Three-dimensional fluoroscopic navigation-assisted surgery for tumors in patients with tumor-induced osteomalacia in the bones

Kobayashi, Hiroshi; Akiyama, Tsuyoshi; Okuma, Tomotake; Shinoda, Yusuke; Oka, Hiroyuki; Ito, Nobuaki; Fukumoto, Seiji; Tanaka, Sakae; Kawano, Hirotaka

doi:10.1080/24699322.2017.1282044

Cited by 16 publications

(8 citation statements)

References 15 publications

(27 reference statements)

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“…It does not make sense to compare the delicate differences between our cases and those reported in various institutes because other cases are so scattered. TIO tumors in the spine are even more rare, with only 18 cases reported in the literature before the current study . Our nine spine cases enriched the current limited experience of this peculiar type of TIO.…”

Section: Discussionsupporting

confidence: 71%

“…TIO tumors in the spine are even more rare, with only 18 cases reported in the literature before the current study. (17)(18)(19) Our nine spine cases enriched the current limited experience of this peculiar type of TIO. Despite the small sample size, we observed unusually poor outcomes of these cases, with more than two-thirds of tumors being persistent or recurrent.…”

Section: Discussionmentioning

confidence: 58%

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Nonremission and Recurrent Tumor-Induced Osteomalacia: A Retrospective Study

Jiang

Huo

et al. 2019

Journal of Bone and Mineral Research

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Tumor‐induced osteomalacia (TIO) is a rare paraneoplastic syndrome. It is curable by excision of the causative tumor. However, a few cases may persist or relapse after tumor resection. We aimed to investigate the rate of these events and related factors. We retrospectively studied TIO patients treated with surgery in a tertiary hospital. TIO was established based on a pathologic examination or the reversion of hypophosphatemia. Refractory TIO patients consisted of those with nonremission or recurrent hypophosphatemia after surgery. A total of 230 patients were confirmed as having TIO. After primary surgery, 26 (11.3%) cases persisted, and 16 (7.0%) cases recurred. The overall refractory rate was 18.3%. The median time of recurrence was 33 months. Compared with patients in the recovery group, patients in the refractory group were more likely to be female (59.5% versus 41.0%, p = .029) and have a lower serum phosphate level (0.44 ± 0.13 versus 0.50 ± 0.11 mmol/L, p = .002). The refractory rate was lowest in head/neck tumors (7.5%) and highest in spine tumors (77.8%). Regarding the tissue involved of tumor location, the refractory rate was higher in tumors involving bone than tumors involving soft tissue (32.7% versus 7.0%, p < .001). The outcomes of malignant tumors were worse than those of benign tumors (p < .001): nonremission rate, 21.4% versus 9.7%; recurrence rate, 28.6% versus 6.5%. In the multivariate regression analysis, female sex, spine tumors, bone tissue‐involved tumors, malignancy, and low preoperation serum phosphorus levels were identified as risk factors for refractory outcomes. High preoperative fibroblast growth factor 23 (FGF23) levels were also associated with refractory after adjusting for involving tissue and tumor malignancy. In summary, we are the first to report the rate and clinical characteristics of refractory TIO in a large cohort. For patients with multiple risk factors, especially spine tumors, clinical practitioners should be aware of a poor surgical prognosis. © 2019 The Authors. Journal of Bone and Mineral Research published by American Society for Bone and Mineral Research.

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Section: Discussionsupporting

confidence: 71%

Section: Discussionmentioning

confidence: 58%

Nonremission and Recurrent Tumor-Induced Osteomalacia: A Retrospective Study

Jiang

Huo

et al. 2019

Journal of Bone and Mineral Research

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“…[1–3] Diffuse bone pain caused by poor bone mineralization is the most frequent symptom in these patients suffering from TIO. [1–3,11,12] To date, less than 500 cases have been reported in literature, thus the majority of clinicians are less aware of this disease. In addition, the clinical course of TIO is often slow, and the volume of pathogenic tumor is commonly very small.…”

Section: Discussionmentioning

confidence: 99%

“…Based on our review of the literature on PubMed, the average time from onset of symptoms to a confirmed diagnosis of TIO often exceeds 2.5 years. [1–3,8–11,17,18] Definitive treatment is further delayed by an average of 5 years due to inability to find the underlying tumor due to the characteristics of being small and slow growing and being located in particular or atypical sites. [8–11,17,18] Typical laboratory findings include hyperphosphaturia, elevated alkaline phosphatase, and low serum 1,25-dihydroxy vitamin D in literature, respectively.…”

Section: Discussionmentioning

confidence: 99%

“…[1–3,8–11,17,18] Definitive treatment is further delayed by an average of 5 years due to inability to find the underlying tumor due to the characteristics of being small and slow growing and being located in particular or atypical sites. [8–11,17,18] Typical laboratory findings include hyperphosphaturia, elevated alkaline phosphatase, and low serum 1,25-dihydroxy vitamin D in literature, respectively. [1–3,12,13] Hypophosphatemia is secondary to inhibition of renal phosphorus reabsorption, and the vitamin D synthetic defect blocks the compensatory rise of calcitriol stimulated by the hypophosphatemia.…”

Section: Discussionmentioning

confidence: 99%

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Successful treatment of tumor-induced osteomalacia causing by phosphaturic mesenchymal tumor of the foot

et al. 2019

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Tumor-induced osteomalacia causing by phosphaturic mesenchymal tumor of the foot is exceedingly rare, thus may bring great challenges to the timely and proper diagnosis and treatment of clinicians. The only definitive management is removal of the phosphaturic mesenchymal tumor completely. The objective of this article is to report 2 unusual cases with tumor-induced osteomalacia causing by phosphaturic mesenchymal tumor of the foot. We describe 2 patients with phosphaturic mesenchymal tumor involving the foot who were successfully treated with tumor resection. On presentation to our institution, the patients both had signs of severe osteomalacia, and the patients’ most outstanding complaints were diffuse bone pain, general weakness, and disabled walking. A 53-year-old female underwent surgical excision of pathogenic tumor on the sole of left foot. A 62-year-old female underwent complete excision of pathogenic tumor of right plantar. The patients showed appropriate destruction of the tumor, adequate pain relief, and the elevated blood phosphorus levels compared with the previous status. Surgical resection is the most effective treatment option for patients with tumor-induced osteomalacia who can undergo appropriate surgical treatment. This represents a safe and reasonable approach to sustainably relieve pain and other symptoms with tumor-induced osteomalacia in the foot.

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Navigation in Pelvic Surgery

Joyce

2021

Surgery of Pelvic Bone Tumors

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Three-dimensional fluoroscopic navigation-assisted surgery for tumors in patients with tumor-induced osteomalacia in the bones

Abstract: Navigation-assisted surgery using a 3D fluoroscopy-based navigation system is effective for tumors in patients with TIO.

Cited by 16 publications

References 15 publications

Nonremission and Recurrent Tumor-Induced Osteomalacia: A Retrospective Study

Nonremission and Recurrent Tumor-Induced Osteomalacia: A Retrospective Study

Successful treatment of tumor-induced osteomalacia causing by phosphaturic mesenchymal tumor of the foot

Navigation in Pelvic Surgery

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