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Sarcomas are rare diseases, the treatment of which requires an appropriate technical plateform and a broad spectrum of multidisciplinary specialists. Many are initially treated by unplanned excision, and then referred to specialized centres. Secondary treatments may lead to higher complication rates and local recurrence, with lower functional outcome, life quality and possibly overall survival. In order to improve the accessibility for referral to a specialist centre, the coordination of clinical and research activities, and the quality of the management of sarcomas in general, Lausanne University Hospital (CHUV) has opened a Sarcoma centre on October 1st 2016. The objective of the present paper is to illustrate the concept and provide useful clinical recommendations., Competing Interests: Les auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

Objective: The purpose of this article is to assess the effect of the adaptive statistical iterative reconstruction (ASIR) technique on image quality in hip MDCT arthrography and to evaluate its potential for reducing radiation dose., Subjects and Methods: Thirty-seven patients examined with hip MDCT arthrography were prospectively randomized into three different protocols: one with a regular dose (volume CT dose index [CTDIvol], 38.4 mGy) and two with a reduced dose (CTDIvol, 24.6 or 15.4 mGy). Images were reconstructed using filtered back projection (FBP) and four increasing percentages of ASIR (30%, 50%, 70%, and 90%). Image noise and contrast-to-noise ratio (CNR) were measured. Two musculoskeletal radiologists independently evaluated several anatomic structures and image quality parameters using a 4-point scale. They also jointly assessed acetabular labrum tears and articular cartilage lesions., Results: With decreasing radiation dose level, image noise statistically significantly increased (p=0.0009) and CNR statistically significantly decreased (p=0.001). We also found a statistically significant reduction in noise (p=0.0001) and increase in CNR (p≤0.003) with increasing percentage of ASIR; in addition, we noted statistically significant increases in image quality scores for the labrum and cartilage, subchondral bone, overall diagnostic quality (up to 50% ASIR), and subjective noise (p≤0.04), and statistically significant reductions for the trabecular bone and muscles (p≤0.03). Regardless of the radiation dose level, there were no statistically significant differences in the detection and characterization of labral tears (n=24; p=1) and cartilage lesions (n=40; p≥0.89) depending on the ASIR percentage., Conclusion: The use of up to 50% ASIR in hip MDCT arthrography helps to reduce radiation dose by approximately 35-60%, while maintaining diagnostic image quality comparable to that of a regular-dose protocol using FBP.

Background: Limb-salvage surgery remains current best practice for management of soft tissue and bony sarcomas about the knee, with the range of reconstructive options all providing reassuring levels of long-term survival and function. There is no current consensus as to the best method of reconstruction of the extensor mechanism of the knee (quadriceps-patellar complex), with a wide variety of options proposed. The techniques described in the literature include prosthetic reconstruction, soft tissue reconstruction (comprising reconstruction with pedicled muscle flaps or autogenous tendon grafts), and bony reconstructions (including vascularised fibula flaps). An evidence-based literature review assessing the available reconstructive options has not been undertaken., Methods: A thorough literature review was undertaken, evaluating the current evidence regarding the use of surgical techniques for reconstruction of the extensor mechanism of the knee following oncologic resection. The literature identified was critically evaluated based on the current Oxford Centre for Evidence-Based Medicine definitions., Results: There are no randomised trials in the literature in this setting, and thus no level 1 or level 2A studies to support any given technique. As such, there are many favourable techniques for reconstruction that have been well described and have some evidence base to support their use. Overall, there is a trend towards improved outcomes with biological reconstructive options, with lower reported levels of failure, infection and amputation. Despite this, no single technique has adequately proven to be superior., Conclusion: Given the proposed difficulties in randomising patients, good evidence for the optimal reconstructive choices may be hard to establish.

Purpose: To review outcomes and complications of 25 consecutive patients with soft tissue sarcomas in the adductor compartment., Methods: Records of 11 men and 14 women aged 20 to 83 (mean, 56) years who underwent resection for soft tissue sarcomas in the adductor compartment were reviewed. Two of the patients had undergone inadequate resection of the tumour elsewhere. No patient had metastases. 20 and 2 patients underwent neo-adjuvant and postoperative radiotherapy, respectively. The interval between radiotherapy and surgery was at least 3 weeks. No neo-adjuvant chemotherapy was given. 24 patients underwent limb salvage surgery and one had external hemipelvectomy. 21 patients had direct wound closure; in 4 a microsurgical free flap was used., Results: The overall survival rate was 81% and 72% at 3 and 5 years, respectively, and remained unchanged until the end of follow-up. Four patients died from pulmonary metastases and one died from liver metastases. One patient had local recurrence, and 7 (26%) developed major complications. Five patients underwent revision surgery., Conclusion: Good survival and local control rates can be achieved in patients with soft tissue sarcomas in the adductor compartment using limb salvage and radiotherapy.

Background: External hemipelvectomy is associated with high post operative morbidity and a poor functional outcome. We aim to explore a reconstruction technique to improve function and post operative appearance for patients who undergo external hemipelvectomy., Case Presentation: We present a Case where extensive cancer involvement of pelvis and femur was managed with a novel surgical technique, which involved a calf sparing modified anterior flap hemipelvectomy combined with rotationplasty of the spared calf and fixation of calcaneus to the sacrum, thereby recreating a new thigh stump., Conclusion: Tibia-hindfoot rotationplasty result in good functional outcome and appearance for selected patients undergoing external hemipelvectomy with unaffected external iliac and femoral vessels.