Dagan, Roi
McGee, Lisa
Morris, Christopher G.
Kirwan, Jessica M.
Knapik, Jacquelyn
Reith, John
Scarborough, Mark T.
Gibbs, C. Parker
Marcus, Robert B., Jr.
Zlotecki, Robert A.
BACKGROUND: Marginal excision of soft tissue sarcoma (STS), defined as resection through the tumor pseudocapsule or surrounding reactive tissue, increases the likelihood of local recurrence and necessitates re-excision or postoperative radiation. However, its impact after preoperative radiation therapy (RT) remains unclear. This study therefore investigated the significance of marginal margins in patients treated with preoperative RT for extremity STS, reporting long-term local control and limb preservation endpoints. METHODS: The records of 317 adults at the University of Florida with nonmetastatic extremity STS treated from 1980 to 2008 with preoperative RT as part of a limb conservation strategy were reviewed. The median follow-up was 4.7 years (8.3 years for living patients). The median tumor size was 10 cm (range, 2-36 cm), and 86% were high grade. The median RT dose was 50.4 Gy (range, 12.5-57.6 Gy). Margins were classified as wide/radical (n = 105), marginal (n = 179), contaminated (n = 15), positive (n = 17), or unknown (n = 1). Endpoints were local control (LC), amputation-free survival (AFS), cause-specific survival (CSS), and overall survival (OS). RESULTS: Five-year CSS and OS rates were 62% and 59%, respectively. Five-year LC and AFS was 93% and 89%, respectively. AFS by margin status was 64%, 83%, 97%, and 92% for positive, contaminated, marginal, and wide/radical margins, respectively (P<.005). Marginal excision following preoperative RT resulted in equivalent LC and AFS compared with wide/radical margins. CONCLUSIONS: Marginal resection after preoperative RT does not compromise LC or AFS in extremity STS. This finding may be related to radiosterilization of tumor cells within the reactive zone following preoperative RT. Cancer 2012;118: 3199207. (C) 2011 American Cancer Society.
Stevens, Jennifer E.
Pathare, Neeti C.
Tillman, Susan M.
Scarborough, Mark T.
Parker Gibbs, C.
Shah, Prithvi
Jayaraman, Arun
Walter, Glenn A.
Vandenborne, Krista
Muscle atrophy is clearly related to a loss of muscle torque, but the reduction in muscle size cannot entirely account for the decrease in muscle torque. Reduced neural input to muscle has been proposed to account for much of the remaining torque deficits after disuse or immobilization. The purpose of this investigation was to assess the relative contributions of voluntary muscle activation failure and muscle atrophy to loss of plantarflexor muscle torque after immobilization. Nine subjects (ages 19-23) years with unilateral ankle malleolar fractures were treated by open reduction-internal fixation and 7 weeks of cast immobilization. Subjects participated in 10 weeks of rehabilitation that focused on both strength and endurance of the plantarflexors. Magnetic resonance imaging, isometric plantarflexor muscle torque and activation (interpolated twitch technique) measurements were performed at 0, 5, and 10 weeks of rehabilitation. Following immobilization, voluntary muscle activation (56.8 +/- 16.3%), maximal cross-sectional area (CSA) (35.3 +/- 7.6cm(2)), and peak torque (26.2 +/- 12.7N-m) were all significantly decreased (p < 0.0056) compared to the uninvolved limb (98.0 +/- 2.3%, 48.0 +/- 6.8 cm(2), and 105.2 +/- 27.0 N-m, respectively). During 10 weeks of rehabilitation, muscle activation alone accounted for 56.1% of the variance in torque (p < 0.01) and muscle CSA alone accounted for 35.5% of the variance in torque (p < 0.01). Together, CSA and muscle activation accounted for 61.5% of the variance in torque (p < 0.01). The greatest gains in muscle activation were made during the first 5 weeks of rehabilitation. Both increases in voluntary muscle activation and muscle hypertrophy contributed to the recovery in muscle strength following immobilization, with large gains in activation during the first 5 weeks of rehabilitation. In contrast, muscle CSA showed fairly comparable gains throughout both the early and later phase of rehabilitation. (c) 2006 Orthopaedic Research Society. Published by Wiley Periodicals, Inc.
Soni, Emily E. Carmody
Miller, Benjamin J.
Scarborough, Mark T.
Gibbs, C. Parker
Background: Treatment of periacetabular sarcomas remains a difficult challenge. Many reconstruction options are fraught with high complication and failure rates. Little is known about patients' functional outcomes, and there have been no studies that examine how these reconstructions affect patients' gait parameters. The purpose of this study is to evaluate gait parameters and functional outcome in patients whom have undergone periacetabular resections with either an ischiofemoral pseudoarthrodesis or soft tissue reconstruction only. Methods: Ten patients with sarcoma of the periacetabular region were identified from our database. Functional outcome was assessed using the Musculoskeletal Tumor Society Scores (MSTS) and Toronto Extremity Salvage Score (TESS) scoring systems. Gait analysis was performed on all subjects. Results: Patients in both surgical groups had average functional scores. All patients were ambulatory. Cadence and velocity in the surgical group were significantly slower than the control group, however, the remainder of the gait parameters examined were similar to controls. Conclusion: Patients who underwent minimal reconstruction following periacetabular resections demonstrated average functional scores, comparable to those undergoing more extensive reconstructions. With the exception of speed, gait parameters were not significantly different than controls. Complication rates were low. Pseudoarthrodesis or even no bone reconstruction following periacetabular resection is reasonable and functional options for many of these patients. J. Surg. Oncol. 2012; 106:844849. (C) 2012 Wiley Periodicals, Inc.
Indelicato, Daniel J.
Keole, Sameer R.
Shahlaee, Amir H.
Shi, Wenyin
Morris, Christipher G.
Gibbs, C. Parker, Jr.
Scarborough, Mark T.
Marcus, Robert B., Jr.
Purpose: This retrospective analysis describes our 35-year experience with respect to disease control and functional status. Patients and Methods: Thirty-five patients with localized Ewing tumors of the pelvis and sacral bones were treated from 1970 to 2005. Twenty-six patients were treated with definitive radiotherapy (RT), and 9 patients were treated with combined local therapy in the form of surgery + RT. The median RT dose was 55.2 Gy. The patients who received RT alone were more likely to he older men with larger tumors exhibiting soft-tissue extension. Patients in the definitive RT group were more likely to receive etoposide and ifosfamide or undergo hone marrow transplant. Median potential follow-up was 14.4 years. Results: The 15-year-actuarial cause-specific survival, freedom from relapse rate, and local control rates were 26% vs. 76% (p = 0.016), 28% vs. 78% (p = 0.015), and 64% vs. 100% (p = 0.087), respectively, for patients treated with definitive RT and combined therapy. Overall, tumors < 8 cm had significantly [letter cause-specific survival, but this was unrelated to local control. The median Toronto Extremity Salvage Score for the definitive RT and combined therapy groups were 99 and 94, respectively (p = 0.19). Seven definitive RT patients (27%) had serious complications. Conclusion: Combined modality local therapy should he considered if pelvic Ewing tumors are resectable. However, because of the extent of local disease, most patients have unresectable or partially resectable tumors and therefore require RT in some capacity. For this reason, innovative RT strategies are needed to improve long-term disease outcomes and minimize side effects while maintaining an acceptable functional result. (C) 2008 Elsevier Inc.