases of pending fractures of bone tumors, 37.5 to 46.2% of operations were canceled.
Conclusion The SARS-CoV-2 pandemic caused a significant reduction in healthcare (surgery, radiotherapy, chemotherapy) for malignancies of the musculoskeletal system. Delaying or stopping these treatments is life-threatening or can cause severe morbidity, pain, and loss of function. Although the coronavirus disease causes severe medical complications, serious collateral damage including death due to delayed or untreated sarcomas should be avoided
Post-Radiation Sarcomas
No full textRadiation-induced sarcomas are rare, high-grade
sarcomas that may arise within the radiation field at a
mean latency period of 3-55 years after radiation therapy,
doses of which range from 45 to 60 Gy. Radiation-induced
osteosarcomas, fibrosarcomas, and malignant fibrous
histiocytomas are the most common. Wide resection with
limb salvage or amputation is recommended for improved
local control. Adjuvant radiation therapy and chemotherapy
have not been shown to improve survival rates significantly.
The prognosis is poor
Side effects of chemotherapy in musculoskeletal oncology
No full textWith recent advances in medical and orthopedic oncology, radiation therapy and single- or multiple-agent perioperative chemotherapy are currently applied as an essential part of the multidisciplinary treatment to improve disease-free and overall survival of patients with primary and metastatic bone and soft tissue tumors. However, these treatments have led to unwanted complications. A better understanding of the effects of various antineoplastic agents on bone, soft tissue, and organs may provide the basis for the more efficacious use of antiproliferative drugs when fracture healing or allograft incorporation is required. This knowledge may also provide a rationale for concurrent treatment with drugs that protect against or compensate for adverse effects in osseous repair resulting from chemotherap
Palliative embolization for osteosarcoma
No full textBACKGROUND: The prognosis of patients with metastatic, recurrent, and/or unresectable osteosarcoma is poor. Aggressive local and medical treatments are available for palliation. Palliative treatments include isolated limb perfusion, radiation therapy, embolization, chemoembolization, thermal ablation, and cryoablation. Their aim is pain relief and tumor size reduction with minimum complications.
MATERIALS AND METHODS: We present 19 patients with metastatic, recurrent, and/or unresectable osteosarcoma of the pelvis and lower lumbar spine treated with palliative selective embolization using N-2-butyl cyanoacrylate. All patients had chemotherapy. At the time of embolization, they experienced severe pain refractory to analgesics. Diagnostic angiography was performed pre-embolization to determine the vascular mapping and hemodynamic status of the tumor. Post-embolization angiography was done to evaluate for complete occlusion of the pathological vessels. Mean follow-up was 18 months. Local pain, tumor necrosis and size, and complications were recorded.
RESULTS: In all patients, pre-embolization angiography showed hypervascularity of the tumor from extensive neovascularization. Five patients had repeat embolization. All patients experienced pain relief at a mean of 3 days post-embolization. No patient had recurrent pain with the intensity of that before embolization. Variable tumor necrosis was observed in follow-up imaging, and reduction in tumor size was minimum. All patients experienced pain at the site of embolization, which resolved completely 1-5 days after embolization. Four patients with pelvic osteosarcomas experienced paraesthesias at the distribution of the sciatic nerve.
CONCLUSION: Selective arterial embolization is a useful local palliative treatment for patients with advanced osteosarcoma for pain relief
Periprosthetic fractures of the humerus.
No full textClassifications have been previously reported and biomechanical studies have been performed, but the management of humeral fractures between implants remains problematic. At the time of arthroplasty, planning of the optimum length of the prostheses is required, especially for patients being considered for a second arthroplasty in the ipsilateral elbow or shoulder. Current treatment may be conservative if reduction can be obtained and the prostheses are stable, or it may be surgical using internal fixation with plates, strut grafts, double plates, or a plate and strut graft construct if the fracture extends around the components of the prosthesis and autogenous bone grafting
Surgery of Giant Cell Tumours of the sacrum: an analysis of 31 cases
No full textSurgery of Giant Cell Tumours of the sacrum: an analysis of 31 case
Modern Palliative Treatments for Metastatic Bone Disease: Awareness of Advantages, Disadvantages and Guidance.
No full textMetastatic disease is the most common malignancy of bone. Prostate, breast, lung, kidney and thyroid cancer account for 80% of skeletal metastases. Bone metastases are associated with significant skeletal morbidity including severe bone pain, pathological fractures, spinal cord or nerve roots compression, and malignant hypercalcemia. These events compromise greatly the quality of life of the patients. The treatment of cancer patients with bone metastases is mostly aimed at palliation. Currently, modern treatments are available for the palliative management of patients with metastatic bone disease. These include modern radiation therapy, chemotherapy, embolization, electrochemotherapy, radiofrequency ablation, and high intensity focused ultrasound. This article aims to present these palliative treatments for the patients with bone metastases, summarize the clinical applications, and review the techniques and results. It gives an extensive overview of the possibilities of palliation in patients with metastatic cancer to bone. As such it is of interest for all physicians with no experience with these developments to make palliative procedures safer and more reliable
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