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Background: The risk of metastasis and the survival in patients with primary extremity soft tissue sarcomas is worse when tumour size is large and the grade of malignancy is high. Such tumours may receive chemotherapy and/or radiation therapy (RTX) for optimising local control. Irradiation can either be applied preoperatively or after tumour resection. The question arises if the kind of RTX in the absence of chemotherapy influences the outcome concerning local control, metastatic disease, survival and complications., Methods: We retrospectively reviewed the clinical outcome of 233 patients with a primary extremity soft tissue sarcoma treated between 1990 - 2000 with a mean follow-up of 35.8 (4-120) months in our institute. 41 patients had high grade, deep and large tumours (>8 cm), an AJCC stage III (no evidence of metastasis prior to treatment) and were treated with limb salvage surgery and irradiation but stayed without additional chemotherapy. Two groups of patients were compared: the first group received postoperative RTX after tumour resection (n = 33); the second group was treated with preoperative RTX (n = 8). Both groups did not differ concerning clinical parameters. We analysed primary and secondary outcomes., Results: 56% (23/41) of the population developed metastatic disease, 24% (10/41) local recurrence. The risk of metastasis was higher in the group with preoperative irradiation (p = 0.046). The overall (p = 0.0248) and relapse free survival (p = 0.104) were worse in this group. The delay to tumour resection amounted 8 weeks on average in the preoperative group. Local control was not different (p = 0.38) in both study groups. Wound infections and other combined therapy related complications were equally distributed (p = 0.22)., Conclusion: Without chemotherapy there remains a high risk of metastasis in AJCC grade 3 patients. In high risk patients treated without chemotherapy the elapsed time to tumour resection after preoperative radiation might contribute to the development of metastasis. This outcome may support the thesis that a combination of RTX and offensive multimodal treatment protocols is advantageous in such a subset of patients.

Four patients were treated with limb lengthening to correct a leg-length discrepancy that developed after a hip transposition after pelvic resection for sacroma of the pelvis. Three patients had Ewing's sacroma and one patient had osteosarcoma. All patients received chemotherapy; radiotherapy also was administered to the three patients with Ewing's sacroma. Femur lengthening was started at an average of 5.7 years (range, 4.4-6.8 years) after tumor surgery. At the start of elongation, the average age of the patients was 17.3 years (range, 10.3-20.8 years). The average leg-length discrepancy was 10.3 cm (range, 6-12 cm). The average of achieved lengthening was 6.4 cm (range 6-7.5 cm). The average healing index was 32 days (range, 27-40 days) per 1-cm elongation. According to the classification of Paley, two problems and two minor complications were treated by additional interventions. At the final followup, the average functional score was 22 (73%) according to the system of the Musculoskeletal Tumor Society. Leg-length discrepancy after hip transposition can be corrected with distraction osteogenesis. All patients who wore a stiff ankle-foot orthosis before lengthening wore an ordinary shoe lift after lengthening. The problems of the lengthening procedure are similar to the general complication rate of bone lengthening. Because the 5-year survival after resection of a pelvic sarcoma is only 20% to 30%, leg lengthening after hip transposition should be offered only to long-term survivors with at least 5 years event-free survival.

Background and Objectives: Local therapy of pelvic Ewing's sarcoma remains a challenge because of the complex anatomy and large tumor volumes. Wide resections often end up contaminated with marginal margins in one part of the specimen. Pelvic tumor surgery causes considerable disability, because of the loss of hip function. This may cause a low quality of life for tumor survivors. The aim of the study was to evaluate the oncologic results of combined surgery and radiotherapy of pelvic Ewing's sarcoma. Functional and psychosocial outcome of the tumor survivors was assessed., Methods: Thirty-six pelvic Ewing's sarcoma patients were treated surgically for local tumor control between 1986 and 1996. Chemotherapy was administered according to current European Intergroup/Cooperative Ewing's Sarcoma Study (EI/CESS) protocols. Radiotherapy was also performed on all patients. All patients were intended to get wide tumor excision and a limb salvage procedure. Complications necessitating operative revision were analyzed and functional results were scored according to the criteria of the Musculoskeletal Tumor Society (MSTS). Quality of life and psychosocial functioning was assessed by the QLQ-C 30 of the European Organization for Research and Treatment of Cancer (EORTC)., Results: The overall 5- and 10-year survival rate was 45%. The prognosis of patients with primary metastases was 33%. There were two local recurrences after marginal resection. Every second patient needed at least one surgical revision. A secondary hindquarter amputation was avoided in all patients. MSTS functional evaluation instruments reached 59% (+/-21.0%). Global quality of life of the QLQ-C 30 showed good results (70 +/- 16%) compared to the general population (75 +/- 24%)., Conclusions: The advantages of surgical local control of pelvic Ewing's sarcoma should be offered to the patient. Quality of life measurement after internal hemipelvectomy shows that the life of these patients is more than worth living and that they are able to compensate the functional impairment., (Copyright 2003 Wiley-Liss, Inc.)

Aim: Distraction osteogenesis for the correction of deformities with an external fixator is well established. The hexapod principle of robotic technique was invented for the Ilisarov apparatus (e. g. Taylor-Spatial-Frame/TSF). Treatment with conventional frames needs a patient-customised frame mounting. This demanding procedure is markedly reduced using this technology. The aim of this study was to analyse the value of the hexapod principle in external fixation., Method: The potential of a frame to correct deformities is limited by its work space. The geometry of a conventional frame is different from the geometry of a hexapod frame, which is the reason for their different work spaces. The work space of the hexapod frame is compared to the work space of a conventional frame. Important parameters for this analyses are minimal and maximal frame heights and the potential of correction., Results: The minimal frame height of hexapod fixators is higher compared to conventional Ilisarov fixators. The standard hexapod frame (TSF 155 mm ring diameter) can correct 23 degrees of angulation, 36 mm of shortening, 71 mm of translation and 43 degrees of rotation without changing the telescope rods. The standard conventional frame (160 mm ring diameter) can correct 90 degrees of angulation, 100 mm of shortening, 25 mm of translation and 12.5 degrees of rotation without remounting of the frame., Conclusion: The different work spaces of the different frames result in consequences for their clinical application. The hexapod frame has more power to correct translation and rotational deformities than a conventional frame. Correction of extensive angulation and shortening deformities almost always needs an exchange of telescopic rods. Conventional frames are usually able to correct these deformities with the primary mounting. Because of its increased minimal frame height, the indication for hexapod constructs in child orthopaedics can be limited.

Aim: The treatment of choice for local tumor control was amputation in the 1970's. Nowadays, limb salvage procedures have become the new standard, implicating that limb salvage surgery results in a better quality of life. This study attempts to prove this hypothesis., Method: In total, 102 patients who survived longer than ten years after tumor treatment of the lower extremities were investigated, of these, 71 patients underwent ablative procedures compared to 31 patients with limb salvage surgery. Operative revisions, education level, and occupational situation were evaluated in both groups. To analyze the outcome of every patient regarding functional results, quality of life, life contentment, and social parameters, the functional evaluation system of the Muskulo-Skeletal-Tumor Society (MSTS), the Freiburger Life-Contentment-Questionnaire (FLZ) and the Quality of Life Questionnaire (QLQ-C-30) of the European Organization of Research and treatment of Cancer (EORTC) were used., Results: Patients treated with a limb salvage procedure underwent more surgical revisions (p < 0.000). Educational level and occupational situation showed no difference in both groups. Functional results reached similar levels in both groups (74.6% vs. 73.8%). Life contentment and Quality of Life measurements showed good results in both groups. The FLZ-questionnaire showed significantly better results for the ablative group in some items., Conclusion: The type of surgical local therapy of lower extremity tumors has no measurable effect on quality of life according to long-term follow-up in lower extremity tumors. In cases with a risk of inadequate margins when performing limb salvage surgery, an ablative procedure should be preferred.