骨腫瘤之治療 簡松雄
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Transcript of 骨腫瘤之治療 簡松雄
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Limbsalvage of
Bone and Soft-Tissue Tumors
骨科
簡松雄
Tel:07- 3208209
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Bone and Soft-Tissue Tumors
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Bone and Soft-Tissue Tumors
Osteochondroma
Enchondroma
Chondroblastoma
Chondrosarcoma
Lymphoma
Ewing’s sarcoma
Osteoblastoma
Osteoid osteoma
Osteosarcoma
Maligant fibrous Histiocytoma
Myeloma
Fibrosarcoma
Giant cell tumor
0 10 20 30 40 50 60 70 FIGURE69-1. Age distribution of patients with bone tumor according to type. (Wilkins. R.M. and
Sim. F.H. Evaluation of Bone and Soft Tissue Tumors. In D Ambrosia R.D.(ed): Musculcskeletal
Disorders Philadelphia J. B.Lippincou. 1986
Age(years)
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Bone and Soft-Tissue Tumors
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Clinical Approach to Musculoskeletal Tumors KMU PRACTICE GUIDELINES PATIENT COMPLAINT
HISTORY AND PHYSICAL EXAMINATION
SOFT TISSUE CLINICAL INFORMATION BONE
IMAGE STUDY IMAGE STUDY
LAB TEST TUMOR TUMOR LAB TEST
INTERPRETATION
DIFFFERENTIAL DIAGNOSIS
BONE TUMOR
BENIGN MALIGNANT METASTASES
SOFT TISSUE TUMOR
BENIGN MALIGNANT PROBABLE PROBABLE
BIOPSY
CLINICAL, RADIOGRAPHIC, AND
PATHOLOGIC CORRELATION
DIAGNOSIS
SURGICAL STAGING
TREATMENT DESIGN Bone and Soft-Tissue Tumors
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Surgical Margin of Musculoskeletal Tumors
Musculoskeletal Cancer Surgery
M.M.Malawer 2001
Bone and Soft-Tissue Tumors
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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
soft part sarcoma—1, metastases--5
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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
intercalate diaphysis—2(humerus-1, tibia-1)
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Results-1
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Results-2
1. 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)
infection 3 ( 1 A-K amputation)
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Discussion
1. Satisfied functional result
2. Normal soft tissue envelope
3. Longevity of prosthesis
4. Infection rate
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Malignant Tumor
Non-Resection
IORT
(60Gray)
Resection
Re-Implantation
1.Autoclave
(121-135 C,
5-15 min)
2.Pasteurization
(62 C, 71 C,
30min)
3.after IORT
(extracorporeal)
4.alcoholization
(95% A/C, 30 min)
5.Liquid N2, 30 min
Bone-Transplantation
1.Autograft
a. free
b.vascular
c.lengthen
2.Allograft
3.Xenograft
Only Prosthesis
Replacement
Rotation
Plasty
Segment
Amputation
Amputation
Utilization Bone of tumor Discarding
Limb salvage
oo
o
1.Custom
2.Growing
3.Spacer
4. lengthen
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Bone Cancers KMU PRACTICE GUIDELINES EVALUATION TREATMENT FOLLOW-UP RECURRENCE
Bone lesion
Chest x-ray
Lab studies
MRI + CT
P’t complain
S/S
H & P
Biopsy • needle
(CT,Echo)
•open
•frozen
Bone scan
•Single
•Multiple
Staging
Diagnosis(special fig.)
•Osteosarcoma
•Chondrosarcoma
•Ewing’s Sarcoma
•Other primary malignant
•Carcinoma Metastases
Surgery
•En block resection
•Reconstruction
•Wide margins
•Limbsalvage if possible
•Amputation
Chemotherapy C/T
•Preoperation
•Postoperation
Radiotherapy R/T
•Preoperation
•Postoperation
Follow-up
-every 3 mo for yr1+2
-every 4 mo for yr 3
-every 6 mo for yr 4+5
-every 1 yr for yr 6-10
•Physical examination
•X-ray of lesion
•Chest x-ray
•Bone scan
•Lab test
•Chest CT if abnormal
x-ray finding
Local
•Repeat
primary
treatment
Systemic
metastases
•Lung only:
resection+C/T
•Other sites:
Best
supportive
Treatment
Bone and Soft-Tissue Tumors
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Soft-tissue Sarcomas KMU PRACTICE GUIDELINES EVALUATION TREATMENT MODALITY FOLLOW-UP RECURRENCE
Surgery
•En block resection
•Wide margins
•Limbsalvage if possible
•Amputation Follow-up: -every 3 mo for yr1+2
-every 4 mo for yr 3
-every 6 mo for yr 4+5
-every 1 yr for yr 6-10
•Physical examination
•X-ray of lesion
•Chest x-ray
•Galium scan
•Lab test
•Chest CT if abnormal
x-ray finding
P’t complain
S/S
H&P
Soft tissue
mass
Echo
Chest x-ray
Lab studies
MRI + CT
Biopsy • Needle
(CT,Echo)
•Open
•Frozen
•Galium scan
•Single
•Multiple
Staging
Radiotherapy
Chemotherapy •Doxorubicin
•Ifosfamide
•TPOG-RMS-95
Resectable
Low grade,
Effective wide
margin
Unresectable
•High grade
•No effective
wide margin Resectable
Local:
Repeat
treatment
Metastases: •Single organ—debulking tumor,or
metastasectomy ,+R/T ,+C/T
•Disseminated---- palliative surgery,
best supportive treatment
Metastases
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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
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THANKS FOR YOUR ATTENTION
Bone and Soft-Tissue Tumors