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M Dominkus

Publications and source records attributed to M Dominkus.

At least 19 recordsLinked to original sources
PubMed2006

Prognostic factors in metastatic renal cell carcinoma: metastasectomy as independent prognostic variable.

Prognostic and predictive factors in patients with metastatic renal cell carcinoma (MRCC) have been evaluated from untreated patients or patients on several different treatment approaches. The aim of this analysis was to define prognostic and predictive factors in patients treated uniformly with a low-dose outpatient cytokine combination. The relationship between patient-, tumour-, and treatment-related factors was analysed in 99 patients with MRCC. These features were first examined in univariate analyses, then a stepwise modelling approach based on Cox regression was used to form a multivariate model. Nuclear grade, metastasectomy--even incomplete--C-reactive protein and lactate dehydrogenase were identified as independent prognostic factors for survival. Patients assigned to three different risk groups had statistically significant survival differences (30, 22 and 6 months, respectively). A total of 43.4% had undergone metastasectomy, mostly incomplete. Risk group affiliation was correlated with response to treatment. Our findings strongly suggest the consideration of metastasectomy in the management of patients with metastatic renal cell cancer undergoing either immunotherapy or targeted treatment.

Adult↗
PubMed2006

Histologically verified lung metastases in benign giant cell tumours--14 cases from a single institution.

From 1975 to 1997, 649 cases of benign giant cell tumours of the bone were treated at the Istituto Rizzoli. Fourteen patients (2.1%) experienced lung metastases after a mean of 35.2 months. The time interval between the diagnosis and the appearance of the lung metastases ranged from 3 months to 11.9 years. Metastasectomy was performed in all patients. Histologically, the metastases were identical to the primary bone lesions. Two patients with unresectable multiple metastases received additional chemotherapy. After a follow-up of 70 months (range: 8.2 to 185 months), all patients are alive. Ten patients showed no evidence of disease, one of these after a second resection of metastases, and four patients presented stable disease with multiple lung metastases. Local recurrence of the bone lesion occurred in seven patients before or simultaneously to the metastases. In contrast to previous reports, we could not detect a predominance of the distal radius, but all of the patients had a stage III tumour according to the Enneking criteria of benign lesions. We conclude that even metastatic benign giant cell tumours have an excellent prognosis after adequate resection. No prognostic factors despite high-grade lesions were detectable.

Adolescent↗
PubMed2005

[Functional tendon repair in orthopedic tumor surgery].

Large defects of functional soft tissue structures, e.g., extensor mechanism, ligaments, muscles, and joint capsule, may occur in tumor surgery or revision surgery following conventional joint replacement. Reconstruction can be performed using biological grafts such as free or pedicled tendon-muscle flaps, allografts, or synthetic material. Prerequisites for synthetic material are good biologic tolerance with fibroblastic ingrowth, mechanical resistance to fatigue, and a maximum of tension force with a minimum of elongation. In this study we used a nonresorbable band of longitudinal polyester fibers with a minimal rupture level of 4000 N and an elongation rate less than 7% of its original length. The shape of the band was designed for universal use with 40 cm length and 6 cm width. Its primary indication was augmentation or complete reconstruction of the extensor mechanism of the knee joint after large extra-articular tumor resections in primary bone tumors. Furthermore, its use for hip joint capsule reconstruction in luxation, coverage of megaprostheses of the humerus, and augmentation after biological reconstruction of tendons achieved excellent results.

Bone Neoplasms↗
PubMed2003

[Endoprosthesis management of the extremities of children after resection of primary malignant bone tumors].

In recent years, significant progress has been made in the treatment of primary malignant bone tumors. The surgeon is confronted with increasing demand for limb-sparing surgery by patients and parents alike. In the skeletally immature, resection of the growing physis will ultimately result in leg length discrepancies and functional impairment. An adequate reconstruction therefore calls for the compensation of the expected growth deficit to achieve symmetry and an optimized function of the extremity. Between 1975 and 2000, 55 patients (24 female, 31 male) were referred and treated at our institution. All patients were not older than 10 years (4.2-10, mean: 7.9 years). Histological diagnosis was Ewing's tumors ( n=19) and osteosarcoma ( n=36). Localization in the extremities was predominantly in the lower extremity with 63.6% around the knee joint (distal femur and proximal tibia). Surgical treatment was performed in all patients. Endoprosthetic reconstruction was performed in 34 patients (lower extremity n=30, 29 Howmedica Modular Reconstruction System, HMRS, 1 Pafford prosthesis; upper extremity n=4, 4 HMRS); in another case of humeral tumor involvement a resection replantation procedure was carried out. The other patients received a rotationplasty ( n=7), a biologic reconstruction ( n=6), resection replantation of the humerus ( n=1), no reconstruction ( n=3), or had to be amputated ( n=4). After a mean follow-up of 114 months (24-256 months) 11 patients had died. Even in young children endoprosthetic reconstruction with relatively early mobilization and high quality of life can be a very successful method for limb salvage. Optimal reconstructive results following resection of primary malignant bone tumors in children are reached when indications and limitations of each method are carefully considered on an individual basis taking into account the patients' expectations.

Activities of Daily Living↗
PubMed2003

Osteosarcoma over the age of forty.

The European Musculo Skeletal Oncology Society (EMSOS) has carried out a retrospective review of patients over the age of 40 years with osteosarcoma. 481 patients from 12 centres or multicentric groups were included. 42 patients had osteosarcoma arising in Paget's disease, median survival was 9 months. Patients with axial or metastatic tumours also did badly whilst 41 patients with radiation-induced osteosarcoma had a prognosis paralleling conventional osteosarcoma matched for patient age and site of the tumour. 238 patients had high grade non-metastatic osteosarcoma and had a survival of 46% at 5 years. Older patients had less chemotherapy and fared worse. Osteosarcoma in the elderly is a curable condition and warrants intensive treatment with chemotherapy and surgical resection.

Adult↗
PubMed2003

Bone mineral density in long-term survivors of highly malignant osteosarcoma.

We studied the bone mineral density (BMD) of 48 long-term survivors of highly malignant osteosarcoma who had been treated according to the chemotherapy protocols of the German- Swiss-Austrian Co-operative Osteosarcoma Study Group which include high-dose methotrexate. The mean age of the patients was 31 +/- 4.2 years and the mean follow-up 16 +/- 2.2 years. The BMD of the lumbar spine and of the proximal femur of the non-operated side was measured by dual-energy x-ray absorptiometry. A questionnaire was given to determine life-style factors, medical history and medication. Ten patients were osteoporotic, 21 osteopenic and 17 normal according to the WHO definition. Eighteen patients suffered fractures after receiving chemotherapy and all had significantly lower levels of BMD for all the sites measured.

Absorptiometry, Photon↗
PubMed2002

Peripheral osteoid osteoma. Is there still a place for traditional surgery?

We treated 106 patients with a peripheral osteoid osteoma by conventional surgical methods; 81 had curettage and 25 en-bloc resection. The rate of local recurrence after curettage was 12% and after en-bloc resection 4.5%. Postoperative fractures were observed in 3% after curettage and in 4.5% after en-bloc resection. We compared our findings with those reported in the literature after minimally invasive treatment and concluded that curettage can be regarded as the treatment of choice in patients in whom minimally invasive methods do not offer any advantage, for example, for subperiosteal tumours which are readily accessible, or when the diagnosis is unclear and further histological analysis is required.

Adolescent↗
PubMed2002

Revision of the Kotz type of tumour endoprosthesis for the lower limb.

In 251 patients over a period of 15 years an uncemented Kotz modular femoral and tibial reconstruction mega prosthesis was implanted after resection of a malignant tumour of the lower limb. Twenty-one patients (8.4%) underwent revision for aseptic loosening, again using an uncemented prosthesis, and five of these required a further revision procedure. The median follow-up time from the first revision was 60 months (11 to 168) and after a second revision, 33 months (2 to 50). The probability of a patient avoiding aseptic loosening for ten years was 96% for a proximal femoral, 76% for a distal femoral and 85% for a proximal tibial implant. At the time of follow-up all radiographs were assessed according to the International Symposium of Limb Salvage criteria. The first radiological signs of aseptic loosening were always seen at the most proximal or distal part of the anchorage stem at a mean of 12 months (4 to 23) after the first implantation. Using the Musculoskeletal Tumor Society score for evaluation, the clinical results showed a mean of 88% of normal function.

Adolescent↗
PubMed2002

[Bone metastases: new trends in diagnostic imaging].

Skeletal metastases are common in patients with cancers of the breast, lung, kidneys, prostate, and thyroid gland. Two main aspects have to be considered in diagnostic imaging. Screening in patients with known primary tumor. Triphasic Sczintigraphy is the imaging modality of choice for this purpose, however, whole-body-magnetic resonance imaging seems to be a potential alternative. Evaluation of suspicious skeletal lesions, which is currently dominated by magnetic resonance imaging. New perspectives for preoperative staging as well as for reconstruction- and implant-surgery are made available by multidetector-row-computed tomography. Non-invasive techniques, such as diffusion weighted imaging, positron emission tomography and positron emission tomography/computed tomography are now available, which seem to have potential for reliable tissue characterization. This feature is critical for monitoring treatment response in oncology.

Biopsy↗
PubMed2001

[Diagnostic imaging of giant cell tumors].

Although classified as benign neoplasms, giant cell tumors are locally aggressive with a high recurrence rate of 30-50%. The histological appearance include osteoclast-like, multinucleated giant cells and round to spindle-shaped mono-nuclear stromal cells. These neoplasms predominately affect adults in the third and forth decades of life (70-80%). Giant cell tumors predominately arise in long tubular bones (75-95%) with the majority occurring around the knee (50%). The next most common site being the distal radius (10%). The epicenter of giant cell tumors is in the epiphysis. The radiographic signs of giant cell tumors are a geographical radiolucency with no internal mineralization, a thinning of the cortex, eccentric in the epiphysis of long bones. MRI signs of giant cell tumors are high signal intensity in T2-weighted images, high contrast media enhancement, fluid levels, signs according to haemorrhage and haemosiderin deposition. CT shows the expanded and thinned cortex. Plain radiographs remain the mainstay of diagnosis of giant cell tumors. MRI and CT are important for staging and therefore for surgical planning.

Bone Neoplasms↗
PubMed2001

[Diagnostic-therapeutic procedure in benign bone tumors].

The indications of surgical treatment of benign bone tumours are strongly related to the clinical behaviour, the patient's complaints and the activity in Tc-bone scan. Some lesions--like the nonossifying fibroma--that can safely be diagnosed by conventional x-rays may not be treated surgically--as long as the patients are free of pain, and there is no risk of pathologic fracture. In case of clinically relevant lesions, activity in Tc-bone scan, or a risk of fracture, biopsy and curettage combined with autologous or homologous bone grafting is indicated. Some aggressive tumors, like the giant cell tumor, have to be treated more aggressively by curettage with adjuvant measures (Phenole) or by marginal excision.

Biopsy↗
PubMed2001

Recurrence of curetted and bone-grafted giant-cell tumours with and without adjuvant phenol therapy.

AIMS: Giant-cell tumour of bone (GCT) represents 5% of all primary bone tumours. The aim of this study was to compare the outcome of GCT treated with or without phenol. METHODS: Out of 53 patients primarily treated for a giant-cell tumour, 47 were followed, with a median follow-up of 11 (range 4-43) years. All patients were disease-free at the latest follow-up. Of the 40 tumours (85%) located in long bones, 14 (35%) were treated by curettage and bone grafting and 12 (30%) by additional adjuvant phenol treatment. Fourteen patients (35%) received different therapies, including en-bloc resection, endoprosthesis, cement packing or other therapy. RESULTS: There were seven (17.5%) recurrences in long bones after a median of 12 (range 4-60) months, three (3/14, 21%) in the group treated without phenol and three (3/12, 25%) in the group with phenol. Of the seven tumours located in the axial skeleton, two patients died within the first year after surgery. The remaining five patients were followed, with a median follow-up of 12 (range 8-23) years. No patients had metastases or a multicentric tumour. CONCLUSIONS: Despite the different rates of recurrence reported in literature, this study suggests that local recurrence rate of giant-cell tumours located in long bones treated with or without phenol is similar. Adequate removal of the tumour seems to be a more important predictive factor for the outcome of surgery than the use of phenol as an adjuvant therapy.

Adolescent↗
PubMed2001

A long-term review of the treatment of patients with Ewing's sarcoma in one institution.

AIMS: The treatment of patients suffering from Ewing's sarcoma has changed over the last three decades. We report the analyses, significant prognostic factors, interdisciplinary approach and development of therapy in one institution in Austria. METHODS: One hundred and forty-two patients treated for Ewing's sarcoma between 1949 and 1994 were reviewed. Median follow-up was 8.5 years. Fifty-six patients were treated between 1949 and 1980 (group 1), and 86 patients between 1981 and 1994 (group 2). Patients in group 1 were treated with polychemotherapy. Patients in group 2 were treated with a neoadjuvant CESS (Cooperative Ewing's Sarcoma Study) regimen. In group 1, 24 patients underwent biopsy only, 32 patients had a definitive operation, 48 patients received either radiation therapy only or additional radiation therapy compared with in group 2: 6, 80 and 44 cases, respectively. RESULTS: Five-year overall survival (OS) increased from 27% to 57%. Significant prognostic factors for OS were pre-operative metastases (P=0.0001), tumour location (P=0.0048), type of chemotherapy (P=0.002) and response to chemotherapy (P=0.0004). Chemotherapy (P=0.037), tumour location (P=0.0017) and metastases at diagnosis (P=0.0025) were significant. CONCLUSION: The most effective treatment of Ewing's sarcoma is chemotherapy.

Adolescent↗
PubMed2001

Long-term followup of uncemented tumor endoprostheses for the lower extremity.

Between 1982 and 1989, 100 primary lower limb reconstructions were done using the Kotz Modular Femur Tibia Reconstruction System after resection of a malignant tumor. In 32 patients a proximal femur prosthesis was implanted, in 40 patients a distal femur prosthesis was implanted, in 19 patients a proximal tibia component was implanted, in four patients a total femur prosthesis was implanted, and in five patients a total knee prosthesis was implanted. The Kaplan-Meier estimate of the overall survival rate of the prostheses was 85% after 3 years, 79% after 5 years, and 71% after 10 years. The most common reason for implant failure was aseptic loosening in 27% of patients (11 patients; range, 10-121 months) after the initial operation. The other reasons for revision surgery were implant fracture (n 5 4) and infection (n 5 4). Early repair of prostheses-related minor complications, such as worn polyethylene bushings, resulted in a statistically significant reduction of implant failure. After a median followup of 127.5 months after the initial surgery, 51 patients had died and eight patients were lost to followup. Forty-one patients were evaluated clinically and radiologically using the Musculoskeletal Tumor Society score and the radiologic implant evaluation system of the International Symposium on Limb Salvage; these 41 patients had a mean of 80% (range, 40%-100%) of the normal functional capability.

Adult↗
PubMed2001

Growth prediction in extendable tumor prostheses in children.

Limb salvage procedures for malignant bone tumors of the lower limb in children usualy involve resection of at least one growing physis. To achieve equal leg length, reconstruction relies on accurate prediction of the remaining growth potential of the child. The current authors present the results of predicted growth versus actual prosthetic elongation observed in a group of 15 children fitted with extendable tumor endoprostheses of the lower limb who subsequently have reached skeletal maturity. All patients had at least one of the distal femoral or proximal tibial physes resected for a primary malignant bone tumor. Eight patients underwent distal femoral resection, four patients underwent proximal tibial resection, and three patients had total resection of the femur. All patients received custom-made Howmedica extendable prostheses. In two patients, a newly developed automatic elongation module was used. At followup, between 70 and 158 months, the patients achieved a mean elongation of the surgically treated limb of 10.4 cm (range, 1.1-19.5 cm), which exceeded the predicted growth by 24.3%. Final leg length discrepancies did not exceed 1 cm. Using incremental extendable tumor endoprostheses, individual adaptation of the elongation procedures could be achieved for equalization of leg length discrepancies in children after resection of primary malignant bone tumors of the lower limb.

Adolescent↗
PubMed2001

The role of surgery and resection margins in the treatment of Ewing's sarcoma.

Because of the enormous progress in surgery in the treatment of patients with tumors, the current study analyzed the influence of wide surgical resection margins on the outcome of patients with Ewing's sarcoma. Between 1980 and 1994, 86 patients were treated with systemic therapy and surgery (biopsy in six patients, tumor resection in 80 patients). Forty-four patients also had radiation therapy. The 5-year overall survival was 56.8% (5-year disease-free survival, 59.4%). The 5-year overall survival after radical or wide resection was 60.2% (5-year disease-free survival, 58.2%), in comparison with 40.1% (46.7%) after marginal or intralesional resection. Two patients with inadequate resection margins had local recurrences. In addition to the influence of neoadjuvant chemotherapy for higher survival rates (5-year overall survival with a good response was 80.2% versus 41.7% with a poor response), adequate surgical margins significantly affect the outcome for patients with Ewing's sarcoma.

Adolescent↗
PubMed2000

[Analysis of the migration of cementless all-metal hip endoprosthesis].

Since September 1997, 58 patients have received a newly developed all-metal hip prosthesis at the department of orthopaedic surgery, University Hospital Vienna. In a retrospective study, the migration profile of 26 acetabular components of these prostheses with all-metal cups was evaluated. A total of 25 patients (10 men, 15 women, mean age 61 years) who had been operated on earlier than 11 months previously were studied. Indications included coxarthrosis (15), congenital dysplasia of the hip (7), post-traumatic coxarthrosis (3), and change of the implant due to infection (1). Twenty-three patients (7 men, 16 women; mean age 63 years) with 25 metal-backed polyethylene implants and matched demographic data, indications and cup size, served as the group for comparison. The mean duration of follow-up for both groups was 14 months. For analysis of migration a modified version of Dickob's method for digital measurement of comparative hip radiographs was used. Measurements were performed three times by one examiner. Migration values of more than 2.0 mm were regarded as a sign of possible cup loosening. After 13 to 20 months the average migration was -0.10 mm in horizontal and 0.18 mm in vertical direction for all-metal prostheses, and -0.20 mm horizontally and 0.47 mm vertically for the other group. Mean migration values exceeded the critical limit of 2.0 mm in two patients in the all-metal group, one of whom also had clinical signs of cup loosening. The covariance analysis of the highest migration levels of each patient revealed no significant differences between the groups; the postoperative Harris hip score was 98 points (range, 93-100) in the all-metal group and 97 (range, 92-100) in the other. Provided metal is carefully processed and cups are initially stable, the all-metal implants have equivalent in-growth as expressed by the migration analysis, and thus constitute an alternative therapeutic modality without polyethylene components.

Adult↗