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Article: Current concepts in the surgical treatment of skeletal metastases.

Ehne, Jessica / Tsagozis, Panagiotis

2020 Volume 11, Issue 7, Page(s) 319–327

Abstract: Symptomatic metastatic bone disease affects a large proportion of patients with malignant tumours and significantly impairs patients' quality of life. There are still controversies regarding both surgical indications and methods, mainly because of the ... ...

Abstract	Symptomatic metastatic bone disease affects a large proportion of patients with malignant tumours and significantly impairs patients' quality of life. There are still controversies regarding both surgical indications and methods, mainly because of the relatively few high-quality studies in this field. Generally, prosthetic reconstruction has been shown to result in fewer implant failures and should be preferred in patients with a good prognosis. Survival estimation tools should be used as part of preoperative planning. Adjuvant treatment, which relies on radiotherapy and inhibition of osteoclast function may also offer symptomatic relief and prevent implant failure. In this review we discuss the epidemiology, indications for surgery, preoperative planning, surgical techniques and adjuvant treatment of metastatic bone disease.
Language	English
Publishing date	2020-07-18
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	2649712-8
ISSN	2218-5836
ISSN	2218-5836
DOI	10.5312/wjo.v11.i7.319
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Article: Multidisciplinary treatment of soft tissue sarcomas: An update.

Gómez, Jorge / Tsagozis, Panagiotis

World journal of clinical oncology

2020 Volume 11, Issue 4, Page(s) 180–189

Abstract: Standard treatment for soft tissue sarcoma, based on complete surgical resection with or without adjuvant radiotherapy and chemotherapy, has not substantially changed during the last several decades. Nevertheless, recent advances have contributed to ... ...

Abstract	Standard treatment for soft tissue sarcoma, based on complete surgical resection with or without adjuvant radiotherapy and chemotherapy, has not substantially changed during the last several decades. Nevertheless, recent advances have contributed to considerable improvement in the management of these patients; for example, new magnetic resonance imaging sequences such as diffusion-weighted imaging and magnetic resonance imaging radiomics can better assess tumor extension and even estimate its grade. Detection of circulating genetic material (liquid biopsy) and next-generation sequencing are powerful techniques for genetic analysis, which will increase our understanding of the underlying molecular mechanisms and may reveal potential therapeutic targets. The role of chemotherapy in non-metastatic disease is still controversial, and there is a need to identify patients who really benefit from this treatment. Novel chemotherapeutic regimens have entered clinical praxis and can change the outcome of patients with metastatic disease. Advances in radiotherapy have helped decrease local adverse effects and sustain good local control of the disease. The following report provides an updated view of the diagnosis, treatment, and future perspectives on the management of patients with soft tissue sarcomas.
Language	English
Publishing date	2020-04-30
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	2587357-X
ISSN	2218-4333
ISSN	2218-4333
DOI	10.5306/wjco.v11.i4.180
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Article: Outcome of Surgical Treatment for Spinal Cord Compression in Patients With Hematological Malignancy.

Tsagozis, Panagiotis / Bauer, Henrik C F

International journal of spine surgery

2019 Volume 13, Issue 2, Page(s) 186–191

Abstract: Background: We investigated the outcome of surgical treatment of patients with radiosensitive hematological malignancies presenting with spinal cord compression.: Methods: Retrospective review of 50 patients who had treatment between 1993 and 2012.!## ...

Abstract	Background: We investigated the outcome of surgical treatment of patients with radiosensitive hematological malignancies presenting with spinal cord compression. Methods: Retrospective review of 50 patients who had treatment between 1993 and 2012. Results: The neurological outcome was favorable in 35 patients, stable in 12, whereas 3 patients deteriorated. Decompression within 48 hours from referral was associated with a superior neurological recovery ( Conclusion: Patients with cord compression from hematological malignancy benefit from early surgical decompression. There is an inherent high risk for complications, which increases further if radiotherapy is given. Patients failing to ambulate after surgery have a poor prognosis.
Language	English
Publishing date	2019-04-30
Publishing country	Netherlands
Document type	Journal Article
ISSN	2211-4599
ISSN	2211-4599
DOI	10.14444/6025
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Article ; Online: The obesity paradox and mortality after pathological hip fractures: a Swedish registry study.

Ehne, Jessica / Tsagozis, Panagiotis / Lind, Anja / Wedin, Rikard / Hedström, Margareta

Acta orthopaedica

2022 Volume 93, Page(s) 185–189

Abstract: Background and purpose - Obesity as measured by BMI has been associated with increased survival in various diseases, a phenomenon known as the "obesity paradox." It is unknown whether obesity is associated with survival after pathological fractures. We ... ...

Abstract	Background and purpose - Obesity as measured by BMI has been associated with increased survival in various diseases, a phenomenon known as the "obesity paradox." It is unknown whether obesity is associated with survival after pathological fractures. We investigated the association between BMI and survival after surgery for pathological hip fracture, to improve survival prognostication, and lay grounds for further interventional nutritional studies. Patients and methods - We analyzed prospectively collected data from Swedish nationwide registry "RIKSHÖFT." The study cohort included 1,000 patients operated for a pathological hip fracture between 2014 and 2019. BMI registered on admission was available in 449 patients. Overall patient survival was measured according to the Kaplan-Meier method. Multivariable regression was used to evaluate association with other potential factors that influence patient survival. Results - Overweight and obesity were associated with an increased postoperative survival in male patients with surgically treated pathological hip fractures. Multivariable analysis considering potential confounders confirmed this finding. The association was not that strong in women and did not reach statistical significance. Interpretation - BMI, a commonly available clinical parameter, is a good predictor of overall survival for patients operated on for pathological hip fracture. Incorporation of BMI in existent survival prognostication algorithms should be considered. Treatment of malnutrition in this frail group of patients is worth studying.
MeSH term(s)	Female ; Fractures, Spontaneous/complications ; Hip Fractures ; Humans ; Male ; Obesity/complications ; Obesity/epidemiology ; Registries ; Retrospective Studies ; Risk Factors ; Sweden/epidemiology
Language	English
Publishing date	2022-01-03
Publishing country	Sweden
Document type	Journal Article
ZDB-ID	2180677-9
ISSN	1745-3682 ; 1745-3674
ISSN (online)	1745-3682
ISSN	1745-3674
DOI	10.2340/17453674.2021.1020
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Article: Outcome of surgical treatment for bone metastases caused by colorectal cancer.

Byttner, Martina / Wedin, Rikard / Bauer, Henrik / Tsagozis, Panagiotis

Journal of gastrointestinal oncology

2021 Volume 12, Issue 5, Page(s) 2150–2156

Abstract: Background: Cancer of the lower intestinal tract, although relatively common, rarely metastasizes to the skeleton. The treatment of metastatic bone disease due to colorectal cancer has thus been poorly described and treatment decisions are therefore ... ...

Abstract	Background: Cancer of the lower intestinal tract, although relatively common, rarely metastasizes to the skeleton. The treatment of metastatic bone disease due to colorectal cancer has thus been poorly described and treatment decisions are therefore difficult. The aim of this study was to describe the outcome of orthopedic surgery in patients with pathological fractures from colorectal cancer and investigate factors that correlate with patient survival, since it influences treatment decisions. Methods: Retrospective review of data collected in a prospectively collected database. 36 patients (38 fractures) who underwent surgery between 2000 and 2019 for metastatic bone disease caused by colorectal cancer were included. Results: Most metastases were localized in the axial skeleton and 33/36 patients already had visceral metastases. Patients with pathological fractures from colorectal cancer had poor prognosis, with only 5/36 surviving more than 1 year, median survival being 3 months. Patients presenting with a single skeletal metastasis had a superior overall survival (P≤0.001). Post-operative complications were common, noted in 11 patients, and the surgical failure rate was considerable. Conclusions: Although relatively rare, bone metastases should be suspected in patients with colorectal cancer presenting with signs and symptoms of spinal cord compression or skeletal pain. In this case, the presence of a solitary skeletal lesion is a favorable prognostic sign. Awareness for local complications after surgery should be high.
Language	English
Publishing date	2021-11-02
Publishing country	China
Document type	Journal Article
ZDB-ID	2594644-4
ISSN	2219-679X ; 2078-6891
ISSN (online)	2219-679X
ISSN	2078-6891
DOI	10.21037/jgo-21-108
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Article ; Online: Spinal metastasis with neurologic deficits.

Tsagozis, Panagiotis / Bauer, Henrik C F

Acta orthopaedica

2017 Volume 89, Issue 2, Page(s) 229–233

Abstract: Background and purpose - A significant number of patients with spinal metastases are treated non-surgically, but may need surgical treatment at a later stage due to progression of symptoms. Therefore, we investigated the need for late surgical ... ...

Abstract	Background and purpose - A significant number of patients with spinal metastases are treated non-surgically, but may need surgical treatment at a later stage due to progression of symptoms. Therefore, we investigated the need for late surgical decompression in patients with spinal metastasis who were initially deemed as non-surgical candidates, as well as the outcome of late surgery. Patients and methods - 116 patients who were referred to the orthopedic oncology department between 2002 and 2011 due to spinal metastasis with neurologic symptoms were deemed to be non-surgical candidates. The primary reason was minor neurologic deficits in 40 patients (M) and short survival (S) in 76 patients. Results - 8 patients underwent a late operation due to progression of the neurologic symptoms, all of them belonged to group M. M-patients with a modified Bauer score of less than 2 had both an inferior survival as well as a higher risk for late surgery. Postoperative improvement in neurologic function was noted in 5/8 operated patients, whilst 2 patients had stationary symptoms and 1 deteriorated. Interpretation - The need for late surgery arises in a minority of patients with spinal metastasis primarily treated non-surgically, and only in patients with minor neurologic compromise rather than poor general condition. An established prognostic score (modified Bauer) can be used to guide decision-making. Late surgical decompression is effective in restoring the neurologic status.
MeSH term(s)	Adult ; Aged ; Aged, 80 and over ; Decompression, Surgical ; Female ; Humans ; Kaplan-Meier Estimate ; Lumbar Vertebrae ; Male ; Middle Aged ; Patient Selection ; Retrospective Studies ; Spinal Cord Compression/etiology ; Spinal Cord Compression/surgery ; Spinal Neoplasms/mortality ; Spinal Neoplasms/secondary ; Spinal Neoplasms/surgery ; Survival Rate ; Thoracic Vertebrae ; Treatment Outcome
Language	English
Publishing date	2017-12-12
Publishing country	England
Document type	Journal Article
ZDB-ID	2180677-9
ISSN	1745-3682 ; 1745-3674
ISSN (online)	1745-3682
ISSN	1745-3674
DOI	10.1080/17453674.2017.1412193
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Article: Preoperative radiotherapy of soft-tissue sarcomas: surgical and radiologic parameters associated with local control and survival.

Tsagozis, Panagiotis / Brosjö, Otte / Skorpil, Mikael

Clinical sarcoma research

2018 Volume 8, Page(s) 19

Abstract: Background: Preoperative radiotherapy is often used to facilitate excision of soft-tissue sarcomas. We aimed define factors that affect local tumour control and patient survival.: Methods: A single institution registry study of 89 patients with non- ... ...

Abstract	Background: Preoperative radiotherapy is often used to facilitate excision of soft-tissue sarcomas. We aimed define factors that affect local tumour control and patient survival. Methods: A single institution registry study of 89 patients with non-metastatic soft-tissue sarcomas having preoperative radiotherapy between 1994 and 2014. Radiologic (presence of peritumoural oedema and volume change following radiotherapy) and histopathologic (tumour volume, grade and surgical margin) parameters were recorded. Outcomes were the events of local recurrence, amputation, metastasis and death. Results: Local recurrence rate was low (12%) and marginal excision gave equal local control to wide excision. Pelvic localization was associated with a higher risk for amputation. The absence of peritumoural oedema on MRI defined a subgroup of tumours with more favourable oncologic outcome. Reduction of tumour volume following radiotherapy was also associated with better patient survival. Both these radiologic parameters were associated with lower tumour grade. Tumour necrosis was not significant for patient survival. The local complication rate, mainly wound healing problems and infection, was high (40%), but did not lead to any amputation. Conclusion: Preoperative radiotherapy of high-risk soft-tissue sarcomas allows for good local control rate at the expense of local wound complications, which are however manageable. Marginal excision is sufficient for local control. Absence of peritumoural oedema on MRI, as well as tumour size reduction following radiotherapy are associated to superior patient survival and can be used ass early prognostic factors.
Language	English
Publishing date	2018-10-05
Publishing country	England
Document type	Journal Article
ZDB-ID	2623217-0
ISSN	2045-3329
ISSN	2045-3329
DOI	10.1186/s13569-018-0106-x
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Article ; Online: High complication rate after extendible endoprosthetic replacement of the proximal tibia: a retrospective study of 42 consecutive children.

Tsagozis, Panagiotis / Parry, Michael / Grimer, Robert

Acta orthopaedica

2018 Volume 89, Issue 6, Page(s) 678–682

Abstract: Background and purpose - The long-term outcome of reconstruction with extendible prostheses after resection of tumors the proximal tibia in children is unknown. We investigated the functional outcome, complication rate and final limb salvage rate after ... ...

Abstract	Background and purpose - The long-term outcome of reconstruction with extendible prostheses after resection of tumors the proximal tibia in children is unknown. We investigated the functional outcome, complication rate and final limb salvage rate after this procedure. Patients and methods - 42 children who had a primary extendible replacement of the proximal tibia for bone tumor with a Stanmore implant between 1992 and 2013 were identified in the department's database. All notes were reviewed to identify the oncological and functional outcomes, the incidence of complications and the rate of amputation. 20 children were alive at final follow-up. Median follow-up time was 6 years and minimum follow-up for surviving patients was 3 years. Results - The overall limb salvage rate was 35/42; amputation was needed in 7 children. 15 implants were revised with a new implant. The Musculoskeletal Tumor Society Score was 73% (40-93) at final follow-up. The overall complication rate was 32/42. Soft tissue problems were the most common mode of complication, noted in 15 children, whereas structural failure and infection occurred in 12 children each. Use of prostheses with non-invasive lengthening was associated with a higher infection rate as compared with conventional ones (4/6 vs. 8/36) and inferior limb survival. Interpretation - Extendible replacements of the proximal tibia allow for limb salvage and satisfactory late functional outcome but have a high rate of complications. The use of non-invasive lengthening implants has not shown any benefit compared with conventional designs and is, rather, associated with higher risk for infection and amputation.
MeSH term(s)	Activities of Daily Living ; Amputation/mortality ; Amputation/statistics & numerical data ; Artificial Limbs/adverse effects ; Artificial Limbs/statistics & numerical data ; Bone Neoplasms/mortality ; Bone Neoplasms/physiopathology ; Bone Neoplasms/surgery ; Child ; Female ; Follow-Up Studies ; Humans ; Limb Salvage/statistics & numerical data ; Male ; Postoperative Complications/etiology ; Postoperative Complications/mortality ; Prostheses and Implants/adverse effects ; Prostheses and Implants/statistics & numerical data ; Prosthesis Design ; Prosthesis Failure ; Range of Motion, Articular/physiology ; Retrospective Studies ; Tibia/surgery ; Treatment Outcome
Language	English
Publishing date	2018-10-29
Publishing country	England
Document type	Journal Article ; Video-Audio Media
ZDB-ID	2180677-9
ISSN	1745-3682 ; 1745-3674
ISSN (online)	1745-3682
ISSN	1745-3674
DOI	10.1080/17453674.2018.1534320
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Article ; Online: Giant hydatid cyst of the pelvis, femur and retroperitoneal space: surgical treatment with extended hemipelvectomy.

Tsagozis, Panagiotis / Brosjö, Otte

BMJ case reports

2015 Volume 2015

Abstract: Hydatid disease of the bone is a very rare manifestation of the disease, and is often associated with debilitating symptoms. We present a rare case of skeletal hydatidosis in a 56-year-old man who had been misdiagnosed for many years. Massive involvement ...

Abstract	Hydatid disease of the bone is a very rare manifestation of the disease, and is often associated with debilitating symptoms. We present a rare case of skeletal hydatidosis in a 56-year-old man who had been misdiagnosed for many years. Massive involvement of the pelvic bones and soft tissues was evident. An extended hemipelvectomy was performed in order to achieve resection of the affected segments with a clear surgical margin. The patient recovered uneventfully and there are no signs of recurrence of the disease.
MeSH term(s)	Animals ; Echinococcosis/diagnosis ; Echinococcosis/pathology ; Echinococcosis/surgery ; Echinococcus/pathogenicity ; Femur/pathology ; Hemipelvectomy/methods ; Humans ; Male ; Middle Aged ; Pelvis/pathology ; Pelvis/surgery ; Retroperitoneal Space/pathology ; Treatment Outcome
Language	English
Publishing date	2015-05-12
Publishing country	England
Document type	Case Reports ; Journal Article
ISSN	1757-790X
ISSN (online)	1757-790X
DOI	10.1136/bcr-2015-209715
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Article: Current Strategies for the Treatment of Aneurysmal Bone Cysts.

Tsagozis, Panagiotis / Brosjö, Otte

Orthopedic reviews

2015 Volume 7, Issue 4, Page(s) 6182

Abstract: Aneurysmal bone cysts are benign bone tumors that usually present in childhood and early adulthood. They usually manifest as expansile osteolytic lesions with a varying potential to be locally aggressive. Since their first description in 1942, a variety ... ...

Abstract	Aneurysmal bone cysts are benign bone tumors that usually present in childhood and early adulthood. They usually manifest as expansile osteolytic lesions with a varying potential to be locally aggressive. Since their first description in 1942, a variety of treatment methods has been proposed. Traditionally, these tumors were treated with open surgery. Either intralesional surgical procedures or en bloc excisions have been described. Furthermore, a variety of chemical or physical adjuvants has been utilized in order to reduce the risk for local recurrence after excision. Currently, there is a shift to more minimally invasive procedures in order to avoid the complications of open surgical excision. Good results have been reported during percutaneous surgery, or the use of embolization. Recently, sclerotherapy has emerged as a promising treatment, showing effective consolidation of the lesions and functional results that appear to be superior to the ones of open surgery. Lastly, non-invasive treatment, such as pharmaceutical intervention with denosumab or bisphosphonates has been reported to be effective in the management of the disease. Radiotherapy has also been shown to confer good local control, either alone or in conjunction to other treatment modalities, but is associated with serious adverse effects. Here, we review the current literature on the methods of treatment of aneurysmal bone cysts. The indication for each type of treatment along reported outcome of the intervention, as well as potential complications are systematically presented. Our review aims to increase awareness of the different treatment modalities and facilitate decision-making regarding each individual patient.
Language	English
Publishing date	2015-12-28
Publishing country	Italy
Document type	Journal Article ; Review
ZDB-ID	2508171-8
ISSN	2035-8164 ; 2035-8237
ISSN (online)	2035-8164
ISSN	2035-8237
DOI	10.4081/or.2015.6182
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