We reviewed 124 patients with a conventional pelvic chondrosarcoma who had been treated over a period of 20 years. We recorded the type of tumour (central or peripheral), type of operation (limb salvage surgery or hemipelvectomy), the grade of tumour, local recurrence and/or metastases, in order to identify the factors which might influence survival. More satisfactory surgical margins were achieved for central tumours or in those patients treated by hemipelvectomy. However, grade 1 tumours, whatever the course, did not develop metastases or cause death, while grade 3 tumours had the worst outcome and prognosis. Central, high-grade tumours require aggressive surgical treatment in order to achieve adequate surgical margins, particularly in those lesions located close to the sacroiliac joint. By contrast, grade 1 peripheral chondrosarcomas may be treated with contaminated margins in order to reduce operative morbidity, but without reducing survival.

Bone metastases are a very common problem in prostate cancer. They are associated with considerable morbidity, adversely affect quality of life and frequently lead to advanced bone events (so-called skeletal-related events, SREs); SREs include fractures, spinal cord compression and the requirement for bone surgery or bone radiation. The aim of this paper was to evaluate currently available treatment options in the prevention and management of SREs and bone metastases in men with castration-resistant prostate cancer and to outline the importance of interdisciplinary management strategies. It also discusses the diagnostic workup of osseous metastases and practical considerations for the utilization of bone-targeted therapies in accordance with current guidelines to provide a consensus for special and/or difficult clinical situations.

BackgroundOsteosarcoma and Ewing sarcoma are more common diagnoses in preadolescent and adolescent children compared with the adult population. A greater percentage of patients are treated with limb salvage and reconstruction using modular tumor endoprostheses. Implant-to-bone fixation can be cemented or cementless. Cementless tumor endoprostheses rely on biologic osteointegration for implant stability, and chemotherapy during childhood and adolescence can disturb the bone turnover rate and reduce bone mineral density, which in turn may predispose patients with uncemented endoprostheses to a high rate of revision surgeries.Questions/purposes(1) What is the cumulative incidence of revision operations for any cause (wound dehiscence, periprosthetic fracture, hinge breakage, aseptic loosening, infection, local recurrence, implant removal, and amputation) of cementless tumor endoprostheses around the knee? (2) What is the cumulative incidence of aseptic loosening, periprosthetic fracture, hinge breakage, and infection, and what proportion of patients had other complications? (3) What was the mean limb length discrepancy (LLD) at the time of skeletal maturity? (4) What was the median Musculoskeletal Tumor Society (MSTS) score at most recent follow-up or just before implant removal/amputation if implant removal/amputation were performed?MethodsBetween 2008 and 2019, we treated 328 patients younger than 18 years for a primary bone sarcoma around the knee at our institution. Of those, 138 were treated with resection and reconstruction using two different types of modular tumor endoprostheses. During this period, our general indications for an endoprosthesis were patients who were candidates for an intraarticular resection of the distal femur or proximal tibia and who were at least 10 years of age. Uncemented fixation was always preferred. Cemented fixation was only done when intraoperative press-fitting of a cementless stem was not possible. Among uncemented implants, 26 patients died before completing 2 years of follow-up with intact implants and without further surgery, three were lost to follow-up before 2 years, and four patients received implants as a secondary salvage surgery after a failed primary biologic reconstruction with a vascularized fibular bone graft, leaving 94 patients for evaluation in this retrospective study. The mean age was 15 ± 2 years and the median (interquartile range) follow-up duration was 51 months (39 to 74). We did a competing risks analysis to tally cumulative incidence of all-cause revision procedures and cumulative incidence of aseptic loosening, periprosthetic fracture, hinge breakage, and infection. Other complications, including wound dehiscence, local recurrence, and stem breakage, were characterized descriptively and ascertained by review of electronic records of a longitudinally maintained institutional database by the treating surgeons. LLD was measured by serial clinical assessments and CT scans, starting since primary salvage surgery and until the latest follow-up of eve...

Introduction and aim. Management of complicated wounds after tumor extipiration of pelvic and proximal lower limb musculoskeletal sarcoma represents an essential component in the outcome of these patients. The authors present modified vertical rectus abdominis musculocutaneous (VRAM) flap techniques to reconstruct extensive defects after debridment of these complicated wounds. Material and Methods. Over a period of 4 years (2002–2005), 5 men and 2 women were managed. Median age was 21 years (range 15–49). The patients were managed for complicated lower trunk, groin, and upper thigh wounds after resection of three pelvic chondrosarcomas as well as two pelvic and two proximal femur osteosarcomas. The modifications included a VRAM flap with lateral and tongue-like extension design of the skin paddle (5 cases) or a delayed extended VRAM flap (2 cases). Results. All flaps showed complete survival and healing with no ischemic events providing stable coverage. All patients were ambulant with good limb functions in terms of walking and gait after adequate rehabilitation, 2 needed support with crutches. Conclusion. The modified VRAM flaps offer reliable reconstructive tools for coverage of complex groin and thigh defects by providing larger well-vascularized soft tissue with acceptable donor site.