The results suggest a reduction in the severity of some symptoms experienced while receiving chemotherapy and a shift from concerns about physical to psychosocial issues.

No abstract

Patients use audiotapes of their cancer consultation and individualized letters to review the information given and communicate information to relatives and friends. They prefer audiotapes to letters. Clinicians should consider installing audiotape-recording facilities that could be used to tape new-patient consultations.

Women more than fifty-five years of age who are managed with removal of a thigh sarcoma combined with radiation therapy have a higher risk of pathologic fracture. The frequency of pathologic fractures associated with higher doses (60 or 66 Gy) of radiation is significantly higher than that associated with lower doses (50 Gy).

Vascular reconstruction is a feasible option in limb-salvage surgery for soft tissue sarcoma but is associated with an increased risk for postoperative complications, including amputation. Although function is not significantly worse after vascular reconstruction, the results are less predictable.

We considered whether a positive margin occurring after resection of a soft-tissue sarcoma of a limb would affect the incidence of local recurrence. Patients with low-grade liposarcomas were expected to be a low-risk group as were those who had positive margins planned before surgery to preserve critical structures. Two groups, however, were expected to be at a higher risk, namely, patients who had undergone unplanned excision elsewhere with a positive margin on re-excision and those with unplanned positive margins occurring during primary resection. Of 566 patients in a prospective database, 87 with positive margins after limb-sparing surgery and adjuvant radiotherapy were grouped according to the clinical scenario by an observer blinded to the outcome. The rate of local recurrence differed significantly between the two low- (4.2% and 3.6%) and the two high-risk groups (31.6% and 37.5%). This classification therefore provides useful information about the incidence of local recurrence after positive-margin resection.

Pathologic fracture through giant cell tumor is thought to be associated with higher rates of recurrence and poor functional outcome. We compared patients with and without pathologic fracture through giant cell tumor of weightbearing long bones. We retrospectively reviewed 139 patients with giant cell tumor of weightbearing long bones with (n = 43) and without (n = 96) pathologic fracture at presentation; the two groups had similar demographics. Joint salvage was successful in 84% of the fracture group and 96% of the nonfracture group. Five-year recurrence-free survival rates were comparable between the two groups (82.6% [95% confidence interval, 69.1-95.9%] in the fracture group and 77.9% [95% confidence interval, 67.7-88.1%] in the non-fracture group). There was a trend toward lower 5-year metastatic-free survival in the fracture group (94.7% [95% confidence interval, 87.3-100%]) than in the nonfracture group (97.3% [95% confidence interval, 93.5-100%]). Functional outcome was good and similar in the two groups. Arthrofibrosis was more common in the group with pathologic fracture. Joint salvage for patients with pathologic fractures through giant cell tumor of weightbearing bones is a reasonable option with functional outcomes and recurrence rates comparable to those of patients without fracture.

Presentation with a pathologic fracture in osteosarcoma did not preclude limb salvage surgery in a majority of patients, did not increase the risk of local recurrence, but was associated with poorer overall survival.