Osteosarcoma is the most common primary malignant tumor that develops in bone. Since chemotherapy was introduced into the multi-modality treatment regimen for high-grade osteosarcoma, its prognosis has been impressively improved; about two-thirds of all patients could achieve long-term survival. This review summarized the history of chemotherapy for osteosarcoma and current chemotherapeutic treatment strategies for classical osteosarcoma. The review also emphasized the necessity that the patients should be treated in specialized centers and prospective, multi-institutional trials are needed.

Objective To investigate indications,technique,prognosis and complications of anterior flap hemipelvectomy (hemipelvectomy using a quadriceps femoris muscle flap with superficial femoral artery)in the treatment of pelvic tumors.Methods From April 2009 to October 2010,10 patients with pelvic tumors underwent anterior flap hemipelvectomy in our department.There were 9 males and 1 female,aged from 30 to 62 years (average,46 years).There were 7 cases of chondrosarcoma,1 case of epithelioid sarcoma,1 case of pleomorphic liposarcoma and 1 case of spindle cell sarcoma.Results Nine patients were followed up for 12 to 30 months (average,21.5 months).Superficial skin necrosis occurred in 1 patient,while there was no wound infection.Local recurrence (33.3％) occurred in 3 patients,including 2 cases of chondrosarcoma and 1 case of epithelioid sarcoma.Three patients died at last,including 2 patients with local recurrence and 1 with pulmonary metastasis from liposarcoma.Two patients survived with pulmonary metastasis,and remaining 3 patients survived without recurrence and metastasis.Conclusion Anterior flap hemipelvectomy is indicated for:(1) patients with extensive soft tissue sarcoma in the buttock,and the tumor or reaction zone involve the subcutaneous tissue; (2) patients with recurrent pelvic tumors,and the conventional posterior flap can't be used due to contamination by the original incision; (3) patients whose posterior flap has poor blood supply due to radiotherapy or other factors.The prerequisite of the surgery is that the blood stream between external iliac artery and femoral artery is unobstructed; moreover the blood vessels are not in the tumor reaction zone.Compared with conventional posterior flap,the anterior flap hemipelvectomy is an easier procedure,which not only can easily cover surgical defect and obtain better surgical margin,but also has less complications.

OBJECTIVETo investigate protective effect of paeonol (Pae) on human umbilical vein endothelial cells (HUVECs)injured by hyperlipidemic serum and explore its possible mechanism.METHODS The injury model was induced by 20％ hyperlipidemic serum incubating HUVECs for 24 h.Pae 124,247 and 495.μmol· L-1 were given followed by administration of hyperlipidemic serum for 24 h.The morphological changes were observed under inverted microscope,cell survival rate was evaluated by MTT method,the nitric oxide (NO) content was measured by nitric acid reductase method and the endothelial nitric oxide synthase (eNOS) mRNA expression was determined by RT-PCR.RESULTSCompared with normal contorl group,most cells in model group split and exfoliated.However,the morphology was tending to normal level after intervention with Pae.Pae significantly improved cell viability(P ＜0.01).Compared with model group,the survival rate increased from (53.0 ±10.1 ) ％ to ( 68.4 ± 9.1 ) ％,( 84.5 ± 6.7 ) ％ and (98.1 ± 7.5 ) ％,respectively.The NO content and eNOS mRNA expression both increased greatly in Pae groups(P ＜ 0.01 ).Compared with model group,content of NO increased from 54 ± 4 to 79 ± 6,115 ± 5 and ( 136 ± 6) μmol · L- 1,respectively.The expression level of eNOSmRNA improved from 0.215 ± 0.060 to 0.451 ± 0.045,0.563 ± 0.013,0.704 ± 0.068,respectively.CONCLUSIONPae exerts protective effect on HUVECs injured by hyperlipidemic serum by increasing eNOS mRNA expression,which might therefore improve the content of NO.

Objective To investigate the incidence and extent of biopsy tract contamination in malignant bone tumors by either core needle biopsy or open biopsy and detect the safe extent in resection of biopsy tract. Methods Forty-eight cases were performed core needle biopsy, including 37 osteosarcomas, 5 malignant fibrous histiocytomas, 1 juxtacortical osteosarcoma, 1 low grade central osteosarcoma, 1 periosteal osteosarcoma, 1 primary malignant melanoma of bone and 2 chondrosarcomas. There were 37 males and 11 females with a mean age of 23.3 years (range, 10-64 years). The mean time between core needle biopsy and definitive surgery was 1.3 months (range, 0-2 months). All the patients were performed limb salvage surgery.Twenty-six cases were performed open biopsy, including 20 osteosareomas, 1 Ewing's sarcoma, 2 chondrosarcomas, 1 mesenchymal chondrosarcoma, 1 malignant fibrous histiocytoma, 1 lymphoma. There were 21males and 5 females with a mean age of 21.9 years (range, 8-59 years). The mean time between open biopsy and definitive surgery was 2.3 months (range, 1-4 months). The tumor and tissue around the biopsy tract at least 2 cm were resected. The pathological examination was performed in specimens via the biopsy tract, including the normal soft tissue outside the tumor, deep fascia, subcutaneous tissue and skin. The incidence and extent of biopsy tract contamination were evaluated with pathological examination. Results Forty-four cases were followed up. The mean follow-up time was 17.6 months (range, 4-39 months). In core needle biopsy group, four of forty-eight cases were found malignant tumor cells seeding in biopsy tract, the positive rate was 8.3%. In open biopsy group, all the cases were followed up with the mean time of 12.9 months (range, 2-29 months), and two of twenty-six cases were found malignant tumor cells seeding in biopsy tract,the positive rate was 7.7%. Conclusion Biopsy of malignant bone tumors has the risk of biopsy tract contamination. The tumor cell seeding exists in both core needle biopsy and open biopsy. The biopsy tract should be performed en bloc resection with the tumor.

Objective To investigate the roles of integrin ανβ6 in the invasion of colon cancer cells and its molecular mechanisms for regulation of the extracellular matrix (ECM) degradation.Methods The RNA interfering technique was used to downregulate the expression of ανβ6 in colon cancer cells. The expression of ανβ6 in transfected cells was determined by RT-PCR and Western blot.The cell invasive capacity was evaluated by reconstituted basement membrane invasion assay. Western blot and gelatin zymography were used to determine whether the reduced αvβ6 expression affects extracellular signal-regulated kinase (ERK), P-ERK, urokinase-type plasminogen activator (uPA) and matrix metalloproteinases (MMPs) expressions. [3H]-labelled type Ⅳ collagen degradation assay was performed to asess if supression of integrin ανβ6 inhibits extracellular matrix degradation.Results Specific siRNA inhibited the expression of ανβ6 in both the protein and mRNA levels in HT29 cells. Down regulation of integrin ανβ6 inhibited ERK, P-ERK1/2 expressions, and the secretion of uPA. pro-MMP-9 and pro-MMP-2 in tumor conditioned medium. Supression of integrin ανβ6 inhibited MAPK dependent [3H]-labelled type Ⅳ collagen degradation. Conclusions These data in our study demonstrats that integrin ανβ6 plays important roles in the invasion of colon cancer cells. The ανβ6 regulates the secretion levels of uPA, pro-MMP-9, pro-MMP-2 and the ECM degradation through the MAPK pathway.

Objective To study the role of endothelial cells on the inflammatory cytokine release in septic shock through the septic shock serum stimulating human primary endothelial cells (HPAEC) and peripheral blood mononuclear cells(PBMC).Methods PBMC isolated from healthy people by density gradient centrifugation.HPAEC cell surface markers CD144 and von Willebrand factor(vWF) molecule expression by RT-PCR and Western blot.Serum levels of IL-6,TNF-α,MCP-1 from septic shock patients and healthy human detected by ELISA.HPAEC and PBMC were stimulated with the isolated serums and LPS,respectively.ELISA was used to detect the supernatant IL-6,TNF-α,MCP-1 levels.HPAEC membrane molecules ICAM-1 expression was detected by flow cytometry with serum shock and LPS stimulation.Supernatant levels of IL-6,TNF-α,MCP-1 of HPAEC with S1P1 receptor agonist CYM-5442 pretreatment was detected by ELISA after shock serum stimulation.Results Endothelial cell markers CD144 and vWF molecules could be detected in the HPAEC.Levels of inflammatory cytokines IL-6,TNF-α,MCP-1 in patients with septic shock serum were significantly higher than healthy people (P＜0.01).PBMC and HPAEC with LPS or shock serum treatment respectively,compared with normal group,levels of inflammatory cytokines in the culture supernatant were significantly higher(P＜0.01).For PBMC,the level of inflammatory cytokines between shock group and LPS group were not significantly different (P＞0.05).But for HPAEC,levels of inflammatory cytokines in the supernatant of the shock group compared to the LPS group was significantly higher (P＜0.01).Similarly,when two cells after LPS stimulation,IL-6,TNF-α levels of HPAEC's supernatant were significantly lower than PBMC' s (P＜0.01),MCP-1 levels was no difference (P＞ 0.05).But when the stimulation of shock serum,HPAEC of IL-6,TNF-α levels and PBMC no significant difference (P ＞0.05).MCP-1 was significantly increased (P＜0.01).Shock patients serum stimulation S1P1 receptorspecific agonist CYM-5442 pretreatment of HPAEC with pretreatment of S1P1 receptor specific agonist CYM-5442,the culture supernatant of inflammatory cytokines IL-6,TNF-α,MCP-1 levels were significantly lower (P＜0.01).Conclusion Endothelial cells may play a central role on the release of inflammatory cytokine during septic shock.

OBJECTIVETo determine whether cancellous bone allograft is the best biological material for filling a cavity bone defect.

METHODSBetween 1992 and 1998, deep frozen cancellous bone allograft was used in the treatment of bone defect in 57 patients following tumor resection. The age of the patients varied from 6 to 56 years (mean 17.4 years).

RESULTSBone unions were achieved in 56 patients, and the average time for union was 4.5 months; One patient had the graft removed for infection. The time for union was different according to the volume of graft. The longer time for union was always accompanied with the larger volume of graft. To compare the union time of admixture of cancellous autograft and allograft with that of cancellous allograft alone, the time for union was same in both group. No immune response and infection was observed in this group. And infection happened in 1 of the 57 patients. The local recurrence rate of tumor was 7%.

CONCLUSIONSThe feasibility and security of this packing method are better than other. Compared with cancellous autograft, no significant difference was found in the time for union and complication rate except local tumor recurrence.

Adolescent ; Adult ; Bone Neoplasms ; surgery ; Bone Transplantation ; adverse effects ; methods ; Child ; Female ; Humans ; Male ; Middle Aged ; Neoplasm Recurrence, Local ; Transplantation, Homologous

Objective To assess the clinical significance of the application of computer assisted navigation technology in excision for sacrum tumor.Methods From December 2007 to June 2009,13 patients with sacrum tumor were treated with computer navigation assisted aggressive curettage.There were 5 males and 8 females.aged 21 to 69 years,with the mean age of 44 years,10 cases were over the level of sacrum3 and 3 cases under the sacrum3.Pathologic diagnosis was chordoma in 7 cases.giant cell tumor in 4 cases and neurofibroma in 2 cases.Five cases were recurrence.The preoperative data of CT and MRI were input into the computer navigation workstation.CT images determined the scope of the invasion of tumor in bone tissue.MRI determined the scope of the invasion of tumor in soft tissue.The CT and MRI image fusion identified the precise boundaries of the tumor in CT images and made markers for navigation guidance in the operative in 10 cases.The Iso-c scan had been made for another 3 cases and fused the Iso-c images with preoperation CT images for improving the images quality.According to preoperative marker in CT images,the aggressive curettage were completed with the real time computer navigation for 7 cases,marginal resection in 4 cases and wide resection in 2.The precise surgical removal of the lesions boundary were verified by computer navigation according to the preoperative planning.Results Thirteen patients were followed up for 7 to 37 months,an average of 18 months,no recurrence cases with marginal resection and wide resection.Two cases with aggressive curettage had recurrence.Conclusion Computer navigation technology helps to precise excision the sacrum tumors,to reduce the recurrence rate.

Objective To evaluate the functional outcomes and complications of patients with bone tumors who were treated with the excision-alcoholization-replantation (EAR) method. Methods From August 1965 to August 2003, 191 patients treated with the EAR method who had suitable follow-up were evaluated in our department, including 102 males and 89 females with an average age of 20 years (range, 10-62). On the basis of Enneking tumor staging, 136 patients were identified II B stage, 25 I B stage, and 30 invasive benign tumors and tumor-like lesion. The length of the resected part ranged from 5 cm to 26 cm, with marginal resection in 30 cases, wide resection in 116. The oncological parameters that were evaluated included survival of the patients, local recurrence, and metastasis. Complications included non-union, infection, and fracture of the grafts. Mankin evaluation system was used to assess functional outcomes. Results The mean follow-up time was 32 months (range, 1-372), 52 patients died with disease at the final follow-up. Five-year survival rates of high grade sarcoma and low grade sarcoma were 59% and 90%, respectively, with statistical significance (P=0.02). Lung metastasis were demonstrated in 52 patients (27.2%, 52/191), 51 (26.7%, 51/191) had local recurrence. Except the tumor factor, the total complication rate was 50.3%(96/191). Local complications included 33 nonunion (17.3%, 33/191), 39 fracture of the grafts (20.4%, 39/191), 39 infections of the graft (20.4%, 39/191), 15 fracture of internal fixation (7.9%, 15/191), 5 instability or semiluxation of the joint (2.6%, 5/191). The 5-year survival rate of inactivated bone was 55%. On the basis of Mankin functional evaluation, the satisfied rate was 50.3%. At last there were 141 patients (73.8%, 141/191) preserved their extremities. Conclusion Compared to other methods in the same period, EAR method is considered on the same level of safety in oncology, which superiorities are economic-applicable to patients and the well fitness of bone graft with the defects.