Length of Time to Clinical Improvement After Orthopedic Oncology Surgery in Patients With Metastatic Cancer: A Multi-Institution Patient-Reported Outcome Study.

Background: Currently, there is a paucity of data that describes the length of time required to realize improvement in pain and function following surgery for patients with metastatic cancer to bone.

Methods: One hundred patients with impending or completed pathologic fractures due to metastatic cancer to bone were enrolled in this prospective cohort study. Outcomes were measured with a Computer Adaptive Test of Patient Reported Outcomes for Pain Interference and Physical Function domains, to determine the time required to achieve a Minimal Clinically Important Difference (MCID) in the tested domains.

The Impact of Chondrosarcoma with Positive Margins and Extraosseous Extension on Patient Outcomes.

Background: Chondrosarcoma accounts for 20% of all bony sarcomas and may present with extraosseous extension (EOE). The presence of an extraosseous component, along with positive surgical margins, has been separately associated with increased risk of local recurrence and decreased survival. This study compared the outcomes between patients with EOE, EOE and positive margins, and a control chondrosarcoma cohort with neither feature.

Surgeon perspectives on a virtual reality platform for preoperative planning in complex bone sarcomas.

Background And Objectives: Treatment of primary bone and soft tissue sarcomas typically includes complete surgical resection with or without adjunctive modalities. Despite best efforts, for the most challenging clinical scenarios such as axial or pelvic sarcoma, five-year survival rates are reported to be between 27 and 40 %. Since quality of resection is a key determinant of oncologic outcomes, it is critical to preoperatively plan the surgical approach to improve resection accuracy, ensure sufficient surgical margins, and reduce the risk of local or metastatic recurrence.

Characterizing the Transformation and Diagnosis of Atypical Lipomatous Tumor to Dedifferentiated Liposarcoma: Single Institutional Outcomes.

Introduction: Atypical lipomatous tumor (ALT) in the extremities is a locally aggressive adipocytic tumor with the potential risk of transformation into dedifferentiated liposarcoma (DDLS). Studies seldom differentiate whether DDLS was diagnosed on initial biopsy, final resected specimen, or subsequent recurrence. Our study seeks to characterize how and when patients received their ALT or DDLS diagnoses to better understand the relationship between the two neoplasms.

Radiotherapy leads to improved overall survival in patients undergoing resection for Undifferentiated pleomorphic sarcoma.

Background And Objectives: Undifferentiated pleomorphic sarcoma (UPS) is a frequent subtype within the heterogeneous group of soft tissue sarcomas (STS). The use of radiotherapy (RT) has become an important component of a multimodal approach to treating STS. Key studies have demonstrated that the addition of RT improves rates of local control in STS, though the effect on overall survival (OS) is less clear.

Outcomes of distal femoral replacement versus internal fixation for metastatic bone diseases of the distal femur.

Background: In clinical practice, internal fixation (IF) is a commonly utilized technique for metastatic bone disease (MBD) to the distal femur. Additionally, distal femoral reconstruction (DFR) has shown to be an effective surgical technique for primary tumors and MBD in the distal femur. The existing body of research comparing these methods has not focused on MBD or pathological fractures and thus does not guide surgical approach in the case of distal femoral MBD.

Novel MRI scoring system to assess osseous malignancy in soft tissue sarcoma patients following radiotherapy.

Purpose: Radiation induced changes in bone such as radiation osteitis are commonly identified on magnetic resonance imaging (MRI) in patients who receive radiotherapy for soft tissue sarcoma (STS) management. This study proposes a novel MRI scoring system to assess osseous lesions and predict potential for malignancy based on MRI score in STS patients who received radiotherapy.

Methods: The MRI score consisted of 3 parameters: morphology, signal intensity, and progression.

Enormous myxoid/round cell liposarcoma: A case report.

Myxoid/round cell liposarcomas (MRCLPS) are a rare soft tissue sarcoma. We report the largest sarcoma in our institutional history. We discuss the patient's surgical management and treatment of the tumor and challenges given its dimensions.

Total Humeral Endoprosthetic Reconstruction: A Systematic Review.

Background: Total humeral endoprosthetic reconstruction (THER) is a rare reconstruction option for limb salvage surgery for large humeral neoplasms or bone destruction.

Materials And Methods: Because of the limited data and need for this procedure, we reviewed the literature surrounding THER and assessed functionality, complications, and revisions using the PubMed, Embase, Ovid, and Scopus databases.

Results: Among 29 articles and 175 patients, the most common indication was neoplasm (n=25, 86%), mean follow-up was 61.

Myoepithelial Carcinoma of Soft Tissue: Report of Two Cases.

Case: A 40-year-old man was evaluated for a painful mass on his right calf, and a 36-year-old woman presented with a painless mass on her right foot. Final pathology revealed marked nuclear atypia and positivity for S100/SOX10 and AE1/AE3 confirming diagnoses of myoepithelial carcinoma. Both patients underwent surgical resection and are without evidence of local recurrence or metastatic disease at 1-year follow-up.

Intra-Articular Nodular Fasciitis of the Knee, A Rare Clinical Presentation and Histological Diagnosis: A Case Report.

Introduction: Nodular fasciitis is a rare, benign soft tissue lesion that can prove to be difficult to diagnose, especially when intra-articular.

Case Presentation: A 17-year-old female softball player presents with several year history of right knee pain and swelling initially attributed to patellar maltracking refractory to non-operative and operative management.

Management And Outcomes: Initial pathology suggested tenosynovial giant cell tumor; however, further tissue diagnosis revealed nodular fasciitis, which was eventually resected.

Hip Arthroplasty Outcomes in Patients with Metastatic Bone Disease.

Background/objective: The hip is a common location for metastatic bone disease (MBD) and surgical intervention is often indicated to relieve pain and improve function. MBD of the hip is usually treated with hemiarthroplasty or with total hip arthroplasty if there are acetabular lesions. As treatment for metastatic disease evolves and patients may expect to live longer after diagnosis, further evaluation of the complications and functional outcomes associated with hip arthroplasty for MBD are necessary.

Development and external validation of a machine learning model for prediction of survival in extremity leiomyosarcoma.

Purpose: Machine learning (ML) models have been used to predict cancer survival in several sarcoma subtypes. However, none have investigated extremity leiomyosarcoma (LMS). ML is a powerful tool that has the potential to better prognosticate extremity LMS.

Evaluation of Absolute Neutrophil Count in the Perioperative Setting of Sarcoma Resection.

Introduction: Limb salvage surgery (LSS) is the preferred surgical treatment for bone sarcomas. Preoperatively, many patients receive chemotherapy and may develop neutropenia. No study has evaluated the effect of a low preoperative absolute neutrophil count (ANC) on postoperative outcomes following LSS.

An Unusual Case of Clear Cell Chondrosarcoma With Early Metastatic Recurrence.

We present a case of a 58-year-old male who presented following 4 months of progressively worsening right upper extremity pain. Initial pathology demonstrated pleomorphic chondroblasts with increased mitotic activity indicating an intermediate grade (Grade 2) clear cell chondrosarcoma of the proximal humerus. Following surgical resection, the primary lesion demonstrated aggressive behavior and early metastasis to the cervical and thoracic spine.

Does Perioperative Radiation Affect Implant Survivorship of Primary Total Hip Arthroplasty in the Setting of Metastatic Bone Disease?

Background: Metastatic bone disease (MBD) commonly affects the hip and surgical intervention including total hip arthroplasty (THA) is often indicated to treat the joint and improve function. Patients with metastatic cancer often receive radiotherapy, and orthopaedic oncologists must consider surgical risks with operating on irradiated bone and soft tissue. We evaluated surgical outcomes and implant survival (IS) of titanium acetabular components and femoral components in patients treated for MBD in the setting of perioperative radiation.

Internal hemipelvectomy: A single institution's learning curve and longitudinal experience.

Background And Objectives: Wide margin resection for pelvic tumors via internal hemipelvectomy is among the most technically challenging procedures in orthopedic oncology. As such, surgeon experience and technique invariably affect patient outcomes. The aim of this clinical study was to assess how an individual surgeon's experiences and advancements in technology and techniques in the treatment of internal hemipelvectomy have impacted patient outcomes at our institution.

Opiate use after total hip arthroplasty for metastatic bone disease.

Objectives: To investigate post-operative opioid use following a total hip arthroplasty (THA) in metastatic bone disease (MBD) patients and identify factors associated with post-operative opioid use at 6 weeks and 90 days.

Background: MBD commonly affects the hip, and surgical intervention including THA may be indicated for pain relief or to improve function. Following THA, patients are often prescribed short courses of opioids for post-operative pain relief.

Challenges in the Management of Complex Soft-Tissue Sarcoma Clinical Scenarios.

With nearly 15,000 new cases of soft-tissue sarcoma (STS) in the United States each year, early diagnosis and therapeutic management is imperative for successful patient outcomes. Primary STS is conventionally treated with a combination of wide-margin resection, neoadjuvant or adjuvant radiation therapy, and, in specific cases, adjuvant chemotherapy. However, in situations of complex disease presentation, guidelines for treatment are less clearly outlined.

The effect of timing between preoperative embolization and surgery: A retrospective analysis of hypervascular bone metastases.

Background And Objectives: The optimal timing between preoperative embolization of hypervascular metastatic bone lesions and surgery has yet to be established. Our analysis sought to evaluate embolization timing impacts blood loss, transfusion risk, and operative time in patients with hypervascular primary tumors.

Methods: We identified patients with renal cell (RCC) or thyroid carcinoma undergoing surgery between 1992 and 2023.

Patient-reported outcome tools in musculoskeletal oncology.

Patient-reported outcomes (PRO) are collected directly from the patient and have become increasingly utilized in the clinical setting and in clinical research. In musculoskeletal oncology patients, a number of patient-reported outcomes measures (PROM) have been developed and investigated to evaluate functional outcomes and health-related quality of life in these patients. With the growing evidence for PROM in musculoskeletal oncology patients, PROM should be considered for the clinical care of these patients.

Radiolucent implants in orthopedic oncology.

Radiolucent implants in have demonstrated promising results for both extremity and spine oncologic procedures. However, questions persist about whether the superiority in surveillance imaging justify the increased cost and technical challenges. In this review, we present the current body of literature for the use of radiolucent implants in musculoskeletal oncology, with a focus on implant complications, including screw loosening, breakage, malposition, and loss of reduction.