骨腫瘤之治療 簡松雄

16
Block 7: Musculoskeletal System 1 Limbsalvage of Bone and Soft-Tissue Tumors 骨科 簡松雄 Tel:07- 3208209 [email protected]

description

 

Transcript of 骨腫瘤之治療 簡松雄

Page 1: 骨腫瘤之治療 簡松雄

Block 7: Musculoskeletal System

1

Limbsalvage of

Bone and Soft-Tissue Tumors

骨科

簡松雄

Tel:07- 3208209

[email protected]

Page 2: 骨腫瘤之治療 簡松雄

Block 7: Musculoskeletal System

2

Bone and Soft-Tissue Tumors

Page 3: 骨腫瘤之治療 簡松雄

Block 7: Musculoskeletal System

3

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)

Page 4: 骨腫瘤之治療 簡松雄

Block 7: Musculoskeletal System

4

Bone and Soft-Tissue Tumors

Page 5: 骨腫瘤之治療 簡松雄

Block 7: Musculoskeletal System

5

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

Page 6: 骨腫瘤之治療 簡松雄

Block 7: Musculoskeletal System

6

Surgical Margin of Musculoskeletal Tumors

Musculoskeletal Cancer Surgery

M.M.Malawer 2001

Bone and Soft-Tissue Tumors

Page 7: 骨腫瘤之治療 簡松雄

Block 7: Musculoskeletal System

7

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

Page 8: 骨腫瘤之治療 簡松雄

Block 7: Musculoskeletal System

8

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)

Page 9: 骨腫瘤之治療 簡松雄

Block 7: Musculoskeletal System

9

Results-1

Page 10: 骨腫瘤之治療 簡松雄

Block 7: Musculoskeletal System

10

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)

Page 11: 骨腫瘤之治療 簡松雄

Block 7: Musculoskeletal System

11

Discussion

1. Satisfied functional result

2. Normal soft tissue envelope

3. Longevity of prosthesis

4. Infection rate

Page 12: 骨腫瘤之治療 簡松雄

Block 7: Musculoskeletal System

12

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

Bone and Soft-Tissue Tumors

Page 13: 骨腫瘤之治療 簡松雄

Block 7: Musculoskeletal System

13

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

Page 14: 骨腫瘤之治療 簡松雄

Block 7: Musculoskeletal System

14

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

Bone and Soft-Tissue Tumors

Page 15: 骨腫瘤之治療 簡松雄

Block 7: Musculoskeletal System

15

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

Bone and Soft-Tissue Tumors

Page 16: 骨腫瘤之治療 簡松雄

Block 7: Musculoskeletal System

16

THANKS FOR YOUR ATTENTION

Bone and Soft-Tissue Tumors