Pruthi Manish, Virk Jagandeep Singh, Tiwari Akshay, Kapoor Gauri, Jain Sandeep, Pasricha Sunil
Department of Orthopaedic Oncology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India.
Department of Orthopaedic Oncology, Paras Hospitals, Panchkula, India.
Indian J Surg Oncol. 2021 Jun;12(2):298-305. doi: 10.1007/s13193-021-01286-9. Epub 2021 Feb 12.
Surgical resection with wide margins is pivotal for sarcoma treatment but achieving the same for fibular sarcomas is a surgical challenge. Thus, we decided to evaluate our own institutional database of primary fibular sarcomas for surgical treatment, margins and pattern of relapse. From July 2014 to October 2018, we identified fourteen patients with histologically confirmed fibular sarcomas. Limb salvage surgery (LSS) was performed in thirteen patients included in our study. One patient treated with definitive radiotherapy was excluded from final survival and functional analyses. The proximal third fibula was the most common site of involvement (85.7%). Osteosarcoma was the histological diagnosis in eight (57.1%) and Ewing's in the remaining six (42.9%). All patients with proximal fibular tumours underwent Malawer type II resection. Margins were reported as free in twelve and involved in one case. The mean follow-up period was 37.15 months. In the operated group ( = 13), distant relapse occurred in 3 patients, combined relapse in 1 patient and 10 patients are alive and disease free until the last follow-up. The Kaplan-Meier survival analyses revealed the EFS (event-free survival-local/distant relapse) probability as 72.7% at 24 months and 53% at the end of 42 months. The OS (overall survival) probability at 24 months was 75.5% and 57.5% at the end of 42 months. Although it is difficult to achieve conventional wide margins in fibular sarcomas, our results suggest no increased incidence of local recurrence rates as compared to sarcomas at other common sites as reported in literature. Our series helps in understanding site-specific behaviour of sarcomas while contributing to the available data.
广泛切缘的手术切除是肉瘤治疗的关键，但对腓骨肉瘤而言，实现这一点是一项手术挑战。因此，我们决定评估本院原发性腓骨肉瘤的手术治疗、切缘及复发模式的数据库。2014年7月至2018年10月，我们确定了14例经组织学确诊的腓骨肉瘤患者。本研究纳入的13例患者接受了保肢手术（LSS）。1例接受根治性放疗的患者被排除在最终生存和功能分析之外。腓骨近端三分之一是最常见的受累部位（85.7%）。组织学诊断为骨肉瘤的有8例（57.1%），其余6例（42.9%）为尤因肉瘤。所有腓骨近端肿瘤患者均接受了Malawer II型切除。切缘报告为阴性的有12例，1例为阳性。平均随访期为37.15个月。在手术组（n = 13）中，3例患者发生远处复发，1例患者发生联合复发，10例患者在最后一次随访时仍存活且无疾病。Kaplan-Meier生存分析显示，无事件生存（局部/远处复发）概率在24个月时为72.7%，在42个月结束时为53%。24个月时的总生存（OS）概率为75.5%，42个月结束时为57.5%。尽管在腓骨肉瘤中难以实现传统的广泛切缘，但我们的结果表明，与文献报道的其他常见部位的肉瘤相比，局部复发率并未增加。我们的系列研究有助于了解肉瘤的部位特异性行为，同时为现有数据做出贡献。
