Proximal fibula resection in the treatment of bone tumours.

Int Orthop. 2011 Nov;35(11):1689-94. Epub 2011 Jan 11.
Dieckmann R, Gebert C, Streitbürger A, Henrichs MP, Dirksen U, Rödl R, Gosheger G, Hardes J.


Source

Department of Orthopaedics and Tumour Orthopaedics, University Hospital of Münster, Albert-Schweitzer-Straße 33, 48149, Münster, Germany, Ralf.Dieckmann@ukmuenster.de.

Abstract

BACKGROUND AND OBJECTIVES:

We present a large study of patients with proximal fibula resection. Moreover we describe a new classification system for tumour resection of the proximal fibula independent of the tumour differentiation.

METHODS:

In 57 patients the functional and clinical outcomes were evaluated. The follow-up ranged between six months and 22.2 years (median 7.2 years). The indication for surgery was benign tumours in ten cases and malignant tumours in 47 cases. In 13 of 45 patients, where a resection of the lateral ligament complex was done, knee instability occurred. In 32 patients a resection of the peroneal nerve with resulting peroneal palsy was necessary.

RESULTS:

Patients with peroneal resection had significantly worse functional outcome than patients without peroneal resection. An ankle foot orthosis was tolerated well by these patients. Three of four patients with pathological tibia fracture had local radiation therapy. There was no higher risk of tibia fracture in patients with partial tibial resection.

CONCLUSIONS:

Resection of tumours in the proximal fibula can cause knee instability, peroneal palsy and in cases of local radiation therapy, a higher risk of delayed wound healing and fracture. Despite the risks of proximal fibula resection, good functional results can be achieved.

IORG Tumor update 

Ewing and osteogenic sarcoma: evidence for multidisciplinary management.

Spine (Phila Pa 1976). 2009 Oct 15;34(22 Suppl):S58-68.
Sciubba DM, Okuno SH, Dekutoski MB, Gokaslan ZL.

Abstract

STUDY DESIGN:

Systematic review of the literature and consensus recommendations by an international expert focus group.

OBJECTIVE:

To review and classify evidence in the literature regarding: (1) the role of neoadjuvant chemotherapy and (2) impact of extent of surgical resection on clinical outcome, particularly survival and local control, in patients with spinal Ewing sarcoma (ES) and osteosarcoma (OS).

SUMMARY OF BACKGROUND DATA:

ES and OS of the spine are currently managed with multimodality treatment involving chemotherapy, radiation therapy, and surgical resection. It is currently unclear if extent of resection, for example, intralesional resection versus marginal or wide resection has an impact on survival or local control of disease.

METHODS:

A systematic literature search for the years 1960 to 2008 was performed looking at publications involving treatment of spinal ES and OS. From these 208 articles, 16 were selected for analysis and were reviewed in depth. Studies were presented to a group of spinal oncology experts. Literature was graded for quality, summarized and presented to an international expert group with consensus recommendations generated.

RESULTS:

For ES of the spine, 10 studies were analyzed. For OS of the spine, 6 studies were analyzed. For both ES and OS of the spine, moderate level evidence supported a strong recommendation that neoadjuvant chemotherapy offers significant improvements in local control and long-term survival and is essential in multimodality management. For spinal ES, very low level evidence supported a weak recommendation that en bloc surgical resection provides improved local control, but not improved overall survival. Radiation therapy for spinal ES may also be used for local control either alone or to supplement incomplete resection. For spinal OS, very low evidence supported a strong recommendation that en bloc resection provides improved local control and potentially improved overall survival.

CONCLUSION:

Patients with ES and OS are currently managed with multiple modalities involving surgery, radiation, and chemotherapy. For both histopathologies, advances in chemotherapy have led to the greatest improvements in survival over the last few decades. Neoadjuvant therapy portents the most favorable local control and long-term survival. En bloc surgical resection may improve overall survival and decrease risk of recurrence.