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Bone Diseases↗
Biomedical subjects
M Campanacci
Publications and source records attributed to M Campanacci.
Radiotherapy in vertebral tumors. Indications and limits: a report on 28 cases of Ewing's sarcoma of the spine.
After brief notes on techniques used to radiate the spine, its indications and the limits of doses required by its adjacency to the spinal cord, our experience in the treatment of 28 patients with a diagnosis of Ewing's sarcoma localized in the spine, not metastatic at onset, that came to our observation between 1980 and 1994 is reported. All of the patients were treated by chemotherapy. As for local treatment radiotherapy was performed in all of the cases, in 50% of cases it was associated with surgery (6 laminectomies, 6 excisions, and 2 vertebrectomies). Five-year survival rate was 43.5%. The prognosis of this group of patients was intermediate among forms localized in the limbs and those localized in the pelvis. There is a greater frequency of cerebral (20%) and skeletal metastases (55%) as compared to the disease that occurred in other sites where secondary pulmonary localizations generally prevailed. Local control was similar for disease occurring in other sites despite the need to deliver doses that were lower than those typically used for this pathology in regions above the cauda.
Adolescent↗
[Local recurrence after surgical or surgical-chemotherapeutic treatment of osteosarcoma of the limbs. Incidence, risk factors and prognosis].
METHODS: Local recidivation (incidence, risk factors an prognosis) was analysed retrospectively in 765 patients with non-metastatic osteosarcoma of the extremities treated between 1972 and 1992 either with surgery alone (78 cases) or with surgery and associated adjuvant (258 cases) and neoadjuvant chemotherapy (429 cases). RESULTS: The local recurrence of the disease, which was documented in 26 patients (3.4%), was significantly related to the type of surgery performed (1.1% in 344 amputated patients vs 5.2% in 422 patients treated with resection; p < 0.003) and with surgical margins (0.6% in 700 radical or extensive operations vs 22.7% in 66 marginal or intralesional interventions; p = 0.0001). In patients treated with neoadjuvant chemotherapy, the incidence of local recidivation was also correlated with the type of histological response to chemotherapy (2.9% in 274 cases with a "good" response vs 8.4% in 154 cases with a "poor" response; p < 0.021). In all 26 patients local recidivation was associated with metastases occurring before (16 cases), after (3 cases) or in concomitance (7 cases) with the local recurrence of neoplasia. In spite of treatment performed at the start of recidivation, 25 patients (96.1%) died from the tumour whereas the mortality rate in those patients with metastases but no local recidivation was only 72.1% (261 out of 362 cases). This difference was also statistically significant (p < 0.01). CONCLUSIONS: The results obtained appear to justify the current trend of minimising demolitive surgery in osteosarcoma of the extremities. Surgery should only be performed in these patients by centres able to make an adequate evaluation of surgical margins and the histological response to preoperative chemotherapy. In view of the fatal prognosis linked to recidivation and the high probability of its onset in cases with inadequate surgical margins and a poor response to chemotherapy, the authors propose that subsequent amputation should be performed immediately in those patients undergoing resection who present both these conditions.
Bone Neoplasms↗