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ABSTRACT: There are no recent reports of giant cell tumors of bone in a large series of Chinese people. The present study was designed to review the epidemiological characteristics and outcomes of surgical management in a large series of Chinese patients with giant cell tumor of an extremity, treated at a single institution.
The records and images of 621 patients in whom a benign giant cell tumor in an extremity was treated between 1989 and 2009 were reviewed retrospectively. There were 359 male and 262 female patients. The mean age at diagnosis was 31.4 years (range, eleven to seventy-one years). Sixty-six percent of the giant cell tumors were localized around the knee. Surgical treatments primarily included curettage, extensive curettage, and resection. The median duration of follow-up was forty-nine months (range, eighteen to 256 months).
Giant cell tumor accounted for 13.7% of all primary bone tumors treated at our institution. Multivariate Cox regression analysis indicated that the only variable that contributed to recurrence-free survival was the type of surgical treatment. The local recurrence rate after extensive curettage was 8.6%, which was significantly lower than the 56.1% recurrence rate after curettage alone. Bone-grafting did not affect local tumor control after extensive curettage; the local recurrence rate was 11.1% if bone graft was used. Recurrent giant cell tumor can be treated by further curettage or resection, with acceptable re-recurrence rates of 6.7% and 9.3% respectively. The Musculoskeletal Tumor Society Score for patients treated with extensive curettage was 92.6%, which was significantly higher than that for patients treated with resection. Twenty-one (3.4%) of the 621 patients developed benign pulmonary metastasis, with a favorable outcome, and three patients presented with multifocal giant cell tumors.
The incidence of giant cell tumor in the Chinese population may be higher than that in Western countries, and it has a male predilection. The results of the present study suggest that extensive curettage provides favorable local control and satisfactory functional outcomes.
The Journal of Bone and Joint Surgery 03/2012; 94(5):461-7. · 3.27 Impact Factor
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ABSTRACT: Although there have been previous efforts to optimize dose intensity or change the chemotherapy protocol for osteosarcoma, long-term survival has not been markedly improved during the past 15 years.
Nude mice bearing established OS-732 human osteosarcoma received varying doses of Adriamycin, paclitaxel and Abraxane to assess tumor growth inhibition. For the dose-response experiments, mice were treated with the following agents at the indicated doses: (A) Adriamycin (2.5 mg/kg, ip), (B) paclitaxel (20 mg/kg, ip), (C-E) Abraxane (10, 20 and 40 mg/kg, ip, respectively) and (F) Saline (20 mg/kg, ip). All agents were administered every 4 days. Mean tumor volume and mice weight measurements were recorded every 3 days. Tumor weights were examined after mice were killed. Real-time polymerase chain reaction and Western blot were used to detect the expression levels of secreted protein, acidic and rich in cysteine (SPARC) in osteosarcoma specimens.
Administration of 40 mg/kg Abraxane showed a tumor inhibitory rate of 98.8% (tumor weight, 0.033 ± 0.044 g, P < 0.01), which was significantly higher than Adriamycin (46.1%, tumor weight, 1.455 ± 1.115 g, P < 0.01) and paclitaxel (40.8%, tumor weight, 1.597 ± 1.834 g, P < 0.05). Real-time polymerase chain reaction and Western blot showed higher expression of SPARC in tumor tissues than in normal tissues.
The antitumor effect of Abraxane was demonstrated in osteosarcoma xenografts in vivo. It suggests that SPARC tends to be highly expressed in osteosarcoma and further experiments need to explore its clinical relevance and the possible mechanisms.
The American Journal of the Medical Sciences 01/2012; 344(3):199-205. · 1.39 Impact Factor
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ABSTRACT: INTRODUCTION: Parosteal osteosarcomas and well-differentiated liposarcomas (WDLPS) of soft tissue share several features: they are slowly progressive, locally aggressive tumors, tend to recur locally, and rarely or never metastasizes if not dedifferentiated. Their treatment is wide surgical resection. Microscopically, both are well differentiated tumors, very like their normal tissue counterpart. They share simple karyotypes with supernumerary ring chromosomes or giant marker chromosomes containing amplified 12q sequences including MDM2 and CDK4 genes, with subsequent overexpression of MDM2 and CDK4 proteins. We present the case of a parosteal osteoliposarcoma made of closely intermingled components of a low-grade osteosarcoma and a WDLPS. CASE: In a 34 year-old woman with a slowly growing mass of the arm, imaging revealed a large well-defined heterogeneous parosteal mass of the upper humerus, with two main components: bone at the base and fat at the periphery. Microscopically, these two components were consistent respectively with low grade osteosarcoma and WDLPS. Cells of the two components were labeled with anti-CDK4 antibody. No labeling with anti-MDM2 antibody and no signal detected with MDM2 FISH analysis were likely due overdecalcification. No frozen tumor tissue was available for FISH analysis nor array-CGH. DISCUSSION: Differential diagnoses of this new entity would be a well-differentiated liposarcoma with a low-grade osteosarcomatous component that originates from the soft tissues, ruled out on imaging, and an ossifying parosteal lipoma, ruled out on immunohistochemistry. CONCLUSION: This is the first description of a low-grade parosteal sarcoma with two components that morphologically and immunophenotypically demonstrate characteristics of a parosteal osteosarcoma and of a well-differentiated liposarcoma.
European journal of radiology 12/2011; · 2.65 Impact Factor
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ABSTRACT: In the last 15 years, chemotherapy-based therapeutic regimens for the treatment of osteosarcoma have failed to demonstrate improved survival rates. Novel approaches, including targeted therapy and antiangiogenic therapy, may provide new methods for the treatment of osteosarcoma, one of the most deadly malignant diseases. In the present study, the therapeutic efficacy of an endogenous angiogenesis inhibitor, endostatin, was tested in combination with the chemotherapeutic agent, adriamycin. BALB/c mice, aged 4-6 weeks were fed animal chow and had access to water ad libitum. The mice were divided into groups and injected with tumor cells. Immunohistochemical staining was performed to identify the microvessel density. The TUNEL technique was also used to determine the apoptotic index. The combination of endostatin and adriamycin produced marked synergistic antitumor activity in a mouse osteosarcoma model. These findings provide new guidelines for designing future clinical trials and for the application of currently available clinical drugs (endostatin has been approved for clinical use) in the treatment of osteosarcoma.
Oncology letters 09/2011; 2(5):773-778. · 0.11 Impact Factor
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The Journal of Bone and Joint Surgery 11/2010; 92(16):2725-31. · 3.27 Impact Factor
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ABSTRACT: ObjectiveTo evaluate the functional outcome and complications of allograft replacement in management of bone tumors.
MethodsBetween March 1992 and September 2002, 164 patients underwent bone tumor resection and massive allograft reconstruction of
bone defects. The length of the resected part ranged from 5–35 cm. The resections were classified as marginal or wide resections
of the tumor on the basis of the Musculoskeletal Tumor Society staging system. Fresh-frozen allografts were employed as osteoarticular
grafts (n = 95), hemi-condylar (n = 15), massive (n = 23), allograft-prosthesis composite (n = 12), intercalary grafts (n = 15) or hemi-pelvic grafts (n = 4). Most of the lesions were osteosarcoma and giant cell tumor of bone and located in proximal and distal femur, proximal
tibia and humerus.
ResultsAt a median follow-up of 47 months (range, 12 to 168 months) after the operation, 154 of the patients in the study were free
of disease and 10 died of disease. Twenty-one (12.8%) patients had local recurrence and 38 (23.2%) nonunion. Late complications
included 11 (6.7%) fractures of the allograft and 18 (11.0%) infections of the graft. Instability of the joint in the form
of subluxation was noted in 13 (7.9%) patients. Ten extremities were amputated due to local recurrence or severe infection.
ConclusionAllografts can be used for reconstruction of bony defects after tumor resection. Allograft has nearly similar shape, strength,
osteo-inductivity and osteo-conductivity with host bone. Allograft implantation is a high complication reconstruction method,
and the risk of recurrence increases when less surgical margin achieves.
The Chinese-German Journal of Clinical Oncology 02/2008; 7(3):159-163.
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ABSTRACT: To determine whether cancellous bone allograft is the best biological material for filling a cavity bone defect.
Between 1992 and 1998, deep frozen cancellous bone allograft was used in the treatment of bone defect in 57 patients following tumor resection. The age of the patients varied from 6 to 56 years (mean 17.4 years).
Bone unions were achieved in 56 patients, and the average time for union was 4.5 months; One patient had the graft removed for infection. The time for union was different according to the volume of graft. The longer time for union was always accompanied with the larger volume of graft. To compare the union time of admixture of cancellous autograft and allograft with that of cancellous allograft alone, the time for union was same in both group. No immune response and infection was observed in this group. And infection happened in 1 of the 57 patients. The local recurrence rate of tumor was 7%.
The feasibility and security of this packing method are better than other. Compared with cancellous autograft, no significant difference was found in the time for union and complication rate except local tumor recurrence.
Zhonghua wai ke za zhi [Chinese journal of surgery] 10/2002; 40(9):665-8.
