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Article: Chondrosarcoma of the Femur: Is Local Recurrence Influenced by the Presence of an Extraosseous Component?

Laitinen, Minna K / Parry, Michael C / Morris, Guy V / Grimer, Robert J / Sumathi, Vaiyapuri / Stevenson, Jonathan D / Jeys, Lee M

Cancers

2024 Volume 16, Issue 2

Abstract: Background: Chondrosarcoma (CS) is the second most common surgically treated primary malignancy of the bone. The current study explored the effect of the margin and extraosseous tumor component in CS in the femur on local recurrence (LR), LR-free ... ...

Abstract	Background: Chondrosarcoma (CS) is the second most common surgically treated primary malignancy of the bone. The current study explored the effect of the margin and extraosseous tumor component in CS in the femur on local recurrence (LR), LR-free survival (LRFS), and disease-specific survival (DSS). Methods: Among 202 patients, 115 were in the proximal extremity of the femur, 4 in the corpus of the femur, and 83 in the distal extremity of femur; 105 patients had an extraosseous tumor component. Results: In the Kaplan-Meier analysis, factors significant for decreased LRFS were the extraosseous tumor component ( Conclusions: In CS of the femur, the presence of an extraosseous tumor component has a predictive role in LRFS, and extraosseous tumor component arising from the superior aspect was significant for decreased LRFS. Wide margins were more commonly achieved when the tumor had only an intraosseous component, and the rate of LR was significantly higher in cases with an extraosseous tumor component. When the extraosseous component arose from the superior aspect of the femur, LR occurred more frequently despite achieving adequate margins.
Language	English
Publishing date	2024-01-15
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2527080-1
ISSN	2072-6694
ISSN	2072-6694
DOI	10.3390/cancers16020363
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Article ; Online: On the effect of setting of a positive surgical margin in soft tissue sarcoma.

Grimer, Robert J

Cancer

2014 Volume 120, Issue 18, Page(s) 2803–2805

MeSH term(s)	Female ; Humans ; Male ; Neoplasm Recurrence, Local/diagnosis ; Sarcoma/pathology ; Sarcoma/surgery
Language	English
Publishing date	2014-09-15
Publishing country	United States
Document type	Comment ; Editorial
ZDB-ID	1429-1
ISSN	1097-0142 ; 0008-543X ; 1934-662X
ISSN (online)	1097-0142
ISSN	0008-543X ; 1934-662X
DOI	10.1002/cncr.28781
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Article ; Online: Intralesional margin after excision of a high-grade osteosarcoma: Is it a catastrophe?

Tsagkozis, Panagiotis / Gaston, Czar L / Styring, Emelie / Haglund, Felix / Grimer, Robert

Journal of surgical oncology

2022 Volume 126, Issue 4, Page(s) 787–792

Abstract: Background and objectives: Treatment of high-grade osteosarcoma (OS) relies on a combination of systemic chemotherapy and radical surgical excision of the tumor. Little is known on what happens in case of an irrefutably inadequate (intralesional) margin. ...

Abstract	Background and objectives: Treatment of high-grade osteosarcoma (OS) relies on a combination of systemic chemotherapy and radical surgical excision of the tumor. Little is known on what happens in case of an irrefutably inadequate (intralesional) margin. We aimed to describe the outcome of patients with high-grade OSs of the trunk and the extremities where planned wide resection resulted in an intralesional margin. Methods: A retrospective study from the Scandinavian Sarcoma Group registry and the Royal Orthopaedic Hospital databases including data from 53 patients surgically treated between the years 1990 and 2017. Results: Local recurrence was observed in 13/53 patients. All patients with local recurrence where the neoadjuvant chemotherapy response could be retrieved (n = 9) were shown to be poor responders. None of the patients with good response to chemotherapy relapsed. Postoperative radiotherapy was not associated with improved local control of the disease. Re-excision surgery was performed in only seven patients, and two of them had tumor relapse. Conclusions: Good response to chemotherapy salvages the outcome of surgical excision with a poor margin in patients with high-grade OSs and a watchful waiting strategy may be justified in these cases. Poor responders have a higher recurrence risk and their approach should be individualized.
MeSH term(s)	Bone Neoplasms/pathology ; Humans ; Margins of Excision ; Neoplasm Recurrence, Local ; Osteosarcoma/pathology ; Retrospective Studies ; Treatment Outcome
Language	English
Publishing date	2022-05-18
Publishing country	United States
Document type	Journal Article
ZDB-ID	82063-5
ISSN	1096-9098 ; 0022-4790
ISSN (online)	1096-9098
ISSN	0022-4790
DOI	10.1002/jso.26926
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Article ; Online: Anatomical distribution, the incidence of malignancy and diagnostic workup in the pathological lesions of the clavicle: a review of 410 cases.

Hussain, Shakir / Khan, Zeeshan / Akhtar, Naved / Jeys, Lee / Parry, Michael / Grimer, Robert J

Archives of orthopaedic and trauma surgery

2022 Volume 143, Issue 6, Page(s) 2981–2987

Abstract: Background: The clavicle poses a diagnostic dilemma of the pathological lesions due to the wide range of pathologies seen at this site. This study aimed to identify and stratify various pathologies seen in the clavicle and to guide ways of investigation ...

Abstract	Background: The clavicle poses a diagnostic dilemma of the pathological lesions due to the wide range of pathologies seen at this site. This study aimed to identify and stratify various pathologies seen in the clavicle and to guide ways of investigation for diagnosis based on age, site and investigation findings. Materials and methods: Four hundred and ten cases with clavicle lesions were identified in our database. Data were collected about the patient's medical history, previous investigation, inflammatory markers radiological investigations and biopsy. All patients were worked up and managed after discussion in a multidisciplinary team meeting (MDT). Results: Non-malignant lesions accounted for 79% of cases. Infection was the most common diagnosis (39%) and the commonest diagnosis in those less than 20 years of age. 73% of the lesions were found at the medial end of the clavicle. Malignant tumours were 21%, while primary benign bone tumours accounted for only 14%. 50% of the malignant lesions were due to metastatic disease. The risk of malignancy increases with advancing age. Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were not sensitive as a diagnostic tool in cases of osteomyelitis confirmed by histology. Magnetic resonance imaging (MRI) was noted to have high sensitivity and specificity for identifying the nature of a lesion and diagnosis. Conclusion: We have identified age as a positive predictor of a malignant cause in pathological lesions of the clavicle. MRI should be considered in all these cases. CRP and ESR have poor predictive values in diagnosing infection in the clavicle. Patients presenting with clavicle lesions should be discussed in a specialist MDT and undergo a systemic diagnostic workup, still in some cases, diagnosis can be speculated based on the patient's age, location of the lesion within the clavicle and the features seen on the MRI scan. Level of evidence: IV.
MeSH term(s)	Humans ; Clavicle/diagnostic imaging ; Incidence ; Bone Neoplasms/diagnosis ; Bone Neoplasms/epidemiology ; Bone Neoplasms/pathology ; Osteomyelitis/diagnosis ; Osteomyelitis/epidemiology ; Biopsy ; C-Reactive Protein
Chemical Substances	C-Reactive Protein (9007-41-4)
Language	English
Publishing date	2022-07-01
Publishing country	Germany
Document type	Review ; Journal Article
ZDB-ID	80407-1
ISSN	1434-3916 ; 0003-9330 ; 0344-8444
ISSN (online)	1434-3916
ISSN	0003-9330 ; 0344-8444
DOI	10.1007/s00402-022-04511-4
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Article: Inadvertent excision of malignant soft tissue tumours.

Grimer, Robert / Parry, Michael / James, Steven

EFORT open reviews

2019 Volume 4, Issue 6, Page(s) 321–329

Abstract: Inadvertent excision of lumps which turn out to be sarcomas is not uncommon.Imaging has a limited role in detecting microscopic residual disease but can show the extent of the previous surgical field.Standard treatment is wide re-excision, usually ... ...

Abstract	Inadvertent excision of lumps which turn out to be sarcomas is not uncommon.Imaging has a limited role in detecting microscopic residual disease but can show the extent of the previous surgical field.Standard treatment is wide re-excision, usually combined with radiotherapy.Residual tumour is found in an average of 50% of reported cases.The presence of residual disease is an adverse prognostic factor.All lumps bigger than a golf ball should have a diagnosis prior to excision. Cite this article:
Language	English
Publishing date	2019-06-03
Publishing country	England
Document type	Journal Article ; Review
ZDB-ID	2844421-8
ISSN	2058-5241 ; 2058-5241 ; 2396-7544
ISSN (online)	2058-5241
ISSN	2058-5241 ; 2396-7544
DOI	10.1302/2058-5241.4.180060
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Article ; Online: Impact of the national sarcoma guidelines on the prevalence and outcome of inadvertent excisions of soft tissue sarcomas: An observational study from a UK tertiary referral centre.

Fujiwara, Tomohiro / Evans, Scott / Stevenson, Jonathan / Tsuda, Yusuke / Gregory, Jonathan / Grimer, Robert / Abudu, Adesegun

European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology

2021 Volume 48, Issue 3, Page(s) 533–540

Abstract: Objectives: This study aims to investigate the impact of the national guideline on the prevalence and outcome in patients with soft-tissue sarcoma (STS) who had undergone inadvertent excisions.: Methods: A total of 2336 patients were referred to a ... ...

Abstract	Objectives: This study aims to investigate the impact of the national guideline on the prevalence and outcome in patients with soft-tissue sarcoma (STS) who had undergone inadvertent excisions. Methods: A total of 2336 patients were referred to a tertiary sarcoma centre from six regions (North East, North West, East Midlands, West Midlands, Wales, and South West) in the United Kingdom with a diagnosis of STS between 1996 and 2016, of whom 561 patients (24.0%) had undergone inadvertent excisions. Patients were categorised into two groups of 10-year periods pre and post the National Institute for Health and Clinical Excellence (NICE) guideline implementation in 2006. Results: The proportion of inadvertent excisions decreased after the NICE guideline implementation: 27.2% (pre-NICE) versus 19.8% (post-NICE) (p = 0.001). A substantial regional variation (17.4%-34.5%) in the proportion of inadvertent excisions in the pre-NICE era was reduced in the post-NICE era (14.3%-22.4%). The 5-year disease-specific survival was 77.7% (pre-NICE) versus 75.6% (post-NICE) (p = 0.961) and there was a trend toward lower incidence of local recurrence in the post-NICE era; 13.5% (pre-NICE) versus 10.5% (post-NICE) (p = 0.522). Multivariate analyses revealed that residual tumours in re-resection specimens were independently associated with an increased risk of disease-specific mortality (HR, 3.35; p < 0.001) and local recurrence (HR, 1.99; p = 0.017), which was significantly reduced after the NICE guideline implementation (53.2% versus 42.0%; p = 0.022). Conclusions: The NICE guideline implementation reduced the proportion of patients with STS who had undergone inadvertent excisions and residual tumour in re-resection specimens, indicating an improved pre-referral management of STSs.
MeSH term(s)	Humans ; Neoplasm, Residual/pathology ; Prevalence ; Retrospective Studies ; Sarcoma/diagnosis ; Sarcoma/epidemiology ; Sarcoma/surgery ; Soft Tissue Neoplasms/epidemiology ; Soft Tissue Neoplasms/surgery ; Tertiary Care Centers ; United Kingdom/epidemiology
Language	English
Publishing date	2021-11-14
Publishing country	England
Document type	Journal Article ; Observational Study
ZDB-ID	632519-1
ISSN	1532-2157 ; 0748-7983
ISSN (online)	1532-2157
ISSN	0748-7983
DOI	10.1016/j.ejso.2021.11.013
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Zs.A 1149: Show issues			Location: Je nach Verfügbarkeit (siehe Angabe bei Bestand) bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular Jg. 1995 - 2021: Lesesall (1.OG) ab Jg. 2022: Lesesaal (EG)
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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: Extracorporeally irradiated clavicle as an autograft in tumour surgery.

Grimer, Robert J / Crockett, Stephen C

Journal of surgical case reports

2015 Volume 2015, Issue 1

Abstract: We report the case of a 45-year-old woman who presented with a lump in the mid-third of the left clavicle, which had recently increased in size to 10 cm in diameter. Plain X-ray, computed tomography and bone scans suggested that the lump was a parosteal ... ...

Abstract	We report the case of a 45-year-old woman who presented with a lump in the mid-third of the left clavicle, which had recently increased in size to 10 cm in diameter. Plain X-ray, computed tomography and bone scans suggested that the lump was a parosteal osteosarcoma. Due to the expected 30% functional loss from claviculectomy [Wood in The results of total claviculectomy. Clin Orthop Relat Res 1986; 207: :186-90.], the patient opted for excision of the tumour plus the adjacent clavicle, irradiation and reimplantation of the bone with internal fixation. On 2-year follow-up, there was no evidence of recurrence or complications, with a good range of movement of the joint. On 4-year follow-up, the patient was found to have discomfort, and X-rays showed that the clavicle had fractured, which was managed symptomatically.
Language	English
Publishing date	2015-01-18
Publishing country	England
Document type	Case Reports
ISSN	2042-8812
ISSN	2042-8812
DOI	10.1093/jscr/rju151
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Article: Chondrosarcoma of the Proximal Humerus: Does the Margin Affect Survival?

Kask, Gilber / Laitinen, Minna K / Parry, Michael C / Albergo, Jose I / Stevenson, Jonathan D / Farfalli, German / Aponte-Tinao, Luis / Grimer, Robert / Sumathi, Vaiyapuri / Jeys, Lee M

Cancers

2023 Volume 15, Issue 8

Abstract: Chondrosarcoma (CS) is the second most common primary malignant bone tumour and, in the absence of reliable chemotherapy and radiotherapy, is effectively a surgical disease. Overall disease specific survival (DSS) is affected by tumour grade, whilst ... ...

Abstract	Chondrosarcoma (CS) is the second most common primary malignant bone tumour and, in the absence of reliable chemotherapy and radiotherapy, is effectively a surgical disease. Overall disease specific survival (DSS) is affected by tumour grade, whilst resection margin contributes to local recurrence free survival (LRFS). The aim of this study was to investigate factors that affect the local and systemic prognoses for conventional central CSs arising from the proximal humerus. A multi-centre, retrospective study from three international collaborative sarcoma centres identified 110 patients between 1995 and 2020 undergoing treatment for a conventional central CS of the proximal humerus; 58 patients (53%) had a grade 1 tumour, 36 (33%) had a grade 2 tumour, and 16 patients (13%) had a grade 3 CS. The mean age of patients was 50 years (range 10-85). The incidence of local recurrence (LR) was 9/110 (8.2%), and the disease specific mortality was 6/110 (5.5%). The grade was a statistically significant factor for LRFS (
Language	English
Publishing date	2023-04-17
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2527080-1
ISSN	2072-6694
ISSN	2072-6694
DOI	10.3390/cancers15082337
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Article: Could Routine Magnetic Resonance Imaging Detect Local Recurrence of Musculoskeletal Sarcomas Earlier? A Cost-effectiveness Study.

George, Andrew / Grimer, Robert J / J James, Steven L

Indian journal of orthopaedics

2017 Volume 52, Issue 1, Page(s) 81–86

Abstract: Background: Current practice in our unit is to perform clinical assessment and plain film radiographs at regular intervals following treatment of a bone or soft tissue sarcoma (STS). Cross-sectional imaging is used in cases with a clinical suspicion of ... ...

Abstract	Background: Current practice in our unit is to perform clinical assessment and plain film radiographs at regular intervals following treatment of a bone or soft tissue sarcoma (STS). Cross-sectional imaging is used in cases with a clinical suspicion of recurrence. We aimed to investigate the effectiveness of this protocol to determine if earlier detection may have been possible had more intensive imaging been undertaken, and whether this may have affected outcome. Materials and methods: We reviewed clinical records and imaging of all patients with diagnosed local recurrence (LR) in the previous 5 years to investigate: how it was diagnosed, the site and size of recurrence, and management. A value judgment was then made as to whether earlier diagnosis may have altered treatment and/or outcome. Results: 161 patients with LR were identified: 87 with a STS and 74 with bone sarcoma. Median time from diagnosis to LR was 17.8 months for STS and 20.1 months for bone sarcoma. One hundred and fifteen cases (71%) were identified by the patient, 28 by routine imaging (17%), 13 by a doctor (8%), and five diagnosed by other methods. Median size of LR was 5.5 cm for STS and 5 cm for bone sarcomas. Seventy nine of the patients (49%) could have had their LR diagnosed earlier with routine imaging. Of these, 53 would have received the same treatment, but 26 (33%) could have had different treatment. Conclusion: Earlier diagnosis could have led to altered management in one-third of those patients with the potential to have their LR diagnosed earlier. If all patients had regular magnetic resonance imaging, it would cost £6987 per recurrence where management was altered in imaging costs alone. We suggest a stratified approach whereby patients at highest risk of LR and those in whom early detection of LR may be easily treatable are prioritised for more intensive followup.
Language	English
Publishing date	2017-02-15
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	603194-8
ISSN	0019-5413
ISSN	0019-5413
DOI	10.4103/ortho.IJOrtho_234_17
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