Introduction: Renal cell carcinoma often metastasizes to the skeleton and less frequently soft tissues, leading to the increased risk of fracture. Previous studies have show that the survival of patients with bone metastases is frequently prolonged and that early failure of surgical implants designed for fracture fixation is high. The aim of the study was to investigate the outcomes from surgical procedures undertaken at a tertiary referral bone tumour unit.

Methods: A retrospective review of consecutive patients presenting with a musculoskeletal metastasis to our unit from October 1976 to June 2007 was undertaken. There were 179 patients seen over this period, 89 with solitary and 90 with multiple mets. The mean age at presentation was 60.0 yrs. The mean follow up was 16.9 months. Kaplan-Meyer implant and patient survival analysis was undertaken.

Results: The mean patient survival was 22 months (range 1 month to 16 years). The 1yr, 3yr and 10yr patient survival was 77 %, 44 % and 11 % respectively. The types of surgical treatment undertaken included EPR in 119 patients, conventional arthroplasty in 15 patients, fracture fixation in 14 patients, excision only in 12 patients, amputation in 9 patients, curettage and cementation in 9 patients, decompression stabilization of spine in 1 patient. Two femoral EPRs failed due to infection, requiring hindquarter amputations. Failure of fixation to the humerous lead to a forequarter amputation, two hip dislocations. Failure of curettage and cementation in the acetabulum and proximal tibia were treated with THR and EPR respectively.

Discussion: Patients with renal cell carcinoma metastases can survive for prolonged periods. Any surgical intervention for bone metastases has to outlive the patient and EPRs are reliable with a low rate of failure or complication. We would recommend resection and reconstruction with endoprostheses for solitary renal metastases in a tertiary referral unit.

Introduction: The use of extendible endoprosthetic implants in the skeletally immature has been used for just under 30 years. Limb salvage has become a realistic alternative to those children presenting with primary bone sarcomas. We aim to review the use of an implant which uses a non-invasive mechanism of adjusting the length of the prosthesis, during the growth phase.

Method: A retrospective review of consecutive patients undergoing primary or revision endoprosthetic replacement with non-invasive extensible implants, was undertaken. Between January 1993 and February 2008, 34 children were treated with non-invasive extensible endoprosthetic replacements, 26 distal femur, 5 total femurs, 3 proximal tibias and 1 proximal femur.

Results: The underlying pathology, requiring excision, was Ewings sarcoma in 4 patients and osteosarcoma in the remaining 30 patients. Most underwent pre-operative chemotherapy and 2 patients died of their disease.

Four operations were secondary procedures following previous non-grower implant failures (1 infection of previous EPR, 1 IM nail non-union, 1 failed allograft and a revision of a proximal femoral EPR to a total femoral prosthesis). Five patients required revision of the primary prosthesis (2 with motor failures, 3 due to prosthesis infections).

Mean time to start lengthening from surgery was 12.2 months. The mean number of lengthenings was 4 with an average total length of 30 mm achieved, mean leg length difference was 0.8 cm. All lengthenings were undertaken with the patient fully alert, no adverse incidents occurred at the time or after lengthening.

Discussion: The non-invasive prostheses show promise in handling the difficult problem of limb preservation in a growing child, with similar complication rates to that of an invasive type, but without the need for multiple anaesthetics for lengthening.

Aim: To investigate the outcome of our management of patients with giant cell tumour of the sacrum and draw lessons from this.

Method: Retrospective review of medical records and scans for all patients treated at our unit over the past 20 years with a giant cell tumour (GCT) of the sacrum.

Results: Of 517 patients treated at our unit for GCT over the past 20 years, only 9 (1.7%) had a GCT in the sacrum. 6 were female, 3 male with a mean age of 34 (range 15–52). All but two tumours involved the entire sacrum and there was only one purely distal to S3. The mean size was 10cm and the most common symptom was back or buttock pain. Five had abnormal neurology at diagnosis but only one presented with cauda equina syndrome. The first four patients were treated by curettage alone but two patients had intra-operative cardiac arrests and although both survived all subsequent curettages were preceeded by embolization of the feeding vessels. Of 7 patients who had curettage, 3 developed local recurrence but all were controlled with a combination of further embolisation, surgery or radiotherapy. One patient elected for treatment with radiotherapy and another had excision of the tumour distal to S3. All the patients are alive and only two patients have worse neurology than at presentation, one being impotent and one with stress incontinence. All are mobile and active at a follow up between 2 and 21 years.

Conclusion: GCT of the sacrum can be controlled with conservative surgery rather than sacrectomy. Embolisation and curettage are the preferred first option with radiotherapy as a possible adjunct. Spino-pelvic fusion may be needed if the sacrum collapses.

Aim: To identify prognostic factors for patients with sarcomas.

Method: A retrospective analysis of all patients with newly diagnosed referred to a specialist musculoskeletal tumour centre, with a minimum 5 year follow up. Factors affecting survival and recurrence were identified.

Results: There were 1175 patients with soft tissue sarcomas and the most common diagnoses were liposarcoma (22%) followed by mfh (12%) and leiomyosarcoma (11%). 55% were high grade, 25% intermediate and 20% low grade. The most common site was the thigh (44%). 9% had metastases at diagnosis and of these only 10% survived 5 years. Prognostic factors were analyzed in the remaining 1075 patients. The 5 year disease specific survival was 87% for low grade, 66% for intermediate grade and 48% for high grade sarcomas. Prognostic factors (p< 0.05) on univariate analysis were grade, depth, size, age, sex, wide margins of excision, limb salvage (vs amputation), having had a previous excision (whoops). Many of these factors however were inter-related and on multivariate analysis it was found that the following were still significant: Grade, size, depth, age and buttock location (all p< 0.0005). There were 2320 bone tumours (954 with osteosarcoma, 454 with chondrosarcoma and 463 with Ewings). Prognostic factors for all tumours were size, good response to chemotherapy and limb salvage (as opposed to amputation)

Conclusion: This study has confirmed the generally held factors for prognosis of sarcomas. It is largely tumour factors, not treatment factors which dictate outcome. Of all the factors leading to a poor prognosis, size is the only one which can appreciably be altered – by earlier diagnosis.

Improving outcomes is important for any patient with any disease. Defining the outcome measure will effect what steps need to be taken to improve it. In 2006 the National Institute of Clinical Excellence (NICE) published evidence based Guidance on measures to be taken in the UK to improve outcomes for patients with sarcomas. The Guidance established the following principles:

That all patients with sarcomas must be treated by a recognised and properly constituted multi disciplinary team

How this Guidance has been implemented and what implications this may have for other countries will be discussed.

The definition of a ‘safe’ tumour margin remains controversial. Enneking’s original definition of intralesional, marginal, wide and radical margins was based on a study of just 40 patients of whom only 12 had limb salvage surgery. Since that time thre have been numerous attempts to try and define tumour margins more clearly based on anatomical structures and distances of the tumour from the cut edge. Whilst all can agree on what is a radical margin (usually an amputation) and what is an intralesional margin (tumour exposed) there remains a lack of clear definition of what comprises a wide margin and what is a marginal margin. As an example three large tumour units were asked to assess their margins for adequacy. While the rated of adequate excision varied from 49% to 70%, all 3 units had near identical local recurrence rates of 17–20%. The rate of local recurrence is also modified by adjuvant therapy. A suggestion for an International study assessing tumour margins is made, investigating both anatomical and biological factors.

Introduction: The aim of this study was to identify the pattern of symptoms in patients presenting with synovial sarcoma, examine how these corresponded to the symptoms outlined by the NICE guidelines on the rapid referral of patients with a suspected sarcoma and spot factors that led to long delays in diagnosis.

Methods: Early symptoms and the results of clinical and radiological investigation were reviewed along with the presumed diagnoses that had been made for 35 children. The total duration of symptoms was separated into patient delay and doctor delay.

Results: Using the four clinical findings suggestive of sarcoma according to the NICE guidance, only half of the patients had one or more of them at the time of initial symptoms. The most common presentation was a painless mass (n=16), and in 10 children there was no mass identified. Seven patients had an inexplicable joint contracture, many having been extensively investigated unsuccessfully. The mean duration of symptoms before the diagnosis was made was 98 weeks (range 2 to 364). The mean number of doctors seen prior to referral was 3 (range 1–6) and for 15 patients the diagnosis was obtained after inadvertent excision. The factors associated with long duration of symptoms before diagnosis were knee and elbow location (p=0.0047) or periarticular location (p=0.01), absence of lump (p=0.016) or painful mass as early symptom (p=0.04), the presence of calcifications on x-rays (p=0.01) and a fixed joint contracture (p=0.0003).

We could not show that delay in diagnosis led to a worse prognosis.

Discussion: This paper highlights the sometimes bizarre symptoms associated with synovial sarcoma and hopefully this will increase awareness of the condition among relevant sections of the medical profession and help to reduce the delay in diagnosing these cases.

Introduction: Modular tumour prosthetic replacement is especially useful in the region of proximal femur following pathological fractures and failed fixation. The aim of the study was to assess the clinical and functional outcomes following modular tumour prosthesis reconstruction of the proximal femur in 100 consecutive patients with metastatic tumours and to assess its cost effectiveness.

Methods: The study was a retrospective review of 100 consecutive patients who underwent modular tumour prosthetic reconstruction of the proximal femur using the METS prosthesis [Stanmore Implants Worldwide] for metastatic tumours from 2001 to 2008.

Results and conclusion: There were 45 male and 55 female patients. The mean age was 60.2 years. The indications were metastasis [23renal ca, 28 breast ca, 11 ca bronchus, 5 ca prostate and 31 others]. 75 patients presented with pathological fracture or with failed fixation and 25 patients were at a high risk of developing fracture. The mean follow up was 24.6 months [range0–74]. Three patients died within 2 weeks following surgery. Of the 60 patients who were dead 58 did not need revision surgery indicating that the implant provided single definitive treatment which outlived the patient. 1 patient had revision surgery. There were 2 dislocations. 6 patients had deep infections. The implant survival was 98% with revision or amputation as end point. The hospital cost of an endoprosthetic replacement is estimated to be £12,000. This procedure becomes cost effective when compared with no treatment if the patients’ life expectancy is more than 40 days and when compared with internal fixation if the patients’ life expectancy is more than 2 years.

We conclude that METS modular tumour prosthesis for proximal femur provides versatility; low implant related complications and acceptable function lasting the lifetime of the patients with metastatic tumours of the proximal femur providing a cost effective solution.

Introduction: The aim of this study was to investigate the results of a series of cases from a single institution with respect to local disease control and patient survival to determine prognostic factors.

Methods: Electronic patient records were reviewed on all patients with STS between February 1963 and January 2007. 2445 patients had over 30 types of STS. 1639 (67%) had not received any treatment prior to presentation, however, 770 patients (32%) had undergone a previous attempted excision. Survival analyses were done using Kaplan Meier and Cox regression analyses, however, for prognostic factor analysis, only patients presenting without prior treatment were included.

Results: Common diagnoses were liposarcoma (292 patients, 12%), synovial sarcoma (242 patients, 10%) and leiomyosarcoma (239 patients, 10%). Most presented in the thigh (950 patients, 39%), arm (325 patients, 13%) or lower leg (275 patients, 11%) and most were deep to fascia (1581 patients, 74%). The mean size was 10.2cm.

Overall cumulative patient survival was 58% at 5 years and 44% at 10 years. Locally recurrent disease occurred in 350 patients (14%), 204 patients (8%) presented with and 720 patients (30%) subsequently developed metastatic disease.

Prognostic factors for locally recurrent disease were arm tumours (p=0.003, HR=0.3), hip tumours (p=0.01, HR=0.31), thigh tumours (p=0.002, HR=0.52), intralesional margins (p< 0.0001, HR=3.7), high grade tumours (p=0.03, HR=1.8), tumour size 3–6cm (p=0.04, HR=0.54) and tumour size 6–10cm (p=0.03, HR=0.63).

Prognostic factors for patient survival were deep location (p=0.02, HR=1.6), high grade tumours (p< 0.0001, HR=4.7), intermediate grade tumours (p< 0.0001, HR=3.4), surgical margins (p=0.04), age at diagnosis (p< 0.0001, HR=1.02), size of tumour < 3cms (p=0.04, HR=0.29), 3–6cms (p< 0.0001, HR=0.41), 6–10cms (p=0.007, HR=0.63), no locally recurrent disease (p=0.0001, HR=0.59).

Conclusions: Significant prognostic factors have been proven for STS, and marginal margins have not been proven to alter the risk of locally recurrent disease or patient survival.

Introduction: Chondrosarcoma has always been treated with respect by oncology surgeons, given that it is relatively resistant to chemotherapy and radiotherapy. The importance of the adequacy of surgical resection margins has been previously reported, however, the aim of the study was to study the outcomes of surgery for Chondrosarcoma and determine the role of initial surgical margins and local recurrence on final outcome.

Methods: Electronic patient records were retrieved on all patients seen at a tertiary referral musculoskeletal oncology centre with Chondrosarcoma of bone with a minimum of 2 years follow up. A total of 532 patients were seen with Chondrosarcoma between 1970 and 1/1/2006. Patients were excluded if they had initial treatment in another unit (20 patients), a subdiagnosis of dedifferentiated Chondrosarcoma (due to very poor prognosis, 43 patients), metastases at presentation (6 patients) and if they presented with disseminated metastases prior to local recurrence (12 patients). This left 451 patients in the study group and the clinicopathological records were reviewed on these patients.

Results: Of the 451 patients, the mean age was 48 years old at diagnosis (range 6–89 years) with the most commonly sites of presentation being in the pelvis in 132 patients (29%), proximal femur in 81 patients (18%), distal femur in 40 patients (9%) and proximal humerus in 40 patients (9%). Grade at presentation was grade 1 in 44%, grade 2 in 44% and grade 3 in 12%. Surgical margins were wide in 45%, marginal in 28% and incisional (including curettage procedures) in 27%. Local recurrence occurred in 88 patients (19.5%). Local recurrence rates were significantly different for surgical margins on Fisher exact testing (p=0.003), which held true even when stratified by presenting grade of tumour. Local recurrence occurred at a mean of 2.8 years, however, 12.5% occurred more than 5 years from diagnosis. There was a significant difference in survival compared between those patients with local recurrent disease and those without on Kaplan Meier analysis; 10 year survival for those without recurrence was 73.1% compared to 41% for those with local recurrence(p< 0.0001, Logrank). On cox regression analysis significant factors affecting survival were pelvic location (p=0.004), local recurrence (p=0.007), age at presentation (p=0.01), marginal margins (p=0.04) and initial tumour grade (p=0.043). There was no significant difference between survival and initial surgical margin when stratified by grade of tumour, possibly as further surgery to improve adequacy of margins. Further sub-analysis is being performed.

Conclusions: There is a complex relationship between surgical margins, local recurrence and margins. It appears that long term survival is possible in approximately 1/3 patients who have local recurrence in intermediate and high grade chondrosarcomas and therefore ever effort should be made to regain local control following local recurrence.

Introduction: Current practice in the UK is to perform clinical follow up on patients with soft tissue sarcoma (STS) and only to request cross sectional imaging if there is clinical suspicion. We aimed to assess the effectiveness of this policy by investigating the patients who developed a local recurrence (LR) after previous treatment for STS and whether the size and extent at diagnosis of LR affected their subsequent management

Method: We reviewed the clinical records and imaging of all patients with diagnosed LR of STS to investigate the site and size of the LR and its management.

Results: 35 patients were diagnosed with LR over a 3 year time period. The average time from previous definitive treatment was almost 19 months. The suspicion was made by the patient in 18 patients, by a doctor in 16 and a district nurse in 1. The patients had MRI to confirm the diagnosis followed by biopsy or excision biopsy. 31 of the tumours were high grade, 2 low and 2 were not excised. The size at time of LR was 5.6 cm (range 0.5–15). 12 of the patients had concomitant metastases. 16 were treated by local excision and 5 by amputation whilst 14 patients had palliation. It was felt that with earlier diagnosis the clinical management would have been different in:

those 7 whose LR was inoperable due to size,

Discussion: Earlier diagnosis could have led to simpler surgery in a third of the affected patients. This study raises the question as to whether a more aggressive policy of follow up with regular imaging (either MRI or ultrasound) could detect LR earlier and lead to improved outcomes.

We reviewed the treatment and clinical outcome of 32 consecutive patients with Ewing’s sarcoma who presented with or developed pathological fracture after biopsy between 1984 and 2004. The minimum follow-up was 18 months. The mean age at diagnosis was 20 years (5 – 51). There were 18 males and 14 females. All patients were newly diagnosed and had localized disease at the time of diagnosis. 21 patients presented with pathological fracture while 11 patients developed fracture during the course of chemotherapy. The femur was the most common location in 15 patients.

All the patients had chemotherapy according to the protocol current at the time of treatment. 6 patients had radiotherapy alone while 26 patients underwent surgical excision and reconstruction. Of the patients who had surgery, 7 patients had adjuvant radiotherapy. Fracture healing was the norm after pre-operative chemotherapy. Surgical margins were wide in 17 patients, marginal in 4 and intralesional in 3 patients.

Local recurrence developed in one patient (3%). Metastases occurred in 12 patients (37%). At the time of review 16 patients were free of disease, 3 were alive with disease and 13 patients had died of disease. The cumulative 5 year metastases free and overall survival in all the patients was 58% and 61 % respectively and similar to patients with Ewing’s sarcoma without fracture treated at our centre. The prognosis of patients who presented with fracture was exactly similar to those who developed fracture in the course of treatment.

We conclude that limb preserving surgery is perfectly safe in patients with Ewing’s sarcoma who have associated pathological fracture and survival is not in any way compromised. Survival of patients who present with fracture is similar to those who develop fracture in the course of treatment. The exact role of adjuvant radiotherapy in these patients needs to be clarified.

We have investigated whether improvements in design have altered outcome for patients undergoing endoprosthetic replacement of the distal femur following tumour resection.

Survival of the implant and ‘servicing’ procedures has been documented using a prospective database and review of the implant design records and case records.

A total of 335 patients underwent a distal femoral replacement with 162 having a fixed hinge design and 173 a rotating hinge. The median age of the patients was 24 years (range 13–82yrs). With a minimum follow up of 5 years and a maximum of 30 years, 192 patients remain alive with a median follow up of 11 years. The risk of revision for any reason was 17% at 5 years, 33% at 10 years and 58% at 20 years. Aseptic loosening was the most common reason for revision in the fixed hinge knees whilst infection and stem fracture were the most common reason in the rotating hinges. The risk of revision for aseptic loosening in the fixed hinges was 35% at ten years but appears to have been abolished by the use of a the rotating hinge knee with a hydroxyapatite collar. The overall risk of revision for any reason was halved by use of the rotating hinge.

Improvements in design of distal femoral replacements have significantly decreased the risk of revision surgery but infection remains a serious problem for all patients. We believe that a cemented, rotating hinge prosthesis with a hydroxyapatite collar offers the best chance of long term prosthesis survival.

Aim: To identify tumour and treatment factors significant for both local control and survival for patients with chondrosarcoma of the pelvis.

Method: The features of all patients with non metastatic chondrosarcoma of the pelvis treated at a tertiary treatment centre between 1971 and 2001 with more than 2 years of follow-up were analyzed.

Results: There were 106 patients with a median age of 44. There were equal numbers of male and female patients in the group. The median size of the tumours was 12cm. 47 tumours were grade 1, 37 were grade 2 and 22 were grade 3. Treatment involved hindquarter amputation in 33 and excision with or without reconstruction in 73. Clear margins (wide or better) were achieved in 34 cases. The excision was marginal in 30 cases and intralesional or contaminated in 37. Local recurrence arose in 39 patients and was related to adequate margins of excision (p=0.03) and grade (p=0.01). Overall survival was 72% at 5 years, 56% at 10 years and 46% at 15 years. Survival was strongly related to grade (p=0.08) but survival beyond 5 years was most strongly related to the adequacy of the excision margins.

Conclusion: Tumour grade is the most important prognostic factor for chondrosarcoma of the pelvis but the ability to obtain clear margins of excision influences both local control and the prospects for long term survival.

We reviewed the treatment and clinical outcome of 32 consecutive patients with Ewing’s sarcoma who presented with or developed pathological fracture after biopsy between 1984 and 2004. The minimum follow-up was 18 months. The mean age at diagnosis was 20 years (5 – 51). There were 18 males and 14 females. All patients were newly diagnosed and had localized disease at the time of diagnosis. 21 patients presented with pathological fracture while 11 patients developed fracture during the course of chemotherapy. The femur was the most common location in 15 patients.

All the patients had chemotherapy according to the protocol current at the time of treatment. 7 patients had radiotherapy alone while 25 patients underwent surgical excision and reconstruction. Of the patients who had surgery, 7 patients had adjuvant radiotherapy. Fracture healing was the norm after pre-operative chemotherapy. Surgical margins were wide in 17 patients, marginal in 4 and intralesional in 3 patients.

Local recurrence developed in one patient (3%). Metastases occurred in 12 patients (37%). At the time of review 16 patients were free of disease, 3 were alive with disease and 13 patients had died of disease. The cumulative 5 year metastases free and overall survival in all the patients was 58% and 61 % respectively and similar to patients with Ewing’s sarcoma without fracture treated at our centre. The prognosis of patients who presented with fracture was exactly similar to those who developed fracture in the course of treatment.

We conclude that limb preserving surgery is perfectly safe in patients with Ewing’s sarcoma who have associated pathological fracture and survival is not in any way compromised. Survival of patients who present with fracture is similar to those who develop fracture in the course of treatment. The exact role of adjuvant radiotherapy in these patients needs to be clarified.

Synovial sarcoma is a morphologically well-defined neoplasm that most commonly occurs in soft tissue accounting for 5% to 10 % of all soft tissue sarcomas. We reviewed 156 patients with synovial sarcoma of soft tissues treated at a supra-regional centre to determine survival and prognostic factors.

There were 77men and 79 women with mean age at presentation of 38 years (3 to 84). Follow-up periods ranged from 3 to 494 months (median 43 months). Tumor was located in lower extremities in 111patients, upper extremities in 34 patients, and trunk and pelvis in 11 patients. Overall survival was 66% at 5 years and 48% at 10 years. The 5 and 10 year survival for the 23 patients who had metastases at the time of diagnosis was 13% and 0% respectively compared to 75% and 54% for those without metastases at diagnosis. Local recurrence occurred in 18 patients (13%). The significant prognostic factors for survival included presence of metastases at diagnosis and development of local recurrence. Tumour size and depth, age of patients and use of chemotherapy did not significantly influence survival.

We conclude that the clinical factors which influence survival of patients with synovial sarcoma are different from those of soft tissue sarcomas in general. Biological factors may better predict prognostic survival than the usual clinical factors.

Purpose: To study the results of treatment of symptomatic non-union with endoprosthesis at the Royal Orthopaedic Hospital

Methods: Between 1987 & 2005, 17patients were treated with massive endoprosthesis for non-union. We performed a retrospective review of these case notes

Results: Mean age at diagnosis was 63years (range 36–86). Location of non-union was distal femur in 9, proximal femur in 4, proximal humerus in 2, proximal tibia in 1, distal humerus in 1. The majority of the patients had received prior multiple operations before endoprosthetic surgery.

Four patients had obvious infection confirmed by histology and/or microbiology prior to surgery. Endoprosthetic Reconstruction was performed as a 1 stage procedure in 13 and as a 2 stage in 4.

Complications occurred in 5 patients. These included recurrence of infection in 1, persistent pain in 1, aseptic loosening in 1, periprosthetic fracture in 1 and a non ST myocardial infarction in 1. At the last follow-up, (mean 5years, range 1–18years) majority of patients achieved good range of motion and good mobility.

Conclusion: We conclude that endoprosthetic replacement is a reasonable option for treatment of end-stage non-union in carefully selected patients. Adequate mobility and function can be achieved in majority of patients following such treatment

Aim: To identify patient, tumour or treatment factors that influence outcome in patients with radiation induced sarcoma of bone.

Method: A retrospective review of an oncology database supplemented by referral back to original records.

Results: We identified 42 patients who presented to our Unit over a 25 year period with a new sarcoma of bone following previous radiotherapy. The age of the patients at presentation ranged from 10 to 84 years of age (mean: 17 years) and the time interval from previous radiotherapy ranged from 4 to 50 years (median: 14 yrs; mean: 17 years). The median dose of radiotherapy given had been 50 Gy but there was no correlation of radiation dose with time to development of sarcoma. The pelvis was the most common site for development of sarcoma (14 cases) but breast cancer was the most common primary tumour (8 cases). 9 of the patients had metastases at the time of diagnosis of the sarcoma. Osteosacoma was the most common diagnosis (30). Treatment was by surgery and chemotherapy when indicated and 30 of the patients had treatment with curative intent. The survival rate was 41% at 5 years for those treated with curative intent but in those treated palliatively median survival was only 6 months and all had died by one year. The only factor found to be significant for survival was the ability to completely resect the tumour, thus limb sarcomas had a better prognosis (66% survival at 5 years) than central ones (12%)(p=0.009).

Conclusion: Radiation induced sarcoma is a rare complication of radiotherapy. Both surgical and oncological treatment is likely to be compromised by previous treatment the patient has received. Despite this 40% of patients will survive more than 5 years with aggressive modern treatment.

Purpose of the study: To analyze survival and prognostic factors in a series of patients treated for chondrosarcoma of the pelvis.

Material and methods: The series included 106 patients (53 women and 53 men) treated for non-metastatic chondrosarcoma of the pelvis. Minimum follow-up was two years. Mean age at diagnosis was 44 years. Tumors were grade 1 (n=47), grade 2 (n=37), grade 3 (n=22). Conservative surgery was performed in 73 patients (resection with or without reconstruction) and interilio-abdominal disarticulation for 33.

Results: Resection margins were sufficient for 34 patients (wide or radical resection), marginal for 35, and intratumoral or malignant for 37. Local recurrence was noted in 39 patients (37%). Prognostic factors affecting local recurrence were: quality of resection (p=0.03), grade (p=0.01). Overall survival at 5, 10 and 15 years were 72, 56, and 46% respectively. Survival was strongly correlated with grade (p=0.08) and survival after five years was also correlated with resection margins.

Conclusions: In this series, tumor grade was the most important prognostic factor for patients with chondrosarcoma of the pelvis but achieving satisfactory resection with wide margins also has a significant effect on prognosis for local recurrence and long-term survival.