Session 16: Tumors
15. November
12:45 - 13:45
Lokale: Sal B
Chair: Christina Holm & Thomas Baad-Hansen
Andrea Thorn1, Kristoffer Seem1, Michala Skovlund Sørensen1, Ninna A. Pedersen2, Thomas Baad-Hansen3, Michael Mørk Petersen1
1. Rigshospitalet – University of Copenhagen, Department of Orthopaedic Surgery 2. Aarhus Universitetshospital, Department of Oncology 3. Aarhus Universitetshospital, Department of Orthopaedic Surgery
Background: Soft tissue sarcomas (STS) are rare cancers originating in the body’s connective tissues, presenting diagnostic challenges due to diverse and unspecific symptoms. Efforts to improve diagnostic processes, such as the implementation of Danish Cancer Patient Pathways (CPP) in 2009, have shown promise in reducing sarcoma size and diagnostic time intervals. However, the direct impact of CPPs on sarcoma patient survival remains uncertain.
Aim: We aim to assess changes in overall survival between national cohorts of STS high-grade patients pre- and post-CPP implementation.
Materials and Methods: We included all patients above the age of 18 years in Denmark with biopsy confirmed diagnosis of high malignant STS (Trojani grade 2+3). Only patients with MR conform deep- seated sarcoma in the extremities or trunk wall, diagnoses from January 1, 2000, to December 31, 2016, were included. Patients diagnosed in the year 2009 were excluded due to different startup points with the implementation of CPP between the two sarcoma centers in Denmark, resulting in a pre-and post-CPP implementation cohort. Patients were followed until death or end of study (01-01-2024)Statistics: Kaplan Meir Survival analysis, log-rank test, and Mann– Whitney test.
Results: A total of 615 adult patients diagnosed with localized deep-seated high malignant STS in the extremities and trunk wall, were identified (Before 2009 (BF): n= 314, After 2009 (A): n=301). 306 patients died during the follow-up (BF: n= 138, A: n= 168). The 5-year overall survival rates were 44% (CI-95: 39-49%) and 59 % (CI-95: 50-61%) for respectively BF and A (p< 0.001). Median tumor size BF: 10 cm (0.5-30) and A: 9.5 cm (1-40), (p=0.4).
Interpretation / Conclusion: A statistically significant increased survival was observed after the implementation of CPP in patients with high malignant deep-seated STS. Despite prior studies indicating reduced tumor size with CPP, we have not been able to verify this finding.
1. Rigshospitalet – University of Copenhagen, Department of Orthopaedic Surgery 2. Aarhus Universitetshospital, Department of Oncology 3. Aarhus Universitetshospital, Department of Orthopaedic Surgery
Background: Soft tissue sarcomas (STS) are rare cancers originating in the body’s connective tissues, presenting diagnostic challenges due to diverse and unspecific symptoms. Efforts to improve diagnostic processes, such as the implementation of Danish Cancer Patient Pathways (CPP) in 2009, have shown promise in reducing sarcoma size and diagnostic time intervals. However, the direct impact of CPPs on sarcoma patient survival remains uncertain.
Aim: We aim to assess changes in overall survival between national cohorts of STS high-grade patients pre- and post-CPP implementation.
Materials and Methods: We included all patients above the age of 18 years in Denmark with biopsy confirmed diagnosis of high malignant STS (Trojani grade 2+3). Only patients with MR conform deep- seated sarcoma in the extremities or trunk wall, diagnoses from January 1, 2000, to December 31, 2016, were included. Patients diagnosed in the year 2009 were excluded due to different startup points with the implementation of CPP between the two sarcoma centers in Denmark, resulting in a pre-and post-CPP implementation cohort. Patients were followed until death or end of study (01-01-2024)Statistics: Kaplan Meir Survival analysis, log-rank test, and Mann– Whitney test.
Results: A total of 615 adult patients diagnosed with localized deep-seated high malignant STS in the extremities and trunk wall, were identified (Before 2009 (BF): n= 314, After 2009 (A): n=301). 306 patients died during the follow-up (BF: n= 138, A: n= 168). The 5-year overall survival rates were 44% (CI-95: 39-49%) and 59 % (CI-95: 50-61%) for respectively BF and A (p< 0.001). Median tumor size BF: 10 cm (0.5-30) and A: 9.5 cm (1-40), (p=0.4).
Interpretation / Conclusion: A statistically significant increased survival was observed after the implementation of CPP in patients with high malignant deep-seated STS. Despite prior studies indicating reduced tumor size with CPP, we have not been able to verify this finding.
Sarah Stammose Freund1, Andrea Pohly Jeppesen Thorn 2, Ajay Puri 3, Michael Mørk Petersen2, Thomas Baad-Hansen 1
1 Department of Orthopedic Oncology, Aarhus University Hospital, Denmark; 2 Department of Orthopedic Surgery, Rigshospitalet - University of Copenhagen, Denmark; 3 Surgical Oncology, Orthopedic Oncology, Tata Memorial Centre, HBNI, Mumbai.
Background: Concerns have emerged regarding elevated levels of cobalt and chromium in patients with metal-on-metal megaprostheses, however few studies on metal-on-polyethylene megaprostheses exists.
Aim: This prospective study aims to identify systemic cobalt and chromium levels in metal-on- polyethylene knee and hip megaprostheses and their associations with other factors.
Materials and Methods: 56 patients underwent knee or hip megaprosthesis surgery at 2 sarcoma centers. Serum cobalt and chromium levels were measured preoperatively and thrice within the first year using Inductively Coupled Plasma Mass Spectrometry.
Results: Following knee megaprosthesis surgery, there was a significant increase in serum cobalt levels (1.4 ppb; 95% CI 0.0–3.3) at 1-year compared to preoperative levels. Conversely, chromium levels in the same group showed no significant change after 1 year compared to preoperative levels (0.05 ppb; CI 0.0–0.8). Additionally, none of the other megaprostheses groups showed elevated cobalt or chromium over time. Associations were observed between younger age, higher eGFR, and elevated cobalt levels. However, no significant correlations were found between ion levels and resection length or the number of modular connections.
Interpretation / Conclusion: Our findings demonstrate elevated serum ion levels in metal-on-polyethylene knee megaprostheses, contrasting with metal-on- polyethylene hip megaprostheses. Furthermore, positive correlations between cobalt and chromium levels, as well as cobalt and eGFR, were noted, along with a negative correlation between cobalt and age, indicating that younger patients with higher activity levels and better eGFR tend to exhibit higher metal ion levels. Notably, contrary to previous suggestions by other authors, we did not observe any association between metal ion levels and resection length. This study highlights the importance of monitoring systemic cobalt and chromium levels in patients with knee megaprostheses.
1 Department of Orthopedic Oncology, Aarhus University Hospital, Denmark; 2 Department of Orthopedic Surgery, Rigshospitalet - University of Copenhagen, Denmark; 3 Surgical Oncology, Orthopedic Oncology, Tata Memorial Centre, HBNI, Mumbai.
Background: Concerns have emerged regarding elevated levels of cobalt and chromium in patients with metal-on-metal megaprostheses, however few studies on metal-on-polyethylene megaprostheses exists.
Aim: This prospective study aims to identify systemic cobalt and chromium levels in metal-on- polyethylene knee and hip megaprostheses and their associations with other factors.
Materials and Methods: 56 patients underwent knee or hip megaprosthesis surgery at 2 sarcoma centers. Serum cobalt and chromium levels were measured preoperatively and thrice within the first year using Inductively Coupled Plasma Mass Spectrometry.
Results: Following knee megaprosthesis surgery, there was a significant increase in serum cobalt levels (1.4 ppb; 95% CI 0.0–3.3) at 1-year compared to preoperative levels. Conversely, chromium levels in the same group showed no significant change after 1 year compared to preoperative levels (0.05 ppb; CI 0.0–0.8). Additionally, none of the other megaprostheses groups showed elevated cobalt or chromium over time. Associations were observed between younger age, higher eGFR, and elevated cobalt levels. However, no significant correlations were found between ion levels and resection length or the number of modular connections.
Interpretation / Conclusion: Our findings demonstrate elevated serum ion levels in metal-on-polyethylene knee megaprostheses, contrasting with metal-on- polyethylene hip megaprostheses. Furthermore, positive correlations between cobalt and chromium levels, as well as cobalt and eGFR, were noted, along with a negative correlation between cobalt and age, indicating that younger patients with higher activity levels and better eGFR tend to exhibit higher metal ion levels. Notably, contrary to previous suggestions by other authors, we did not observe any association between metal ion levels and resection length. This study highlights the importance of monitoring systemic cobalt and chromium levels in patients with knee megaprostheses.
Andrea René Jørgensen 1,2, Mats Bue1,2,3 , Pelle Hanberg 1,2, Harlev Christina1,2, Krogsgaard Petersen Elisabeth 1,2, Rasmussen Hans Christian 1,2, Hansen Jakob 4, Baad-Hansen Thomas2,3, Safwat Akmal 2,5, Stilling Maiken 1,2,3
1. Aarhus Microdialysis Research Group, Orthopaedic Research Unit, Aarhus University Hospital, Aarhus N, Denmark; 2. Department of Clinical Medicine, Aarhus University, Aarhus N, Denmark; 3. Department of Orthopaedic Surgery, Aarhus University Hospital, Aarhus N, Denmark; 4. Department of Forensic Medicine, Aarhus University Hospital, Aarhus N, Denmark; 5. Department of Oncology, Aarhus University Hospital, Aarhus N, Denmark;
Background: Doxorubicin is a central part of many chemotherapeutic regimens, here amongst osteosarcoma. Despite being applied clinically for decades, very little is known about local tissue concentrations of doxorubicin as pharmacokinetic knowledge regarding dosing regimens are almost solely based on plasma concentrations.
Aim: The aim of this study was to evaluate plasma and bone- and soft-tissue concentrations of doxorubicin following two administrations of either bolus or continuous infusion administered at a three- week interval.
Materials and Methods: Eighteen female pigs were included in the study and randomized into two groups of nine. Based on mean body weight, animals received a doxorubicin dosage of 132 mg (2 mg/kg) on day 1 and a dosage of 150 mg on day 22, as either bolus or continuous infusion. From day 1 to 10, doxorubicin concentrations, as well as kidney and liver function, were monitored with plasma samples (total concentrations). On day 22, doxorubicin was measured in plasma samples (total concentration) and microdialysates (unbound concentrations) from subcutaneous tissue, muscle, synovial fluid of the knee joint, cancellous bone, and intravenously.
Results: On day 22, the pharmacokinetic profiles were comparable between the two groups except for plasma AUC0-12h, which was higher after continuous infusion, and intravenous Cmax, which was higher after bolus infusion. Bone- and soft tissue concentrations were below 0.10 ug/mL. With the exception of mean plasma (total) concentration after 6 h on day 1 and 22 in the continuous group which was higher after the first administration (p=0.037), no differences in plasma concentrations were found between the two administrations.
Interpretation / Conclusion: Low mean tissue doxorubicin concentrations and similar pharmacokinetic profiles were found between the bolus and continuous infusion groups. Thus, similar anti-neoplastic efficacy is to be expected with both administration types.
1. Aarhus Microdialysis Research Group, Orthopaedic Research Unit, Aarhus University Hospital, Aarhus N, Denmark; 2. Department of Clinical Medicine, Aarhus University, Aarhus N, Denmark; 3. Department of Orthopaedic Surgery, Aarhus University Hospital, Aarhus N, Denmark; 4. Department of Forensic Medicine, Aarhus University Hospital, Aarhus N, Denmark; 5. Department of Oncology, Aarhus University Hospital, Aarhus N, Denmark;
Background: Doxorubicin is a central part of many chemotherapeutic regimens, here amongst osteosarcoma. Despite being applied clinically for decades, very little is known about local tissue concentrations of doxorubicin as pharmacokinetic knowledge regarding dosing regimens are almost solely based on plasma concentrations.
Aim: The aim of this study was to evaluate plasma and bone- and soft-tissue concentrations of doxorubicin following two administrations of either bolus or continuous infusion administered at a three- week interval.
Materials and Methods: Eighteen female pigs were included in the study and randomized into two groups of nine. Based on mean body weight, animals received a doxorubicin dosage of 132 mg (2 mg/kg) on day 1 and a dosage of 150 mg on day 22, as either bolus or continuous infusion. From day 1 to 10, doxorubicin concentrations, as well as kidney and liver function, were monitored with plasma samples (total concentrations). On day 22, doxorubicin was measured in plasma samples (total concentration) and microdialysates (unbound concentrations) from subcutaneous tissue, muscle, synovial fluid of the knee joint, cancellous bone, and intravenously.
Results: On day 22, the pharmacokinetic profiles were comparable between the two groups except for plasma AUC0-12h, which was higher after continuous infusion, and intravenous Cmax, which was higher after bolus infusion. Bone- and soft tissue concentrations were below 0.10 ug/mL. With the exception of mean plasma (total) concentration after 6 h on day 1 and 22 in the continuous group which was higher after the first administration (p=0.037), no differences in plasma concentrations were found between the two administrations.
Interpretation / Conclusion: Low mean tissue doxorubicin concentrations and similar pharmacokinetic profiles were found between the bolus and continuous infusion groups. Thus, similar anti-neoplastic efficacy is to be expected with both administration types.
Andrea René Jørgensen 1,2, Anders Elias Hansen 3, Jonas Rosager Henriksen 3, Maiken Stilling1,2,4, Hans Christian Rasmussen1,2, Johanne Gade Lilleøre1,2, Magnus Andreas Hvistendahl1,2, Josefine Slater1,2, Elizabeth Serrano-Chávez3, Jakob Hansen5, Mats Bue1,2,4
1. Aarhus Denmark Microdialysis Research (ADMIRE), Orthopaedic Research Unit, Aarhus University Hospital, Aarhus N, Denmark; 2. Department of Clinical Medicine, Aarhus University, Aarhus N, Denmark; 3. Department of Health Technology, Section for Cell and Drug Technologies, Technical University of Denmark, Lyngby, Denmark; 4. Department of Orthopaedic Surgery, Aarhus University Hospital, Aarhus N, Denmark; 5. Department of Forensic Medicine, Aarhus University Hospital, Aarhus N, Denmark.
Background: The local application of drug depot technologies releasing chemotherapeutics in cancerous tissues presents an interesting strategy for enhancing treatment outcome by increasing and sustaining high local chemotherapeutic concentrations.
Aim: This study aimed to assess the feasibility, delivery capacity, and therapeutic efficacy of a doxorubicin-loaded carbohydrate-ester- based (CarboCell) depot technology as a localized drug delivery system.
Materials and Methods: CarboCell was investigated in three experimental setups: A) Release kinetics were evaluated in mice (non-tumour model) 24 h and 48 h after a subcutaneous injection of depot. B) Efficacy in terms of tumour growth control and survival was evaluated in mice carrying large syngeneic CT 26 colorectal cancer. A volume of 50 µl CarboCell containing 1 mg/mL or 4 mg/mL doxorubicin was injected in the tumours twice at 5 days intervals. C) Local and distant release of doxorubicin CarboCell 2 mg/mL (2 mL or 4 mL) injected into tibial metaphysis was evaluated with microdialysis in nine tissue compartments in ten female pigs.
Results: A) Subcutaneous CarboCell depots displayed a continuous release of doxorubicin with 36±13% (mean±SEM) and 48±20% of the loaded dose being released at 24 h and 48 h time points. B) Intratumoral injection demonstrated robust tumour growth control and significantly prolonged median survival time compared to the control group. C) In the porcine model, irrespective of volume injected (2 or 4 ml), doxorubicin could be measured at least 10 mm from the application site in cancellous bone indicating a good metaphyseal distribution. The systemic spill-over was minimal, and only measurable in three out of ten animals.
Interpretation / Conclusion: Doxorubicin-loaded CarboCell proved easily administrable with maintained antitumoural activity and was able to provide much higher local doxorubicin concentrations when injected in metaphyseal bone compared traditional systemic administration. Importantly, minimal systemic spill-over was observed, supporting further exploration of efficacy and tolerability in combination therapies.
1. Aarhus Denmark Microdialysis Research (ADMIRE), Orthopaedic Research Unit, Aarhus University Hospital, Aarhus N, Denmark; 2. Department of Clinical Medicine, Aarhus University, Aarhus N, Denmark; 3. Department of Health Technology, Section for Cell and Drug Technologies, Technical University of Denmark, Lyngby, Denmark; 4. Department of Orthopaedic Surgery, Aarhus University Hospital, Aarhus N, Denmark; 5. Department of Forensic Medicine, Aarhus University Hospital, Aarhus N, Denmark.
Background: The local application of drug depot technologies releasing chemotherapeutics in cancerous tissues presents an interesting strategy for enhancing treatment outcome by increasing and sustaining high local chemotherapeutic concentrations.
Aim: This study aimed to assess the feasibility, delivery capacity, and therapeutic efficacy of a doxorubicin-loaded carbohydrate-ester- based (CarboCell) depot technology as a localized drug delivery system.
Materials and Methods: CarboCell was investigated in three experimental setups: A) Release kinetics were evaluated in mice (non-tumour model) 24 h and 48 h after a subcutaneous injection of depot. B) Efficacy in terms of tumour growth control and survival was evaluated in mice carrying large syngeneic CT 26 colorectal cancer. A volume of 50 µl CarboCell containing 1 mg/mL or 4 mg/mL doxorubicin was injected in the tumours twice at 5 days intervals. C) Local and distant release of doxorubicin CarboCell 2 mg/mL (2 mL or 4 mL) injected into tibial metaphysis was evaluated with microdialysis in nine tissue compartments in ten female pigs.
Results: A) Subcutaneous CarboCell depots displayed a continuous release of doxorubicin with 36±13% (mean±SEM) and 48±20% of the loaded dose being released at 24 h and 48 h time points. B) Intratumoral injection demonstrated robust tumour growth control and significantly prolonged median survival time compared to the control group. C) In the porcine model, irrespective of volume injected (2 or 4 ml), doxorubicin could be measured at least 10 mm from the application site in cancellous bone indicating a good metaphyseal distribution. The systemic spill-over was minimal, and only measurable in three out of ten animals.
Interpretation / Conclusion: Doxorubicin-loaded CarboCell proved easily administrable with maintained antitumoural activity and was able to provide much higher local doxorubicin concentrations when injected in metaphyseal bone compared traditional systemic administration. Importantly, minimal systemic spill-over was observed, supporting further exploration of efficacy and tolerability in combination therapies.
Sarah Stammose Freund1, Michael Melchior Bendtsen1, Bjarne Hauge Hansen1, Henning Andersen2, Thomas Baad-Hansen1
1 Department of Orthopedic Oncology, Aarhus University Hospital, Denmark; 2 Department of Neurology, Aarhus University Hospital, Denmark
Background: Limited knowledge exists on early outcomes post-megaprosthesis surgery. Yet, in counseling of patients understanding these outcomes is crucial.
Aim: This prospective study investigates physical function outcomes in lower limb megaprosthesis surgery patients, employing both objective and subjective measures, while also identifying their associations.
Materials and Methods: 38 patients underwent treatment with a proximal femur, distal femur, or proximal tibia megaprosthesis. Muscle strength tests, range of motion evaluations, the Timed Up and Go test, and the Musculoskeletal Tumor Society score were conducted at 4, 8, and 12-18 months post- surgery. Repeated measurements analysis was performed along with a comparison between treated limb, untreated limb, and predictive values.
Results: : Bilateral muscle strength reduction, especially in regions subjected to surgical intervention, was observed, with the proximal tibia group showing the most pronounced deficits. None of the groups exhibited statistically significant changes in strength over time. All groups had decreased joint flexion in the treated limb compared to the untreated limb 12-18 months post-surgery. Timed Up and Go performance improved in all groups but remained below average compared to reference values. An association was observed between a lower Timed Up and Go Test and higher Musculoskeletal Tumor Society scores, with the latter being lowest in the proximal tibia group.
Interpretation / Conclusion: The study provides data from comprehensive testing the first year following megaprosthesis surgeries providing knowledge in order to inform and guide patients. Markedly reduced strength in both treated and untreated limbs compared to predicted normal values was observed. The significant deficit in walking capabilities showed clear association to patients' reported outcomes.
1 Department of Orthopedic Oncology, Aarhus University Hospital, Denmark; 2 Department of Neurology, Aarhus University Hospital, Denmark
Background: Limited knowledge exists on early outcomes post-megaprosthesis surgery. Yet, in counseling of patients understanding these outcomes is crucial.
Aim: This prospective study investigates physical function outcomes in lower limb megaprosthesis surgery patients, employing both objective and subjective measures, while also identifying their associations.
Materials and Methods: 38 patients underwent treatment with a proximal femur, distal femur, or proximal tibia megaprosthesis. Muscle strength tests, range of motion evaluations, the Timed Up and Go test, and the Musculoskeletal Tumor Society score were conducted at 4, 8, and 12-18 months post- surgery. Repeated measurements analysis was performed along with a comparison between treated limb, untreated limb, and predictive values.
Results: : Bilateral muscle strength reduction, especially in regions subjected to surgical intervention, was observed, with the proximal tibia group showing the most pronounced deficits. None of the groups exhibited statistically significant changes in strength over time. All groups had decreased joint flexion in the treated limb compared to the untreated limb 12-18 months post-surgery. Timed Up and Go performance improved in all groups but remained below average compared to reference values. An association was observed between a lower Timed Up and Go Test and higher Musculoskeletal Tumor Society scores, with the latter being lowest in the proximal tibia group.
Interpretation / Conclusion: The study provides data from comprehensive testing the first year following megaprosthesis surgeries providing knowledge in order to inform and guide patients. Markedly reduced strength in both treated and untreated limbs compared to predicted normal values was observed. The significant deficit in walking capabilities showed clear association to patients' reported outcomes.
Ingrid Frederikke Gottlieb(1), Andrea Pohly Jeppesen Thorn (1), Thomas Baad-Hansen (2), Ninna Aggerholm-Pedersen(3), Michael Mørk Petersen(1),
1. Department of Orthopedic Surgery, Rigshospitalet, Copenhagen; 2. Department of Orthopedic Oncology, Aarhus University Hospital; 3. Department of Oncology, Aarhus University Hospital.
Background: Leiomyosarcomas are rare malignant tumors originating from mesenchymal cells, and these tumors can develop anywhere in the body from blood vessels or smooth muscle cells. The overall 5- year survival probability of patients with leiomyosarcomas in previously published larger European studies is around 60%.
Aim: In this study, we aimed to determine the survival and risk of local recurrence among patients treated for leiomyosarcomas in Denmark between 2000 and 2016.
Materials and Methods: The study involved a thorough analysis of patient data obtained through national databases. A total of 309 patients were initially registered with leiomyosarcoma. The patients were then screened based on the following exclusion criteria: treatment before the year 2000, age below 18 years, and a tumor localization other than either the extremities or trunk wall. The collected data were categorized and analyzed statistically using Kaplan-Meier estimation with calculation of the probability of 5- year survival with 95% confidence interval (CI- 95).
Results: 290 patients (female/male=115/175, median age(range) = 63(18-96) years) diagnosed with leiomyosarcoma were included in the study, and the 5-year overall survival probability was 67% (CI-95: 62-73%). 5-year survival was 81% (CI- 95: 71-90%) for tumors located in the upper extremities, 61% (CI-95: 53-69%) for lower extremities, and 67% (CI-95: 56-79%) for tumors in the trunk wall. Stratification by tumor grade revealed 5-year survival probabilities of 88% (CI-95: 81-96%) for grade 1, 81% for grade 2 (CI-95: 73-89%), and 46% (CI-95: 38-55%) for grade 3. 5-year survival was 80% (CI-95: 74-86%) and 43% (CI-95: 34- 52%) for tumor size below 5 cm and above 5 cm. A total of 52/290 (18%) of the patients experienced a local recurrence and their 5-year survival was 50% (CI-95: 36-64%) compared to 71% (CI-95: 65-76%) for those without local recurrence.
Interpretation / Conclusion: Our findings suggest that Danish patients exhibit survival probabilities consistent with the European standard. This indicates that the treatment of Danish patients with leiomyosarcoma is satisfactory.
1. Department of Orthopedic Surgery, Rigshospitalet, Copenhagen; 2. Department of Orthopedic Oncology, Aarhus University Hospital; 3. Department of Oncology, Aarhus University Hospital.
Background: Leiomyosarcomas are rare malignant tumors originating from mesenchymal cells, and these tumors can develop anywhere in the body from blood vessels or smooth muscle cells. The overall 5- year survival probability of patients with leiomyosarcomas in previously published larger European studies is around 60%.
Aim: In this study, we aimed to determine the survival and risk of local recurrence among patients treated for leiomyosarcomas in Denmark between 2000 and 2016.
Materials and Methods: The study involved a thorough analysis of patient data obtained through national databases. A total of 309 patients were initially registered with leiomyosarcoma. The patients were then screened based on the following exclusion criteria: treatment before the year 2000, age below 18 years, and a tumor localization other than either the extremities or trunk wall. The collected data were categorized and analyzed statistically using Kaplan-Meier estimation with calculation of the probability of 5- year survival with 95% confidence interval (CI- 95).
Results: 290 patients (female/male=115/175, median age(range) = 63(18-96) years) diagnosed with leiomyosarcoma were included in the study, and the 5-year overall survival probability was 67% (CI-95: 62-73%). 5-year survival was 81% (CI- 95: 71-90%) for tumors located in the upper extremities, 61% (CI-95: 53-69%) for lower extremities, and 67% (CI-95: 56-79%) for tumors in the trunk wall. Stratification by tumor grade revealed 5-year survival probabilities of 88% (CI-95: 81-96%) for grade 1, 81% for grade 2 (CI-95: 73-89%), and 46% (CI-95: 38-55%) for grade 3. 5-year survival was 80% (CI-95: 74-86%) and 43% (CI-95: 34- 52%) for tumor size below 5 cm and above 5 cm. A total of 52/290 (18%) of the patients experienced a local recurrence and their 5-year survival was 50% (CI-95: 36-64%) compared to 71% (CI-95: 65-76%) for those without local recurrence.
Interpretation / Conclusion: Our findings suggest that Danish patients exhibit survival probabilities consistent with the European standard. This indicates that the treatment of Danish patients with leiomyosarcoma is satisfactory.
Christian L. Nielsen1., Daniel T. H. Dybdal2., Peter Vester-Glowinski3., Lisa Lyngsie Hjalgrim2., Henrik Hasle4., Birgitte J. Kiil5., Michael M. Bendtsen1., Michael M. Petersen6., Thomas Baad-Hansen1.
1. Department of Orthopedic Surgery, Aarhus University Hospital, Denmark 2. Department of Paediatrics and Adolescent Medicine, University Hospital Copenhagen, Denmark 3. Department of Plastic Surgery and Burns Treatment, University Hospital Copenhagen, Denmark 4. Department of Paediatrics and Adolescent Medicine, Aarhus University Hospital, Denmark 5. Department of Plastic and Breast Surgery, Aarhus University Hospital, Denmark. 6. Department of Orthopedic Surgery, University Hospital Copenhagen, Denmark
Background: Vascularized fibula grafting following tumor resection is an important component in limb salvage surgery.
Aim: The purpose of this study was to determine both surgical and oncological outcomes of patients treated in Denmark between 2009 and 2023.
Materials and Methods: We describe a retrospective review of 27 consecutively treated patients who underwent surgery between the 1st of January 2009 and the 1st of November 2023 at Aarhus and Copenhagen University Hospitals. Patients were identified from the national Danish Sarcoma Database. There were 12 cases of osteosarcoma, 13 cases of Ewing’s sarcoma and 2 cases of Giant cell tumor. Mean age at the time of surgery was 15.1 years (range: 2.4-38.9). Mean follow-up was 74.8 months (range: 12-138). Patients were analyzed overall and stratified on basis of tumor location in an upper and a lower extremity group.
Results: During the follow-up period, 18 patients attained graft union (66.7 %) with a mean time to union of 13.9 months (range: 7-28.5). 6 patients developed nonunion (22.2 %) and 20 patients (74.1 %) had to undergo one or more reoperations in relation to the primary surgery. Patients in the upper extremity group were more likely to attain graft union (91.7 % vs. 46.7 %, RR=5.5, 95 % CI=1.3- 31.5, p=0.02) and less likely to undergo multiple reoperations (16.7 % vs 60 %, RR=0.3, 95 % CI:0.1-0.9, p=0.047) compared to patients in the lower extremity group. 6 patients died during follow-up. Five- year overall survival was 81.2 % (95 % CI: 60.5-91.7). 8 patients (29.6 %) experienced relapse with distant metastases. Among these patients, 5 also developed local recurrence (18.5 %). Mean time to metastasis was 10.3 months (range: 1-18) while mean time to local recurrence was 13.2 months (range: 7-17).
Interpretation / Conclusion: Biological reconstruction with VFG after tumor resection remains a reasonable option, despite the low rate of graft union and the need for multiple reoperations, particularly in lower extremity cases.
1. Department of Orthopedic Surgery, Aarhus University Hospital, Denmark 2. Department of Paediatrics and Adolescent Medicine, University Hospital Copenhagen, Denmark 3. Department of Plastic Surgery and Burns Treatment, University Hospital Copenhagen, Denmark 4. Department of Paediatrics and Adolescent Medicine, Aarhus University Hospital, Denmark 5. Department of Plastic and Breast Surgery, Aarhus University Hospital, Denmark. 6. Department of Orthopedic Surgery, University Hospital Copenhagen, Denmark
Background: Vascularized fibula grafting following tumor resection is an important component in limb salvage surgery.
Aim: The purpose of this study was to determine both surgical and oncological outcomes of patients treated in Denmark between 2009 and 2023.
Materials and Methods: We describe a retrospective review of 27 consecutively treated patients who underwent surgery between the 1st of January 2009 and the 1st of November 2023 at Aarhus and Copenhagen University Hospitals. Patients were identified from the national Danish Sarcoma Database. There were 12 cases of osteosarcoma, 13 cases of Ewing’s sarcoma and 2 cases of Giant cell tumor. Mean age at the time of surgery was 15.1 years (range: 2.4-38.9). Mean follow-up was 74.8 months (range: 12-138). Patients were analyzed overall and stratified on basis of tumor location in an upper and a lower extremity group.
Results: During the follow-up period, 18 patients attained graft union (66.7 %) with a mean time to union of 13.9 months (range: 7-28.5). 6 patients developed nonunion (22.2 %) and 20 patients (74.1 %) had to undergo one or more reoperations in relation to the primary surgery. Patients in the upper extremity group were more likely to attain graft union (91.7 % vs. 46.7 %, RR=5.5, 95 % CI=1.3- 31.5, p=0.02) and less likely to undergo multiple reoperations (16.7 % vs 60 %, RR=0.3, 95 % CI:0.1-0.9, p=0.047) compared to patients in the lower extremity group. 6 patients died during follow-up. Five- year overall survival was 81.2 % (95 % CI: 60.5-91.7). 8 patients (29.6 %) experienced relapse with distant metastases. Among these patients, 5 also developed local recurrence (18.5 %). Mean time to metastasis was 10.3 months (range: 1-18) while mean time to local recurrence was 13.2 months (range: 7-17).
Interpretation / Conclusion: Biological reconstruction with VFG after tumor resection remains a reasonable option, despite the low rate of graft union and the need for multiple reoperations, particularly in lower extremity cases.