• DCE-MRI plays an important role in differentiating benign from malignant cartilage tumours. • Retrospective study defined a threshold for 100 % detection of chondrosarcoma with DCE-MRI. • The threshold values were relative enhancement = 2 and slope = 4.5. • One hundred per cent chondrosarcoma detection corresponds with 36.7 % false-positive diagnosis of enchondroma. • Standard MRI is complementary to DCE-MRI in differentiating cartilaginous tumours.
We retrospectively reviewed 107 patients with 108 malignant or locally aggressive bone tumours treated between 1978 and 2009 by extracorporeal irradiation with 300 Gy to eradicate the tumour, and reimplantation of the bone as an orthotopic autograft. Patient subgroups were defined according to resection type. We describe the local recurrence rate, the graft infection rate and the factors affecting graft healing and graft survival. No local recurrences were detected in the irradiated grafts. At fiveyear follow-up, graft healing had occurred in 64% of patients, providing a stable and lasting reconstruction. For various reasons, 11% of grafts were removed, although no single factor was predictive of failure. All patient subgroups had comparable results. Early infection predicted the development of pseudarthrosis. Pelvic reconstructions had a worse graft survival. Rigid fixation and bridging of the graft appeared to be important technical points.
Anterior lumbar interbody fusion (ALIF) has increased in popularity because it has advantages over posterior fusion. Because there is disagreement about the stability of stand-alone cage ALIF, some surgeons use various types of supplementary fixation, including anterior plates, pedicle screw systems and translaminar screws, to increase segmental stability. Many factors associated with both the cages and endplates influence the time of onset and extent of subsidence after use of stand-alone cage ALIF. A large round cage with an adequate central opening is recommended to facilitate maximum contact with the periphery of the endplate. With regard to the relationship between radiographic fusion and recurrence of symptoms with the development of subsidence, most researchers have reported finding no correlation. Subsidence may be due to a process of bone incorporation between cages and endplates. Does subsidence or nonfusion really matter clinically? Further prospective, randomized controlled trials are very much needed to answer these questions.
We treated 15 patients suffering from an extracompartmental malignant pelvic tumour by resecting the affected part of the bone, irradiating it extracorporeally with 300 Gy, and reimplanting it after having removed the bulk of the lesion. Adjuvant therapies were used according to the type and extension of the tumour. Followup was an average of 4 years 6 months. Complications were seen in 13 patients. Most mechanical complications were related to the use of hip arthroplasties. Internal fixation of the graft failed in one case only, infection was seen in three cases, and seven patients died after local recurrence. Functional scores were fair. Although many complications were seen, this method remains our treatment of choice.Résumé Nous avons traité 15 malades qui souffraient d'une tumeur pelvienne maligne extracompartimentale par résection de la partie affectée, 'irradiation extracorporelle de 300 Gy, puis réimplantation après avoir enlevé la charge de la lésion. Les thérapies adjuvantes ont été utilisées d'après le type et l'extension de la tumeur. Le suivi moyen était de quatre ans et demi. Treize malades ont eu des complications. La plupart des complications mécaniques étaient relatives à la prothése de la hanche. La fixation de la greffe a failli seulement une fois. Il y a eu trois infections. Sept malades sont morts après une ré-cidive locale. Les scores fonctionnels sont moyens. Bien que beaucoup de complications puissent survenir, cette méthode reste notre traitement de choix. IntroductionSeveral strategies have been established to solve the problems inherent in the treatment of malignant pelvic tumours. In 1988 we first reported the technique of extracorporeal irradiation and reimplantation of the resected autograft, which was developed at our department [21]. Since then we have used and refined the technique. Patients and methodsFifteen patients, four women and 11 men aged between 12 and 65 (mean 38) years, with a malignant pelvic tumour were treated between 1977 and 2000 at our facility. All but one had a primary malignant bone tumour. The tumours were graded according to Enneking [4]. All tumours were extracompartmental.The extent, and hence also the plane, of resection of the lesion was established by imaging techniques, including radiography, arteriography, CT-scan, MRI, and Technetium total body scanning. Biopsy remained essential to assess the type and differentiation of the tumour.The surgical procedure consisted of three stages during one operative session. Firstly, the tumour was resected. The approach was planned according to tumour localisation. Care was taken always to include the biopsy tract in the resection specimen. Neurovascular bundles were respected as long as there was no tumoural invasion. The lesion was excised as widely as possible. Since resection with a wide margin is hard to achieve in this location, five resection margins in this series were marginal and five were intralesional. Five resections were wide. The excision type was classified according to Capanna [3]. The res...
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