Surgical Outcomes After Limb-Sparing Resection and Reconstruction for Pelvic Sarcoma

Wilson, Robert J.; Freeman, Thomas H.; Halpern, Jennifer L.; Schwartz, Herbert S.; Holt, Ginger E.

doi:10.2106/jbjs.rvw.17.00072

Cited by 37 publications

(38 citation statements)

References 25 publications

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“…With the depressing performance of systematic therapy in pelvic sarcoma, it seems that the only available option for now is to improve our surgery to get better local control. However, pelvic tumor surgeries are always challenging and with high complication rates (16,17). Thus, proper preoperative planning is of vital importance.…”

Section: Discussionmentioning

confidence: 99%

Artificial Intelligence (AI) Assisted CT/MRI Image Fusion Technique in Preoperative Evaluation of a Pelvic Bone Osteosarcoma

Hua

et al. 2020

Front. Oncol.

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Surgeries of pelvic bone tumors are very challenging due to the complexity of anatomical structures and the irregular bone shape. CT and MRI are used in clinic for tumor evaluation, each with its own advantages and shortcomings. Combining the data of both CT and MRI images would take advantage of the merits of both images and provide better model for preoperative evaluation. We utilized an artificial intelligence (AI)-assisted CT/MRI image fusion technique and built a personalized 3-D model for preoperative tumor margin assessment. A young female patient with pelvic osteosarcoma was evaluated with our novel image fusion 3-D model in comparison with the 3-D model based solely on CT images. The fusion image model showed more detailed anatomical information and discovered multiple emboli within veins which were previously neglected. The discovery of emboli implied abysmal prognosis and discouraged any attempts for complex reconstruction after tumor resection. Based on the experience with this pelvic osteosarcoma, we believe that our image fusion model can be very informative with bone tumors. Though further validation with a large number of clinical cases is required, we propose that our model has the potential to benefit the clinic in the preoperative evaluation of bone tumors.

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Section: Discussionmentioning

confidence: 99%

Artificial Intelligence (AI) Assisted CT/MRI Image Fusion Technique in Preoperative Evaluation of a Pelvic Bone Osteosarcoma

Hua

et al. 2020

Front. Oncol.

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“…Wilson et al8 found that the MSTS was the most frequently used measure and that the TESS was presented only once for pelvic sarcoma patients. Some studies have used both the older and newer versions of the MSTS questionnaires in the same study 18,41.…”

Section: Discussionmentioning

confidence: 99%

“…Groundland et al7 investigated pediatric patients. Wilson et al8 studied pelvic sarcoma patients, and Winnette et al9 investigated all patients with STS, including abdominal sarcomas. Thus, no systematic literature review has previously focused specifically on measurement of FO after surgical treatment of adult lower-extremity STS patients.…”

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confidence: 99%

Functional Outcome Measurement in Patients with Lower-Extremity Soft Tissue Sarcoma: A Systematic Literature Review

et al. 2019

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BackgroundThe importance of functional outcome (FO) in the treatment of patients with extremity soft tissue sarcoma (STS) has been increasingly recognized in the last three decades. This systematic review aimed to investigate how FO is measured in surgically treated lower-extremity STS patients.MethodsA systematic search of PubMed, Web of Science, and Scopus was performed based on the PRISMA guidelines. The methodologic quality of the publications was measured using the MINORS tool. The results from the included studies examining measurement types, measures, and time of FO measurement were compiled. The FO pooled mean and standard deviation were calculated as a weighted average for the groups. The validity of the applied measures is reported.ResultsThe literature search found 3461 publications, 37 of which met the inclusion criteria. The measurement types used were clinician-reported outcomes (n = 27), patient-reported outcomes (n = 20), and observer-reported outcomes (n = 2). The most frequently used measures were the Toronto Extremity Salvage Score (TESS) (n = 16) and the Musculoskeletal Tumor Society (MSTS) score 1993 (n = 12). The postoperative FO was relatively good. The pooled mean TESS and MSTS 1993 scores were respectively 83.3 and 86.2 (out of 100). Of the 10 previously reported measures, 3 provide validated FO scores. The methodologic quality of publications was generally low.ConclusionsBased on this systematic review, several different methods exist for assessing FO in patients with lower-extremity sarcoma. The most frequently used measure is a validated TESS. The postoperative FO of patients with lower-extremity STS seems to increase to the preoperative baseline level during long-term follow-up evaluation.

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“…5 A systematic review of the surgical outcomes of patients with pelvic sarcoma reported a mean nononcologic complication rate of 49%. 6 Moreover, reconstruction methods after surgical resection such as hip transposition, arthrodesis, prosthesis, allograft, ipsilateral proximal femur, and extracorporeal irradiated autograft reportedly are associated with dysfunction. 5,[7][8][9][10][11][12][13] Some patients have refused to undergo surgical resection because of the high complication rate, the possibility of postoperative dysfunction, and limited improvement in prognosis.…”

Section: Introductionmentioning

confidence: 99%

Complication rate, functional outcomes, and risk factors associated with carbon ion radiotherapy for patients with unresectable pelvic bone sarcoma

Takenaka

Araki

Outani

et al. 2020

Cancer

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Background To the authors' knowledge, carbon ion radiotherapy (CIRT) is one of the few curative treatments for unresectable pelvic bone sarcoma. The current study investigated the complications, functional outcomes, and risk factors of CIRT. Methods Of 112 patients who were treated with CIRT for unresectable pelvic bone sarcoma, the authors enrolled 29 patients who were without local disease recurrence or distant metastasis. The mean follow‐up was 93 months. Complications, functional outcomes, and quality of life scores were assessed. Risk factors were analyzed, including the dose‐volume histogram of the femoral head. Results Femoral head necrosis occurred in approximately 37% of patients, pelvic fractures were reported in 48% of patients, and neurological deficits were noted in 52% of patients. Femoral head necrosis was found to be significantly more prevalent among patients with periacetabular tumors (P = .018). The dose‐volume histogram of the femoral head indicated tolerable volume percentages of the femoral head to be <33% for 40 grays (relative biological effectiveness) and 16% for 60 grays ( relative biological effectiveness). The mean Musculoskeletal Tumor Society score and Toronto Extremity Salvage Score were 53% and 64%, respectively, and the mean EuroQol 5 dimensions questionnaire index was 0.587. Patients aged >50 years and those with periacetabular tumors were found to have significantly lower Toronto Extremity Salvage Scores. Conclusions Femoral head necrosis, pelvic fracture, and nerve damage are common complications with the use of CIRT for pelvic bone sarcoma. To prevent femoral head necrosis, the radiation dose to the femoral head should be kept below the estimated tolerance curve presented in the current study. The functional outcome is nearly equivalent to that of surgery. CIRT may be a promising alternative to surgery for patients with unresectable pelvic bone sarcoma.

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Surgical Outcomes After Limb-Sparing Resection and Reconstruction for Pelvic Sarcoma

Abstract: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Cited by 37 publications

References 25 publications

Artificial Intelligence (AI) Assisted CT/MRI Image Fusion Technique in Preoperative Evaluation of a Pelvic Bone Osteosarcoma

Artificial Intelligence (AI) Assisted CT/MRI Image Fusion Technique in Preoperative Evaluation of a Pelvic Bone Osteosarcoma

Functional Outcome Measurement in Patients with Lower-Extremity Soft Tissue Sarcoma: A Systematic Literature Review

Complication rate, functional outcomes, and risk factors associated with carbon ion radiotherapy for patients with unresectable pelvic bone sarcoma

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