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Purpose: The role of chemotherapy (CT) and radiotherapy (RT) for management of extraskeletal osteosarcoma (ESOS) remains controversial. We examined disease outcomes for ESOS patients and investigated the association between CT/RT with recurrence and survival. Patients and methods: Retrospective review at 25 international sarcoma centers identified patients ≥18 years old treated for ESOS from 1971 to 2016. Patient/tumour characteristics, treatment, local/systemic recurrence, and survival data were collected. Kaplan-Meier survival and Cox proportional-hazards regression and cumulative incidence competing risks analysis were performed. Results: 370 patients with localized ESOS treated definitively with surgery presented with mainly deep tumours (n = 294, 80%). 122 patients underwent surgical resection alone, 96 (26%) also received CT, 70 (19%) RT and 82 (22%) both adjuvants. Five-year survival for patients with localized ESOS was 56% (95% CI 51%-62%). Almost half of patients (n = 173, 47%) developed recurrence: local 9% (35/370), distant 28% (102/370) or both 10% (36/370). Considering death as a competing event, there was no significant difference in cumulative incidence of local or systemic recurrence between patients who received CT, RT, both or neither (local p = 0.50, systemic p = 0.69). Multiple regression Cox analysis showed a significant association between RT and decreased local recurrence (HR 0.46 [95% CI 0.26-0.80], p = 0.01). Conclusion: Although the use of RT significantly decreased local recurrences, CT did not decrease the risk of systemic recurrence, and neither CT, nor RT nor both were associated with improved survival in patients with localized ESOS. Our results do not support the use of CT; however, adjuvant RT demonstrates benefit in patients with locally resectable ESOS.

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A significant association between DSL and conduction block in the face of a relatively wide canal indicates the functional importance of DSL in elderly patients with cervical spondylotic myelopathy. In this age group, a high incidence of both DSL (81%) and focal conduction block (91%) at the upper cervical level (C3-C4 or C4-C5) is of clinical interest.

ObjectiveExergaming has been introduced in safe and beneficial intervention for the elderly. However, no study has examined exergaming-based interventions for the elderly that last several years. Therefore, we investigated the effectiveness and safety of a 12-week intervention using step training with exergaming for the elderly (12-week study). Moreover, we conducted an exergaming-based intervention for 3 years (3-year study).Materials and methods12-week study: Forty-two elderly persons participated in this study. Using an in-house developed exergaming protocol, a step training was performed for 15 min/session twice a week for 12 weeks. We investigated post-intervention changes in motor functions, successful step-rate, the intensity of exercise, which was evaluated using Borg scale (Rating of Perceived Exertion). 3-year study: An intervention using exergaming was conducted for 12 weeks by 20 elderly participants. Two courses/year of exercise were performed at 3-month intervals. This was continued for 3 years. The exercise continuation rate, its influence on motor functions were investigated.Results12-week study: Lower-limb muscle strength, balancing capacity, and whole body reaction time significantly improved in the exercise group. The mean score on Borg scale was 12 ± 2 on the first day of the step exercise and 9 ± 2 on the final day. 3-year study: Exercise was continued in 16 out of the 20 subjects. The Timed Up and Go Test, duration of one-footed standing, and quadriceps strength significantly improved.ConclusionThe results of the present study showed that exergaming provided an appropriate exercise intensity for the elderly and safely improved motor functions. The exercise continuation rate in the 3-year study was high. Improvements in motor functions may contribute to the prevention of falls.