骨腫瘤之治療 簡松雄
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骨腫瘤之治療 簡松雄

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骨腫瘤之治療 簡松雄 骨腫瘤之治療 簡松雄 Presentation Transcript

  • Block 7: Musculoskeletal System Limbsalvage of Bone and Soft-Tissue Tumors 骨科 簡松雄 Tel:07- 3208209 shchien@kmu.edu.tw1
  • Block 7: Musculoskeletal System Bone and Soft-Tissue Tumors 2
  • Block 7: Musculoskeletal System Bone and Soft-Tissue Tumors Enchondroma Chondroblastoma Chondrosarcoma Osteoblastoma Osteosarcoma Fibrosarcoma Myeloma Lymphoma Giant cell tumor Ewing’s sarcoma Osteochondroma Osteoid osteoma Maligant fibrous Histiocytoma Age(years) 0 10 20 30 40 50 60 70 FIGURE69-1. Age distribution of patients with bone tumor according to type. (Wilkins. R.M. and 3 Sim. F.H. Evaluation of Bone and Soft Tissue Tumors. In D Ambrosia R.D.(ed): Musculcskeletal Disorders Philadelphia J. B.Lippincou. 1986
  • Block 7: Musculoskeletal System Bone and Soft-Tissue Tumors 4
  • Block 7: Musculoskeletal System Clinical Approach to Musculoskeletal Tumors KMU PRACTICE GUIDELINES PATIENT COMPLAINT HISTORY AND PHYSICAL EXAMINATION SOFT TISSUE CLINICAL INFORMATION BONEIMAGE STUDY INTERPRETATION IMAGE STUDYLAB TEST TUMOR TUMOR LAB TEST SOFT TISSUE TUMOR BONE TUMOR DIFFFERENTIAL DIAGNOSIS PROBABLE PROBABLE BENIGN MALIGNANT BENIGN MALIGNANT METASTASES BIOPSY CLINICAL, RADIOGRAPHIC, AND PATHOLOGIC CORRELATION DIAGNOSIS SURGICAL STAGING 5 TREATMENT DESIGN Bone and Soft-Tissue Tumors
  • Block 7: Musculoskeletal System Bone and Soft-Tissue Tumors Surgical Margin of Musculoskeletal Tumors Musculoskeletal Cancer Surgery 6 M.M.Malawer 2001
  • Block 7: Musculoskeletal System Material and Method-1 Time: 1989---2005 Case: 33 patients, 38 prosthesis ( 5 revision) Sex: 15 male, 18 female Age: 15---63 y/o, average: 28 y/o primary malignant: 22 y/o metastases: 45 y/o Tumor: osteosarcoma– 19, malignant lymphoma– 2 malignant GCT-- 3, admantinoma– 1 chondrosarcoma—1, MFH—1 7 soft part sarcoma—1, metastases--5
  • Block 7: Musculoskeletal System Material and Method-2 Anatomic location: distal femur– 14, proximal femur– 5 total femur– 1 proximal tibia – 6 proximal humerus– 3 pelvic– 2 diaphysis-- 2 (humerus-1, tibia-1) Tumor prosthesis: knee joint– 21 (femur-15, tibia-6) hip joint—8 (saddle-2, THR-3, bipolar-3) shoulder joint– 3 8 intercalate diaphysis—2(humerus-1, tibia-1)
  • Block 7: Musculoskeletal System Results-1 9
  • Block 7: Musculoskeletal System Results-21. Functional scores of M-S Tumor Society: (motion , pain , stability/deformity , strength , functional activities , emotional acceptance ) - Excellent=5 , Good=3 , fair=1 , Poor=0 average 24 (13---28) , 80% normal function (30)2. Complication : aseptic loosen 2 ( revision) stem broken 1 (revision) stem migration 1 (observation) hinge broken 2 (revision) 10 infection 3 ( 1 A-K amputation)
  • Block 7: Musculoskeletal System Discussion 1. Satisfied functional result 2. Normal soft tissue envelope 3. Longevity of prosthesis 4. Infection rate 11
  • Block 7: Musculoskeletal System Malignant Tumor Non-Resection Resection IORT Re-Implantation Bone-Transplantation Prosthesis Only (60Gray) 1.Autoclave 1.Autograft Replacement (121-135 oC, a. free 1.Custom 5-15 min) b.vascular 2.Growing Rotation 2.Pasteurization c.lengthen Plasty (62 o C, 71 oC, 2.Allograft 3.Spacer 30min) 3.Xenograft 4. lengthen 3.after IORT Segment (extracorporeal) Amputation 4.alcoholization (95% A/C, 30 min) 5.Liquid N2, 30 min Utilization Bone of tumor Discarding Limb salvage Amputation 12 Bone and Soft-Tissue Tumors
  • Block 7: Musculoskeletal System Bone and Soft-Tissue TumorsBone Cancers KMU PRACTICE GUIDELINES EVALUATION TREATMENT FOLLOW-UP RECURRENCE P’t complain S/S Diagnosis(special fig.) Follow-up Local H&P •Osteosarcoma •Chondrosarcoma -every 3 mo for yr1+2 •Repeat •Ewing’s Sarcoma primary Bone lesion -every 4 mo for yr 3 Chest x-ray •Other primary malignant treatment Lab studies •Carcinoma Metastases -every 6 mo for yr 4+5 MRI + CT -every 1 yr for yr 6-10 Surgery Biopsy •En block resection •Physical examination Systemic • needle •Reconstruction •X-ray of lesion metastases (CT,Echo) •Wide margins •open •Limbsalvage if possible •Chest x-ray •Lung only: •frozen •Amputation •Bone scan resection+C/T Chemotherapy C/T •Lab test •Other sites: •Preoperation •Chest CT if abnormal Best Bone scan •Single •Postoperation supportive •Multiple x-ray finding Radiotherapy R/T Treatment 13Staging •Preoperation •Postoperation
  • Block 7: Musculoskeletal SystemSoft-tissue Sarcomas KMU PRACTICE GUIDELINES EVALUATION TREATMENT MODALITY FOLLOW-UP RECURRENCE P’t complain Surgery Low grade, Local: S/S •En block resection Effective wide H&P •Wide margins Repeat Resectable margin Soft tissue •Limbsalvage if possible treatment mass •Amputation Follow-up: -every 3 mo for yr1+2 Echo -every 4 mo for yr 3 Chest x-ray -every 6 mo for yr 4+5 •High grade -every 1 yr for yr 6-10 Lab studies •Physical examination •No effective MRI + CT Resectable •X-ray of lesion wide margin •Chest x-ray •Galium scan Biopsy •Lab test •Chest CT if abnormal • Needle x-ray finding (CT,Echo) Unresectable •Open Radiotherapy •Frozen •Galium scan Chemotherapy Metastases: •Doxorubicin •Single organ—debulking tumor,or •Single •Ifosfamide metastasectomy ,+R/T ,+C/T •Multiple •Disseminated---- palliative surgery, Metastases •TPOG-RMS-95 best supportive treatment 14Staging Bone and Soft-Tissue Tumors
  • Block 7: Musculoskeletal System Bone and Soft-Tissue Tumors Summary / take home message  Oncologic team work for treatment of cancer patients  The current trend of surgical method for malignant tumors is limbsalvage more than amputation 15
  • Block 7: Musculoskeletal System Bone and Soft-Tissue Tumors THANKS FOR YOUR ATTENTION 16