Recent Advances in Musculoskeletal Oncology

291 Pages·1992·7.018 MB·English

by  Hitoshi Katayama (auth.), Associate Professor Atsumasa Uchida M.D., Professor Keiro Ono M.D. (eds.)

A. Uchida · K. Ono
(Eds.)
Recent Advances
in Musculoskeletal
Oncology
With 97 Illustrations
Springer Japan KK
Associate Professor ATSUMASA UcHIDA, M.D.
Professor KEIRO 0No, M.D.
Department of Orthopedic Surgery, Osaka University Medical School, Fukushima,
1-1-50, Osaka, 553 Japan
ISBN 978-4-431-68366-7 ISBN 978-4-431-68364-3 (eBook)
DOI 10.1007/978-4-431-68364-3
© Springer Japan 1992
Originally published by Springer-Verlag Tokyo Berlin Heidelberg New York in 1992
Softcover reprint of the hardcover 1st edition 1992
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Preface
Je le pensay, et Dieu le guarist
Ambroise Pare
This was not fully validated in malignant tumors, whichever systems or organs
they may have originated in. Amputation immediately after diagnosis was not
rewarding for patients with musculoskeletal malignancy until the development
in the last 20 years of adjuvant chemotherapy and oncologic surgical techniques
based on the appropriate staging system.
Ever since the advent of effective systemic chemotherapy, further improve
ments in its regimen have been made, based on various theories concerning
cell-cycle-dependent drug sensitivity, drug combinations to minimize tumor
resistance, and dose intensity to enhance the fractional kill of tumor cells.
Histologic subtype, aggressiveness, and particularly the anatomic setting of the
lesions were found to be the determinants of surgical results in the treatment of
musculoskeletal malignancy and hence integrated as a surgical staging system
by Ennecking.
It is essentially important for all orthopedic surgeons, oncologists, radio
logists, nurses, and co-medical staff to dedicate their whole-hearted devotion to
the cause of a modern oncology regimen to combat the patients' suffering
before God's mercy is bestowed on them. Fortunately expenditure for the
treatment of these malignant diseases is covered by the national medical
insurance scheme in Japan. Yet the physical, psychological, educational, and
occupational costs for the patients accompanying the management of the
oncology should not be ignored. Less than 70% survivorship for osteogenic
sarcoma seems to be less than rewarding for all these events related to the
whole process of treatment.
What will the next breakthrough be in musculoskeletal oncology? The
answer to this question should focus on achieving earlier detection of the
lesions, inhibiting and suppressing spread, and improving systematized treat
ment by medical, surgical, and physical modalities, in other words, the rational
method, including enhancement of a patient's self-cure potential, as Pare
prayed for his patients. This was enthusiastically discussed at the 23rd Annual
Meeting of the Musculoskeletal Oncology Society of the Japanese Orthopedic
v
VI Preface
Association, 1990, in Osaka. Plenary lectures, selected papers at the Meeting,
and further invited papers have been collected and organized here in this book,
with the aim of introducing recent advances in musculoskeletal oncology in
Japan and the world. As a potential breakthrough, emphases are placed on the
following subjects: new image technology, new assessment modalities of tumor
aggressiveness, development and refinement of chemotherapy and heavy
particle irradiation, limb saving surgery and newly developed tumor prostheses,
progress in assessment and surgical management of metastatic bone disease,
comprehensive supportive care for patients, and rehabilitation programs.
Even the children, knowing fully well the grave situation in which they are
placed by these malignant tumors, make efforts with nausea and fatigue to
reconcile themselves to their lot, hiding the tragedy of the mental agony of
loneliness within themselves. We should never forget that any progress in
oncology could not be accomplished without the patient's positive collabor
ation. This book is dedicated to all our undefeated patients.
KEIRO 0NO
ATSUMASA UCHIDA
Contents
Preface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . V
List of Contributors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . XI
Part 1 Diagnosis
Section I Diagnostic Technology
1.1 Imaging Diagnosis in Orthopedics: A Basic Introduction to the
Interpretation of MRI . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
HITOSHI KATAYAMA
1.2 MR Imaging of Bone and Soft Tissue Sarcoma:
Significance of MRI in Planning Surgical Margins and
Check Points in Clinical Evaluation . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
MITSURU TAKAHASHI, KEIJI SATO, KEISUKE NAKANISHI,
NAOKI FuKAYA, and TAKAYUKI MIURA
1.3 Determination of Surgical Margins by Intraoperative
Ultrasonography in Malignant Soft Tissue Tumors . . . . . . . . . . . . . . . 23
SHINJI HIRABAYASHI, ATSUMASA UCHIDA, HIDEKI YOSHIKAWA,
and KEIRO ONo
1.4 Gene Analysis for Bone and Soft Tissue Tumors . . . . . . . . . . . . . . . . 30
NosuHITO ARAKI, ATSUMASA UcHIDA, ToMOATSU KIMURA,
HIDEKI YosHIKAWA, YASUAKI AoKI, TAKAFUMI UEDA,
and KEIRO 0NO
Section II Histological Diagnosis
1.5 Histopathological Diagnosis of Soft Tissue and Bone Tumors by
Cytological Architectural and Matrical Characteristics . . . . . . . . . . . 41
HIDEO NAMIKI
VII
VIII Contents
1.6 Preliminary Histomorphometric Study on Pathological Grading of
Giant Cell Tumors of Bone . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52
Rui-ZoNG LEE, SHUN-LV Yu, and ZHAO-HAN BIAN
Part 2 Chemotherapy
2.1 Principles of Adjuvant Chemotherapy for Bone and Soft Tissue
Tumors.................................................... 61
SHUICHI FUJIMOTO
2.2 Principles for Designing Scientific Investigations of
Orthopedic Malignancies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 68
MASANORI FUKUSHIMA
2.3 Preoperative Chemotherapy for the Treatment of
Osteosarcoma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 74
HIDEKI HAMADA, YOSHITAKA SHINTO, TAKAFUMI UEDA,
HIDEKI YOSHIKAWA, ATSUMASA UCHIDA, and KEIRO 0NO
2.4 Intra-Arterial Cisplatin Chemotherapy for Osteogenic
Sarcoma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 81
Soo-YoNG LEE, CHIN Yous CHuNG, Goo HYUN BAEK,
and HoNG SIK BYUN
2.5 Clinical Study of Recombinant Human Granulocyte Colony
Stimulating Factor in Patients Undergoing Intensive Chemotherapy
for Malignant Bone and Soft Tissue Tumors . . . . . . . . . . . . . . . . . . . . 92
YosHITAKA SHINTO, ATSUMASA UcHIDA, IKuo KuDAWARA,
and KEIRO 0No
2.6 Future Directions in the Management of Malignant Bone Tumors 98
RoBERT L. SouHAMI
Part 3 Radiotherapy
3.1 Fast Neutron Radiotherapy for Sarcomas of the Bone and Soft
Tissue . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 111
HIROSHI TSUNEMOTO, SHINROKU MORITA, TAKASHI NAKANO,
and SHINICHIRO SATOH
3.2 Future Directions of Proton Beam Radiotherapy for Bone and
Soft Tissue Tumors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 119
HIROHIKO Tsum and HIROSHI TsuJI
3.3 Treatment of Malignant Bone Tumors Using Radioisotopes 125
RIKUSHI MORITA
Contents IX
Part 4 Surgical Treatment
4.1 Optimal Prosthetic Design in Tumor Prostheses: Application of
Extracortical Bone Bridging and Ingrowth Fixation Principle . . . . . 133
EDMUND Y.S. CHAO
4.2 A Limb-Saving Operation for Cases with Malignant Pelvic Bone
Tumors................................................... 147
ATSUMASA UCHIDA, YOSHITAKA SHINTO, IKUO KUDAWARA,
HIDEKI YosHIKAWA, KEIRO 0No, TAKAFUMI UEDA,
and HIDEKI HAMADA
4.3 Limb-Salvage Procedures for Osteosarcoma Using Intraoperative
Radiation Therapy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 155
YoSHIHIKO KOTOURA, TAKAO Y AMAMURO, KATSUYUKI KASAHARA,
RENPEI IWASAKI, MASAJI TAKAHASHI, and MITSUYUKI ABE
4.4 Replacement by Ceramic Prostheses for the Treatment of
Malignant and Benign Aggressive Bone Tumors . . . . . . . . . . . . . . . 161
HIDEKI HAYASHI, ATSUMASA UCHIDA, HIDEKI HAMADA,
HIDEKI YosHIKAWA, YosHITAKA SHINTO, and KEIRO ONo
4.5 Limb Salvage by Custome Prothesis: Madras Experience 173
M.V. NATARAJAN, V. SHANTA, and S. KRISHNAMURTHI
4.6 Vascularized Bone Grafting for Bone Defects after
Removal of Bone and Soft Tissue Tumors in
Limb-Saving Precedures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 179
AKIO MINAMI and KIYOSHI KANEDA
4. 7 Soft Tissue Reconstruction in Limb-Sparing Tumor Surgery 185
KOICHIRO IHARA, KAZUTERU DOl, KAZUHIRO SAKAI,
KENJI KIDo, TETSURO KISHIMOTO, and SHINYA KAWAI
4.8 Prosthetic Replacement for Malignant Bone and
Soft Tissue Tumors About the Knee: Radiological Evaluation of
Tumor Prosthesis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 192
MASANOBU SAITO, AKIRA MARUOKA, ATSUMASA UCHIDA, and
KEIRO 0NO
4.9 Surgical Reconstruction for Metastatic Malignancies of the
Spine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 201
Po-QuANG CHEN and TANG-KuE Liu
4.10 Prosthetic Replacement Surgery for Spine Metastasis . . . . . . . . . . . 208
KEIRO 0No, SoHEI EBARA, KAzuo YoNENOBU, NoBoRu HosoNo,
and EDwARD J. DuNN
X Contents
Part 5 Prognostic Factors
5.1 Assessment of Malignancy of Bone and Soft Tissue Tumors
Using DNA Cytofluorometry . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 221
KATSUYUKI KusuzAKI, TsuKASA AsHIHARA,
and YASUSUKE HIRASAWA
5.2 The Evaluation of Clinical Prognostic Factors in Osteosarcomas 229
ToHRu UMEDA, TAKESHI IsHII, MASASHI KITOH, TosHIYUKI OzAwA,
NoRIHIKO TAKADA, and SHIN-ICHIRO TATEZAKI
5.3 Histological Typing and Grading of Adult Soft Tissue Sarcomas:
Eastern Cooperative Oncology Group (ECOG) Experiences and
Review of the Literature . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 237
MASANORI SHIRAKI and JoHN J.S. BRooKs
5.4 Multivariate Analysis for Histological Prognostic Factors in
Soft Tissue Sarcoma of Extremities and Trunk . . . . . . . . . . . . . . . . . . 248
TAKAFUMJ UEDA, KATSUYUKI AOZASA, MASAHIKO TSUJIMOTO,
AKIRA MYOUI, SHIGEYUKI KURATSU, ATSUMASA UCHIDA,
and KEIRO ONo
5.5 A Classification of Bone Metastases from Breast Cancer 254
KAzuo YAMASHITA, TAKAFUMI UEoA, Yosmo KoMATSUBARA,
HIROKI KoYAMA, HIDEO INAJI, KAzuo YoNENOBu, and KEIRO 0No
5.6 Alteration of the Metastatic Pattern of Osteosarcoma Associated
with Adjuvant Chemotherapy: An Analysis of 38 Autopsy Cases 260
ATSUMASA UcHIDA, YosHJTAKA SHINTO, NoBUHITO ARAKI,
HIDEKI YOSHIKAWA, TSUGIO KATO, and KEIRO 0NO
Part 6 Total Care
6.1 Gait Analysis and Its Significance in Patients with Total Knee
Prosthesis after Wide Resection of Malignant Tumor . . . . . . . . . . . . 269
HIROYUKI KAWAMURA, TosHIHIKO YoNEDA, YosHITAKA HAYASHI,
ATSUMASA UcHIDA, SHIGEYUKI KuRATsu, KAzuo HIROSHIMA,
and KEIRO 0No
6.2 Nutritional Support of Children with Cancer 278
MASAHIRO FuKUZA w A and AKIRA OKADA
Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 285