Standard Treatment Remains the Recommended Approach for Patients with Bone Sarcoma Who Underwent Unplanned Surgery: Report from the Japanese Musculoskeletal Oncology Group
Background: The results of operations are not planned for bone sarcomas has not often discussed. However, it is important to recognize patterns, treatment, and clinical outcome of the operation was not planned for patients with bone sarcomas. The aim of this multicenter study to characterize the clinical outcome of patients with bone sarcoma who undergo planned operations.
Patients and methods: Data from 43 patients with bone sarcoma who undergo planned operations between 2006 and 2017 was obtained from 23 hospitals in Japan. These included 18 cases of osteosarcoma, Ewing sarcoma of 9, 8 of chondrosarcoma, and 6 undifferentiated pleomorphic sarcoma. The study involved 28 men and 15 women, with an average age of 46 years. The duration of the average follow-up was 59 months.
Results: The main primary tumor sites are the femur (n = 19), spine (n = 6), pelvis (n = 5), the tibia (n = 3), and humerus (n = 3). Diagnosis principal is benign bone tumors (n = 24), trauma (n = 7), bone metastases (n = 5), osteomyelitis (n = 4), degeneration (n = 2), and unknown (n = 1). As unplanned surgery, curettage, with or without bone graft, performed in 26 patients; Internal fixation is done at 7; spine surgery at 5; arthroplasty in 4; and arthroscopy in one.
Thirty-eight patients received standard treatments extra. Thirty-four patients underwent surgical resection of the tumor, including amputation (n = 10), and the remaining 4 receive radiotherapy or carbon ion radiotherapy for the treatment of additional standards. Level 5-year disease-specific survival (DSS) in patients with osteosarcoma, Ewing sarcoma, and chondrosarcoma was 65.5%, 58.3% and 72.9%, respectively. Twelve patients (27.9%) developed local recurrence (LR); among a total of 43 patients studied, the level of 5-year DSS was significantly worse for those who develop LR compared with those who did not (p = 0.03). 5-year DSS levels in patients with and without LR was 44% and 73.8%, respectively.
Conclusions: We recommend that patients undergoing surgery underwent unplanned given standard treatment, including the option to amputation because here, LR proved to be a risk factor for decreased DSS.
The Pathogenesis and Prevention Port-Site Metastasis in Gynecologic Oncology
Port-site metastases (PSM) is a specific and challenging complications of laparoscopic gynecologic oncology procedures. Research has shown that PSM is associated with morbidity and poor results. The exact pathogenesis of PSM in gynecological patients is not clear. Some precautions of PSM has been discussed in the relevant literature, and novel approaches to prevent this complication rarely keep up. In this review, we summarize the potential mechanisms of PSM and discuss the controversy and benefits of measures proposed prevention of PSM in gynecologic oncology.
We conducted a literature search using Medline database to identify studies of the pathogenesis and prevention of laparoscopic PSM. The hypothesis of the pathogenesis PSM at the center of the body’s immune response, pneumoperitoneum, contamination of wounds and surgical methods. convincing evidence of effective prevention of PSM after laparoscopic surgery is less. traditional preventive measures such as irrigation and tumor manipulation must be taken individually.
CO2 insufflation Hyperthermic and humidified CO2 leads to better outcomes in patients with malignant tumors who underwent laparoscopic procedures with the CO2 pneumoperitoneum than normal. Port-resection site showed no advantage in survival and outcome in the event of more injuries. PSM prevention plays an important part in the overall care of patients with gynecological malignancies who underwent laparoscopic procedures.
Standard Treatment Remains the Recommended Approach for Patients with Bone Sarcoma Who Underwent Unplanned Surgery: Report from the Japanese Musculoskeletal Oncology Group
End of the decision on the limitation of treatment in patients with cancer: an empirical analysis of the end-of-life practice of hematology and oncology unit at a university hospital in Germany
Background: The decision to limit treatment (DLTs) were essential to protect patients from overtreatment but it is one of the most ethically challenging situations in the practice of oncology. Ethics Policy Planning in Advance Care and Treatment study Limiting (EPAL), we examined how often DLT preceded the death of the patient and how early they were determined before (T1) and after (T2) the implementation of ethics policies intrainstitutional in DLT.
Methods: This prospective quantitative recruited 1,134 patients with hematology / oncology neoplasia within a period of 2 × 6 months at the Hospital of the University of Munich, Germany. Information on admission, discharge, diagnosis, age, DLT, date and place of death, and the time span between the initial determination of the DLT and the death of a patient are recorded using a standard form.
Results: Overall, 21% (n = 236) of the 1,134 patients, DLT was made. After the implementation of the policy, the proportion of reduction (26% T1 / T2 16%). However, the decision was more comprehensive, including more frequent combinations of ‘Do Not Resuscitate’ and ‘no intensive care unit’ (44% T1 / T2 64%). The median time between the determination of DLT and the patient’s death is equally short with 6 days in regular wards (each T1 / T2) and 10.5 / 9 (T1 / T2) days in the palliative care unit. For patients with solid tumors, DLTs made earlier in both routine and palliative care units than the deceased with hematologic neoplasia.
Description: Vascular endothelial growth factor receptor 2 (VEGFR-2) belongs to the family of receptor tyrosine kinases (RTKs) and is almost exclusively restricted to endothelial cells. VEGFR-2 has a lower affinity for VEGF than the Flt-1 receptor, but a higher signaling activity
Description: Amyloid ?-Peptide (1-40) (human), (C194H295N53O58S1), a peptide with the sequence H2N-DAEFRHDSGYEVHHQKLVFFAEDVGSNKGAIIGLMVGGVVIA-OH, MW= 4329.8. Amyloid beta (A? or Abeta) is a peptide of 36-43 amino acids that is processed from the Amyloid precursor protein.
Description: Sequence: Asp-Ala-Glu-Asn-Leu-Ile-Asp-Ser-Phe-Gln-Glu-Ile-ValThe cloned complementary DNA sequence encoding the human gonadotropin-releasing hormone (GnRH) precursor protein was used to construct an expression vector for the bacterial synthesis of the 56-amino acid GnRH-associated peptide (GAP).
Description: Glucagon Like Peptide-1 Human Recombinant produced in E.Coli is a single, non-glycosylated, polypeptide chain containing 31 amino acids and having a molecular mass of 3298.7 Dalton. The GLP-1 is purified by proprietary chromatographic techniques.
Conclusions: Our results show that the ethics policy in DLT be sensitive to the limitations of treatment in terms of frequency and extension but did not have a significant impact on the time DLT. Since patients with hematological malignancies tend to undergo intensive therapy more frequently during their final days than patients with solid tumors, particular attention should be given to this group. To support the timely discussion, we suggest that the concept of advance care planning.
