Aim

Synovial sarcoma (SS) is a malignant soft tissue sarcoma with a poor prognosis because of late local recurrence and distant metastases. To our knowledge, no studies have minimum follow-up of 10 years that evaluate long-term outcomes for survivors.

The practice of rotator cuff repair rapidly moves towards arthroscopic techniques especially for single tendon tears. Although the clinical results are relatively well established, the structural results of open rotator cuff repair and their correlation with the clinical outcome are poorly known. In order to provide a baseline for future studies using other repair techniques, this study was carried out to assess the structural changes in the repaired musculotendinous unit and to correlate these findings with the clinical outcome after rupture and repair of an isolated full thickness single tendon tear of the rotator cuff.

To prospectively assess the quality of an open rotator cuff tendon repair technique, to determine how structural changes of rotator cuff muscles are affected by tendon repair, and to correlate the structural results of MRI studies with the clinical outcome.

Direct open repair of a complete, isolated single tendon tear of the rotator cuff resulted in significant improvement in function and objective evidence of tendon healing on MRI. Successful direct repair was not associated with recovery of preoperative muscular atrophy or fatty infiltration when comparing Goutallier stage fatty infiltration between pre and postoperative patients.

The age and gender-adjusted Constant score increased significantly from an average of 63.9% preoperatively to 94.5% postoperatively (p< 0.0001). Pain improved significantly from 6.8 points to 13.2 points on a visual analogue scale. (p< 0.0001). Activities of daily living increased from 11.2 points preoperatively to 17.9 points postoperatively (p< 0.0001). Anterior elevation, abduction and internal rotation improved significantly for subscapularis and supraspinatus repairs, but there was no significant change in external rotation. The overall rerupture rate was 12.5%. There was no significant improvement or recovery of muscular atrophy or fatty infiltration after tendon repair.

Thirty-two consecutive open repairs of a single tendon tear of the rotator cuff were analysed. The supraspinatus tendon was involved in twenty-two patients and the subscapularis tendon in ten patients. All tendons were repaired using an open technique, a modified Mason-Allen suturing technique, and transosseus fixation with non-absorbable suture material knotted over a bone augmentation device.

The influence of advancements in imaging and chemotherapy on patient with dedifferentiated chondrosarcoma was determined. There were forty-two cases in which twenty-seven patients received adjuvant therapy. Median survival was eight months and five-year survival was 4.8%. There was no statistical difference (p=0.62) in survival between patients who did and did not receive chemotherapy, had wide versus radical resection, or had limb sparing versus sacrificing procedures. There were no statistically significant differences between patients treated prior to 1986 and those subsequently. Despite advances, dedifferentiated chondrosarcoma continues to carry a poor prognosis. The routine adjuvant chemotherapy in this population should be questioned

The long-term survival for patients that presented with dedifferentiated chondrosarcoma has historically been poor. A large clinical series has not been analyzed in the era of modern diagnostic and treatment modalities. The current study was performed to look at the influence of advancements in imaging and chemotherapy on patient outcome. A retrospective chart review of all cases of patients presenting with dedifferentiated chondrosarcoma at our institution from 1984–2000 was performed. This was done as an extension to a study published in 1986 prior to the era of modern chemotherapy.

There were forty-two cases in twenty-five men and seventeen women of average age fifty-six (range twenty-four-eighty-three years). MSTS grades at presentation were IIA(5), IIB(27), and III(10). Three patients underwent biopsy only, nineteen had limb sacrificing surgery, and twenty had limb sparing procedures. Surgical margins were intralesional in three, marginal in two, wide in twenty, and radical in fourteen. Twenty-seven patients received adjuvant therapy (twenty-two chemotherapy only, two radiotherapy only, three combined therapy). Median survival was eight months and five-year survival was 4.8%. There was no statistical difference (p=0.62) in survival between patients who did and did not receive chemotherapy, had wide versus radical resection, or had limb sparing versus sacrificing procedures. There were no statistically significant differences between patients treated prior to 1986 and those subsequently.

Despite advances in diagnostic modalities, surgical treatments, and adjuvant therapies, dedifferentiated chondrosarcoma continues to carry a poor prognosis. The routine use of current adjuvant chemotherapy and its inherent risks and benefits in this population should be questioned.

Introduction and Aims: Multimodal treatment has dramatically improved the outcome of patients with Ewing’s sarcoma. However, little is known about treatment-related complications in patients who are long-term survivors.

Method: Forty-one patients with Ewing’s sarcoma treated at the authors’ institution between 1963 and 1980 and who survived by at least 20 years were included in this study. This patient group comprises 17 men and 24 women. The mean age at presentation was 16.8 (range five to 51) years. Three patients presented with metastatic disease. The location included 14 axial, and 27 appendicular lesions. All but nine patients had chemotherapy as part of their multimodality treatment.

Results: The overall follow-up averaged 297 (range 240–430) months. All except one patient were alive at final follow-up, the latter dying of radiotherapy-induced secondary malignancy after 33 years. Five patients survived, despite developing local recurrence or metastatic disease. Only 16 (39%) patients were free of any complication. These included metastases (12%), local recurrence (7%), secondary malignancies (7%), pathologic fractures (20%), and radiation (32%), and chemotherapy-associated morbidities (20%). The complication rate in this series of long-term survivors treated prior to 1980 is surprisingly high. Current treatment advances should result in improved long-term results.

Conclusion: Even when patients with Ewing’s sarcoma survive the primary cancer, only a minority of them remain without treatment-associated morbidities.

Introduction and Aims: Sacrococcygeal chordoma presents a difficult diagnostic and therapeutic problem with a high incidence of local recurrence. The report aims to define the importance of adequate surgical treatment on outcome and survival.

Method: Fifty-eight patients underwent surgical treatment for sacrococcygeal chordoma between 1979 and 2001. The series included 19 women and 39 men with an average age of 56.2 (range 13–76) years at diagnosis. Depending on the level and extent of the lesion, a posterior approach was performed in 25 patients, and a combined antero-posterior approach in 33 patients. A wide surgical margin was achieved in 22 patients, 14 marginal and 22 intralesional.

Results: At average follow-up of 92.2 (range 18–276) months. Thirty-three patients were alive with no evidence of disease. Twenty-one patients had local recurrence. Recurrence-free survival at five years was 67% and at 10 years 57%. The overall survival was 74%, 51%, 42% at five years, 10 years, and 15 years, respectively. All patients with wide margins survived (100%), which was significantly different from patients who had either marginal or intralesional excision (p=0.0001). The type of surgical approach (p=0.138) does not influence the likelihood to obtain a good margin, although patients with wide margins were also more likely to have small tumors. A wide margin was achieved in 48% using a combined antero-posterior approach, whereas this was the case only in 29% using a posterior approach. Tumor volume univariately assessed, however, does not seem to compromise the possibility of obtaining a wide margin (p=0.21). Multivariate analysis identified – in contrast to tumor volume (p=0.13) – margin (p=0.0001) and age (p=0.04) as predictors of survival. Whereas survival is independent of age in the case with wide margins, patients with marginal or intralesional margins and an age above 60 years have a better survival (43% at 10 years) than patients younger than 60 years with those parameters (20% at 10 years; p=0.0776).

Conclusion: A wide margin is the most important predictor of survival in patients with sacrococcygeal chordoma. Tumor volume per se has no negative impact on survival as long as a wide margin is obtained. Therefore, for large tumors and tumors above S3 we prefer combined antero-posterior approach. If a wide margin cannot be obtained, then young patients have a worse prognosis than older patients.