Purpose: A multi-centre study to assess the value of combined surgical resection and radiotherapy for the treatment of desmoid tumours. Patients and methods:One hundred and ten patients from several European countries qualified for this study. Pathology slides of all patients were reviewed by an independent pathologist. Sixty- eight patients received post-operative radiotherapy and 42 surgery only. Median follow-up was 6 years (1 to 44). The progression-free survival time (PFS) and prognostic factors were analysed. Results:The combined treatment with radiotherapy showed a significantly longer progressionfree survival than surgical resection alone (p smaller than 0.001). Extremities could be preserved in all patients treated with combined surgery and radiotherapy for tumours located in the limb, whereas amputation was necessary for 23% of patients treated with surgery alone. A comparison of PFS for tumour locations proved the abdominal wall to be a positive prognostic factor and a localization in the extremities to be a negative prognostic factor. Additional irradiation, a fraction size larger than or equal to 2 Gy and a total dose larger than 50 Gy to the tumour were found to be positive prognostic factors with a significantly lower risk for a recurrence in the univariate analysis. This analysis revealed radiotherapy at recurrence as a significantly worse prognostic factor compared with adjuvant radiotherapy. The addition of radiotherapy to the treatment concept was a positive prognostic factor in the multivariate analysis. Conclusion:Postoperative radiotherapy significantly improved the PFS compared to surgery alone. Therefore it should always be considered after a non-radical tumour resection and should be given preferably in an adjuvant setting. It is effective in limb preservation and for preserving the function of joints in situations where surgery alone would result in deficits, which is especially important in young patients.

Since 1995 patients with T1a glottic carcinomas have been treated with laser surgery at the Department of Otorhinolaryngology, Rikshospitalet in Oslo. During this period we have in many cases noticed an inconsistency between the clinical outcome and the histopathological report describing that the resection margins were not free. We wanted to investigate this discrepancy, and the charts with the histopathological reports of 171 patients treated between 1995 and 2005 have been reviewed. Seventeen patients (10%) experienced a recurrence of the initial disease and were treated by repeated laser surgery, radiotherapy, or radiotherapy and laryngectomy. Two patients (1%) had died from the disease. In 36% of the cases (62 patients) the histopathological report indicated "not free" or "probably not free" resection margins. The discrepancy between the histopathological reports and the clinical outcome reflects the pathologist's difficulty in orienting and determining resection margins in laser-resected specimens. Because of the low number of recurrences or metastases, the verdict of a violated resection margin should probably not be crucial for further treatment. The surgeon's peroperative judgement may be trusted, however, with very close follow-up in order to detect early recurrences.

Stress fractures occur in 13.2-37.0% in running athletes. There is a decreasing incidence of these fractures in the tibia (33%), navicular (20%), metatarsus (20%), femur (11%), fibula (7%) and pelvis (7%). Clinically stress fractures present themselves with uncharacteristic local pain under weightbearing conditions. In 75% the medial tibial crest is involved. Usually the pain disappears when the patient is non-weightbearing. As causal factors wrong training methods, oligomenorrhoe (6x incidence), low nutrition input (8x incidence) and a genu recurvatum-morphotype can be found. Misinterpretation can result from a similar clinical and radiological (conventional x-ray, scintigraphy, MRI) early course in stress fractures and bone tumors. We present a patient with a clinical diagnosis of a meniscus lesion. The following MRI was suspect for a malignant lymphoma or histiocytoma. Biopsy was performed and showed the final diagnosis of a stress fracture.

This case represents the first report of resected primary MGCT involving the posterior fossa and arising from the suboccipital nerve.