[Show abstract][Hide abstract] ABSTRACT: Prolonged bed rest and elevation have traditionally been considered necessary after free-flap transfer to the lower extremities. In this retrospective study, we tried to mobilize patients early after free-flap transfer to the lower extremity by means of flow-through anastomosis for both arteries and veins.
Plastic and Reconstructive Surgery–Global Open. 03/2014; 2(3):e127.
[Show abstract][Hide abstract] ABSTRACT: Resection of malignant bony tumours of the pelvis creates large bone and soft-tissue defects, and is frequently associated with complications such as wound dehiscence and deep infection. We present the results of six patients in whom a rectus abdominis myocutaneous (RAM) flap was used following resection of a malignant tumour of the pelvis. Bony reconstruction was performed using a constrained hip tumour prosthesis in three patients, vascularised fibular graft in two and frozen autograft in one. At a mean follow-up of 63 months (16 to 115), no patients had a problem with the wound. Immediate reconstruction using a RAM flap may be used after resection of a malignant tumour of the pelvis to provide an adequate volume of tissue to eliminate the dead space, cover the exposed bone or implants with well-vascularised soft tissue and to reduce the risk of complications. Cite this article: Bone Joint J 2014;96-B:270-3.
[Show abstract][Hide abstract] ABSTRACT: Alveolar soft part sarcoma (ASPS) is a rare soft tissue tumor characterized by pseudoalveolar growths associated with abundant sinusoidal vessels. It has a high proclivity to blood-borne metastasis, but the exact mechanism of spread has not been widely discussed, and detailed histological analysis of vascular involvement is still lacking. In this study, we histologically analyzed 32 surgically resected ASPSs, with particular attention to the mode of vascular involvement. Among 188 instances of unequivocal vascular involvement, 184 (98%) were in the form of variously sized cohesive clusters that were completely enveloped by endothelial cells, confirmed by CD31 immunostaining. Discohesive intravascular tumor cells without endothelial wrapping were rare (2%). The clinical relevance of vascular involvement was supported by survival analysis where the average number of vascular involvements per slide was an independent risk factor for shorter progression-free survival. Our findings suggest that ASPSs do not actively break through the vascular walls to initiate the metastatic process. They instead suggest that ASPSs almost exclusively follow the recently postulated "invasion-independent mechanism" for entry into circulation, in which cancer cells are shed into vessels, while being completely enveloped by endothelial cells, and are subsequently entrapped at recipient organs. Because the latter mechanism is reportedly dependent on tumor angiogenesis and vascular remodeling, our data provide a morphological rationale for the use of anti-angiogenic therapy to treat ASPSs.
Human pathology 01/2014; 45(1):137-42. · 3.03 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: We report the case of a patient in whom the diagnosis of Ewing sarcoma arising from a soft tissue was made after successful treatment of diffuse large B-cell lymphoma. A 65-year-old woman presented with a rapidly growing mass in her left scapular region 8 years after successful chemotherapy with the cyclophosphamide, hydroxydaunomycin hydrochloride, vincristine, prednisolone regimen for diffuse large B-cell lymphoma. Computed tomographic examination and magnetic resonance imaging of the thorax revealed an intramuscular tumour measuring 40 mm in size in the left scapular region. Histopathological examination of an open biopsy specimen revealed a small round cell tumour that showed positive staining for CD99. Fluorescence in situ hybridization showed a split signal by a break-apart probe for the EWS gene in chromosome 22q12. Reverse transcriptase-polymerase chain reaction confirmed the expression of EWS-FLI1 fusion transcripts. Based on these findings, the patient was diagnosed as having secondary Ewing sarcoma. Despite adjuvant chemotherapy, however, she died of pulmonary metastases 2 years after the diagnosis of Ewing sarcoma. Therapy-related haematological malignancies with balanced translocations have been reported previously. A mechanism similar to that underlying the development of secondary malignancy might explain the occurrence of this solid cancer.
Japanese Journal of Clinical Oncology 03/2013; · 1.90 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: This study seeks to discuss the efficiency of minimally invasive surgery of posterior long segmental fixation plus direct decompression in patients with spinal metastatic tumors. Twenty-five patients received minimally invasive surgery of long segmental fixation combined with direct decompression from posterior approach. Pain and neurologic improvement in these patients pre- and post operation were evaluated by Denis' Pain Scale and Frankel Score, respectively. Seventeen patients (68.0%) showed significant decreases in Denis' Pain score after surgery (p < 0.0001). Paralysis symptoms were improved in nineteen patients (76.0%). The Frankel Score exhibited significant difference between pre-operation and post-operation (p < 0.0001). Operation time and blood loss in this cohort were 324 ± 90 minutes and 1047 ± 730 ml, respectively. No fatal complications were observed as a result of surgery. In conclusion, minimally invasive surgery of posterior long segmental fixation combined with direct decompression is a safe and efficient strategy to release pain and improve neurological function in patients with spinal metastatic tumors.
International Journal of Surgery (London, England) 12/2012; · 1.44 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The aim of this study was to investigate the prognostic implications of (18)F-2-fluoro-2-deoxy-d-glucose positron emission tomography/computed tomography in patients with chest wall sarcoma.
Positron emission tomography/computed tomography scans of 42 patients (mean age: 46 years) with chest wall sarcomas were analyzed. Pathologic confirmation was obtained by surgical specimens in all patients. Tumor grade assessed by Ki-67 (MIB-1) immunohistochemical analysis and expression of glucose transporter protein 1 were compared with a maximum standardized uptake value. Univariate and multivariate analyses were conducted for estimates of overall and event-free survivals.
The median maximum standardized uptake value of the tumor was 10.2 and the median MIB-1 index of the tumor was 32.5%. Glucose transporter protein 1 expression was found in 29 patients (69%). Univariate analyses revealed that surgery, chemotherapy, MIB-1 labeling index (cut-off 32.5%), MIB-1 grade, glucose transporter protein 1 expression and maximum standardized uptake value were possible predictors for overall and event-free survival. Multivariate analysis revealed that surgery (hazard ratio, 4.852; P = 0.017), maximum standardized uptake value (hazard ratio, 3.077; P = 0.037) and MIB-1 labeling index (hazard ratio, 6.549; P = 0.003) were independent predictors of event-free survival. In addition, surgery (hazard ratio, 4.092; P = 0.021) and maximum standardized uptake value (hazard ratio, 2.968; P = 0.027) were independent predictors of overall survival.
(18)F-2-fluoro-2-deoxy-d-glucose positron emission tomography/computed tomography allows the prediction of prognosis after treatment in patients with chest wall sarcoma and may be useful in selecting high-risk patients for more risk-adapted treatments.
Japanese Journal of Clinical Oncology 07/2012; 42(10):912-8. · 1.90 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Extraskeletal myxoid chondrosarcoma (EMC) is a rare soft tissue sarcoma. Although it has been regarded as a low-grade sarcoma unassociated with tumor-related death, a recent study has suggested an insidious nature with a high propensity for relapse during a long disease course. The aim of this study was to clarify the long-term clinical features of EMC treated at a single referral center using state-of-the-art techniques.
A retrospective review of 23 consecutive patients (10 males, 13 females; mean age 58 years) treated between 1979 and 2008 (mean follow-up; 109 months) was performed.
Surgery for the primary tumor was performed in 22 patients, and 7 cases recurred locally due to inadequate resection. Eleven patients had metastatic disease, either at diagnosis (3) or developing later (8). The 5/10-year overall survival rates were 91/84 %, and the 5/10-year local recurrence-free and metastasis-free survival rates for patients with localized disease were 89/62 and 89/61 %, respectively. Larger tumor size (>10 cm) and metastases at diagnosis were significant negative prognostic factors. Four patients received ifosfamide-based chemotherapy with no objective response. There was no local recurrence in three patients who underwent R1 resection followed by adjuvant radiotherapy. Clinical palliation and retarded progression of the metastatic disease were achieved in three patients who underwent radiotherapy.
EMC is indolent but has a high propensity for relapse over 5 years of follow-up. Definitive initial surgery and careful monitoring for a prolonged period are important. Radiotherapy seems beneficial in an adjuvant setting and as palliative therapy for metastatic disease.
Archives of Orthopaedic and Trauma Surgery 06/2012; 132(10):1379-86. · 1.36 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Background. Alveolar soft part sarcoma (ASPS) is a rare tumor, and little information is available regarding its clinical features and appropriate treatments. Methods. A retrospective review of 26 consecutive ASPS patients (12 male, 14 female; mean age of 27 years) treated at our institution over 30 years (mean followup; 71 months) was performed. Results. The primary tumor developed in the lower extremity (12), trunk (8), and upper extremity (6), with an average size of 7.2 cm (range, 2-14 cm). The AJCC stage at presentation was IIA (7), III (3), and IV (16). Surgical excision was performed in 20 patients (R0 18, R1 plus radiotherapy 2) without local recurrence. Six patients (stage IIA 3/7, stage III 3/3) later developed metastases after an average period of 28.7 months. The median survival of the 26 patients was 90 months, with overall 5/10-year survival rates of 64%/48%. AJCC stage and tumor size were significant prognostic factors. Significant palliation and slowing of metastasis progression were achieved with gamma knife radiotherapy. Nine patients receiving chemotherapy showed no objective response. Conclusions. ASPS is indolent but has a high propensity for metastasis. Early diagnosis and complete excision of the small primary tumor are essential in the treatment of ASPS.
[Show abstract][Hide abstract] ABSTRACT: The aim of the present study was to determine whether metabolic reduction is capable of reflecting the histopathologic response and outcome after neoadjuvant chemotherapy in patients with high-grade sarcoma.
Forty-two patients with histologically proven high-grade sarcoma underwent neoadjuvant chemotherapy followed by surgical resection. Quantitative F-18 fluorodeoxyglucose (F-18-FDG) positron emission tomography (PET)/computed tomography scans were acquired before and after the first cycle and after completion of neoadjuvant chemotherapy. Standardized uptake values (SUVs) and metabolic reduction rates were compared with histopathologic response, progression-free survival, and overall survival.
Baseline SUVmax was 10.9 ± 3.6 (range, 3.8-19.6). Therapeutic effect resulted in 10 patients (24%) with a satisfactory response and in 32 patients (76%) with an unsatisfactory response after completion of neoadjuvant chemotherapy. The SUV decreased to 7.8 ± 3.4 after the first cycle (t1) of chemotherapy and to 5.2 ± 3.4 after completion (t2) of chemotherapy. Histopathologic response and percentage SUV (t2) reduction rate were independent predictors of progression-free survival and overall survival in the multivariate analyses.
Metabolic reduction after neoadjuvant chemotherapy evaluated by F-18 FDG PET or computed tomography can be used for stratification of the histopathologic response in patients with high-grade sarcoma.
Clinical nuclear medicine 07/2011; 36(7):526-32. · 3.92 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The purpose of this study was to evaluate the efficacy of taxane regimens in patients with metastatic angiosarcoma. Forty-one patients with metastatic angiosarcoma treated at the National Cancer Center Hospital between January 1982 and January 2009 were retrospectively classified into 3 groups according to the treatment type: (i) taxane (n=11), (ii) non-taxane (n=14), and (iii) best supportive care (BSC; n=16) groups. The taxane group received paclitaxel (n=6), docetaxel (n=4), or albumin-bound paclitaxel (n=1), and the non-taxane group received mainly doxorubicin-containing regimens (n=12). The differences in progression-free survival (PFS) among the 3 groups were statistically significant (P<0.001). After adjusting for prognostic factors, the taxane group had significantly longer PFS than the non-taxane (hazard ratio=0.282; 95% confidence interval=0.086-0.923; P=0.036) and BSC (hazard ratio=0.015; 95% confidence interval = 0.003-0.083; P<0.001) groups. Overall survival was also significantly longer in the taxane group than in the other groups. A taxane regimen may be more effective than a non-taxane regimen for treating patients with metastatic angiosarcoma.
European journal of dermatology: EJD 06/2011; 21(4):539-45. · 1.95 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: We aimed to develop prognostic biomarkers for synovial sarcoma employing a proteomic approach. We examined the proteomic profile of synovial sarcoma using two-dimensional difference gel electrophoresis (2D-DIGE). We identified 20 protein spots whose intensity was statistically different (p<0.01) between a group of eight patients who were alive and continuously disease-free for over five years and a group of five patients who died of the disease within two years post diagnosis. Mass spectrometric protein identification demonstrated that these 20 spots corresponded to 17 distinct gene products. Three of the 20 spots corresponded to secernin-1 and had higher intensity in the good prognosis group. The prognostic performance of secernin-1 was further examined immunohistochemically in 45 synovial sarcoma cases. The 5-year survival rate was 77.6% and 21.8% for patients with secernin-1 positive and negative primary tumors respectively (p=0.0015). The metastasis-free survival was significantly higher in the patient group with high secernin-1 expression compared to that with low expression (p=0.0012). Uni- and multivariate analyses revealed that secernin-1 expression was a powerful prognostic factor compared to other clinico-pathological parameters examined. These results indicate that secernin-1 may be used as a biomarker to predict the overall and metastasis-free survival in synovial sarcoma patients.
Journal of proteomics 03/2011; 74(6):829-42. · 5.07 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Angiosarcoma is an extremely rare tumor among sarcomas and comprises a heterogeneous group of high-grade vascular malignancies. Our study aimed to examine the correlations between 6 immunohistochemical biomarkers-stem cell factor receptor (KIT), platelet-derived growth factor receptor (PDGFR)-α, PDGFR-β, vascular endothelial growth factor receptor (VEGFR)-1, VEGFR-2, and VEGFR-3-and overall survival (OS) in patients with angiosarcomas.
Immunohistochemical analyses for the 6 biomarkers were performed by using tumor specimens obtained from 34 patients with angiosarcomas. Correlations between biomarkers were examined by Fisher's exact test. For each biomarker, the correlation between the immunohistochemical score and OS was examined by the log-rank test and Cox regression analysis.
The percentages of angiosarcoma patients with positive expressions (immunohistochemical score > 0) of KIT, PDGFR-α, PDGFR-β, VEGFR-1, VEGFR-2, and VEGFR-3 were 14.7%, 11.8%, 88.2%, 61.8%, 94.1%, and 100.0%, respectively. No statistically significant correlations between any 2 biomarkers were observed. Cox regression analysis demonstrated a significant positive correlation between short OS and the immunohistochemical score for PDGFR-β and between long OS and the immunohistochemical score for VEGFR-2.
Increased expression of PDGFR-β may be a statistically significant prognostic factor for poor OS, while increased expression of VEGFR-2 may be a favorable prognostic factor for patients with angiosarcoma.
Annals of Surgical Oncology 03/2011; 18(10):2841-50. · 4.12 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Transfer of a vascularized fibular graft is the method of first choice for reconstruction of defects of long bones. In particular, the vascularized fibula head graft is preferred for patients with bone defects of the upper limb involving the distal radius or the proximal humerus. The aim of the present study was to analyze the operative results, complications, and postoperative function after vascularized fibula head graft transfer and the indications for this procedure.
From 1998 through 2008, vascularized fibula head graft transfer was performed in eight patients to reconstruct bone defects following resection of tumors of the upper limb. The primary site of the tumor was the proximal humerus in four patients and the distal radius in four patients. The postoperative course of the transferred bone was examined, and functional results were evaluated.
All vascularized fibula head grafts were transferred successfully. During the follow-up period, absorption of the transferred fibula head was not observed. The mean overall functional rating of the reconstructed shoulder joint was 70 percent. The range of motion of the reconstructed wrist joint showed no specific patterns, and instability of the wrist joint was observed in only one case.
The authors believe that the vascularized fibula head graft transfer is a safe and reliable method for reconstructing the upper limb, especially for patients with a defect of the distal radius or the proximal humerus. This procedure is also useful for pediatric patients, in whom bone growth is expected after transplantation, and for salvage procedures after reconstructive materials of an artificial joint have failed.
Plastic and Reconstructive Surgery 11/2010; 127(3):1244-53. · 3.33 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: In the management of soft tissue sarcomas, perioperative radiation therapy has been used to reduce the risk of local recurrence after resection. However, a significance of postoperative high-dose rate brachytherapy (HDRBT) remains to be studied. Retrospective analysis was performed to elucidate the role of postoperative HDRBT.
Twenty-five patients with 26 soft tissue sarcoma lesions underwent postoperative HDRBT using (192)Ir remote afterloader without external beam radiation therapy. Ninety-two percent of the lesions were Grade 2 or 3 malignancies, and 50% were resected with positive surgical margins. The remaining 50% had very close margins. Fourteen lesions were treated for local recurrences after previous resections. Applicators of HDRBT were placed during the operation to include only the tumor bed excluding surgical scars. Applied dose was mainly 36Gy/6 fractions/3 d b.i.d.
Five-year local recurrence-free survival was 78.2% in all the 26 lesions. Recurrences were not seen within the treated volume of HDRBT. Two groups were defined according to the marginal status and number of previous operations. Group 1 was the lesions with a positive margin and foregoing resections. The remaining lesions were classified as Group 2. Five-year local recurrence-free survival was 43.8% and 93.3% in Group 1 and Group 2, respectively with a statistically significant difference (p=0.004).
Postoperative HDRBT was effective in controlling local lesions; but in Group 1 lesions, addition of a wide field external beam radiation therapy seems to be necessary to improve the local control rate.
[Show abstract][Hide abstract] ABSTRACT: Although deep infection remains one of the most difficult complications to manage in the treatment of musculoskeletal tumor reconstructed with an endoprosthesis, limited information with respect to its incidence and risk factors has been reported.
This multicenter, retrospective, uncontrolled study reviewed the medical records of 82 patients who underwent reconstruction with an endoprosthesis or temporary spacer for bone-immature patients after resection of malignant bone tumor around the knee. Risk factors for deep infection and the impact of deep infection on prosthesis survival and oncological outcomes were analyzed. Deep infection was defined according to the Centers for Disease Control and Prevention (CDC) guidelines with minor modification.
Deep infection occurred in 14 cases (17%), identified at a mean of 10.9 months (range <1 to 48 months) after initial surgery. Univariate analysis identified surface infection (P < 0.001) and skin necrosis (P < 0.001) as risk factors associated with deep infection. Conversely, tumor origin, chemotherapy, number of postoperative antibiotics, and length of bone resection were not associated with infection. Subclass analysis in femur cases identified a correlation between infection and the extent of partial resection of the quadriceps muscle (P = 0.04). In the multivariate analysis, surface infection represented an independent risk factor for deep infection (P = 0.03). Deep infection was a risk for endoprosthesis survival (P = 0.003) but did not affect the oncological outcome.
A strong correlation between the condition of soft tissue and establishment of deep infection is suggested in this study. Although practical options for preventing deep infection seem limited, the present data allow a form of perioperative evaluation for patients with a higher risk of deep infection.
Journal of Orthopaedic Science 05/2010; 15(3):331-9. · 0.96 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Osteosarcoma (OS) is the most frequent primary malignant bone tumor of children and young adults. Although the introduction of combined neoadjuvant chemotherapy has markedly improved survival, the outcome of OS patients with distant metastasis and/or poor response to chemotherapy is still unsatisfactory. Therefore there is a need to develop new therapeutic agents that suppress OS cell proliferation with higher efficacy. The protein kinases are a family of genes that play critical roles in various signaling pathways. Some cancer cells show addiction to constitutive activation of certain signaling pathways for proliferation and survival. To identify new drug targets for OS, we screened a panel of small interfering RNAs (siRNAs) that target 691 genes encoding human protein kinases and related proteins. We found that different constructs of siRNA specifically targeting polo-like 1 kinase (PLK1) significantly caused mitotic cell cycle arrest and subsequent apoptotic cell death in a variety of OS cell lines. siRNA targeting PLK1 also suppressed the growth of OS xenografts established in immunodeficient mice. Recently, phase I clinical trials of PLK1 chemical inhibitors have been reported. Our results indicate that PLK1 is a promising molecular target for pharmacologic intervention in OS.
Cancer Science 09/2009; 100(12):2268-74. · 3.48 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Synovial sarcoma have two histological subtypes, biphasic and monophasic, defined respectively by the presence or absence of glandular epithelial differentiation. To develop histological biomarkers for synovial sarcoma subtypes, we examined the proteomic profile using two-dimensional difference gel electrophoresis. We identified 29 protein spots whose intensity was statistically different between the monophasic (15 cases) and biphasic (9 cases) subtypes (p <0.01). Mass spectrometric protein identification demonstrated that these 29 spots corresponded to 24 distinct gene products involved in cytoskeletal organization, trsnscription/trsnslation, protein/collagen binding, and ion transport, as well as structural constituents of the epidermis. Two of the 29 spots derived from glutathione S-transferase P (GST-P1) had higher intensity in biphasic type. Immunohistochemistry on additional 42 synovial sarcoma cases revealed that positive expression of GST-P1 was observed in 10 of 12 biphasic (83.3%), in 4 of 27 monophasic (14.8%) and in 1 of 3 poorly differentiated synovial sarcomas (p = 0.0002). Among the clinico-pathological parameters examined, GST-P1 expression significantly correlated only with the histological subtype. GST-P1 had more discriminative power than the status of fusion genes SYT-SSX1 and SYT-SSX2, previously reported to be correlated with the histological subtype. These results establish GST-P1 as a histological biomarker candidate for synovial sarcoma differentiation into subtypes.