Üçüncü basamak bir ortopedik onkoloji merkezinde opere edilen radius primer kemik tümörleri ve tümör benzeri lezyonları

Öz

Amaç: Bu çalışmada, üçüncü basamak bir ortopedik onkoloji merkezinde radius primer kemik tümörü tanısı opere edilen hastaların insidansı, cerrahi tedavisi, histolojik ve anatomik dağılımlarının değerlendirilmesi amaçlanmıştır. Gereç ve Yöntemler: Onyedi yıllık (2003-2020) zaman aralığında radius kemik tümörü tanısı ile merkezimize başvuran toplam 96 hasta ( 37 kadın, 59 erkek ) incelendi. Hastalar yaş, cinsiyet, şikayetler, tümör derecesi, lokalizasyon, tedavi yöntemi, nüks ve fonksiyonel sonuçlara göre değerlendirildi. Bulgular: Çalışmamızda 85 (%88,5) benign ve 11 (%11,5) malign tümör vardı. Tüm malign tümörlerde ağrı ve şişlik belirgindi. Benign lezyonlardan 57'sinde ağrı, 19'unda deformitenin de eşlik ettiği şişlik vardı. Radiusun malign ve iyi huylu tümörleri ikinci ve üçüncü dekat yaş aralıklarında sık saptandı. En sık görülen benign ve malign tümörler dev hücreli tümörler (n=29, %30.2) ve Ewing sarkomu (n=6, %6.2) idi. 85 benign lezyonun 56'sı (%65.8) ve 11 malign lezyondan 7'si (%63.6) distal radiusta yerleşimliydi. MSTS skorları benign ve malign lezyonlar için sırasıyla 27.6±1.72 ve 24.5±1.77 idi. Üç dev hücreli tümörde ve bir Ewing sarkomu hastasında lokal nüks meydana geldi. Sonuç: Bu çalışma, radiusun benign lezyonları için küretajın uygulanabilir ve ilk seçenek olmaya devam ettiğini göstermektedir. Anatomik özellikleri karmaşık olsa da malign tümörlerde geniş cerrahi rezeksiyon ve biyolojik rekonstrüksiyon ile ekstremite koruyucu cerrahi mümkündür.

Anahtar Kelimeler

• Radius
• primer kemik tümörü
• benign
• sarkom
• insidans

Primary bone tumors and tumor-like lesions of the radius operated in a tertiary orthopedic oncology center

Öz

Aim: This study aimed to evaluate the incidence, surgical management, histologic and anatomic distribution of patients who operated in a tertiary orthopedic oncology center with diagnosing primary bone tumors of the radius. Material and Methods: A total of 96 patients ( 37 female, 59 male ) who presented to our department in the period of 17 years (2003-2020) with the diagnosis of bone tumors of radius were analyzed. The patients were assessed according to age, gender, complaints, tumor grade, localization, treatment method, recurrence, and functional outcomes. Results: There were 85 (88.5%) benign and 11 (11.5%) malign tumors. Pain and swelling were evident in all malign tumors. Of the benign lesions, 57 had pain, and 19 had swelling accompanied by deformity. The malign and benign tumors of the radius were also detected in the second and third decades. The most common benign and malignant tumors were giant cell tumors (n=29, 30.2%) and Ewing sarcoma (n=6, 6.2%). Fifty-six of 85 (65.8%) benign lesions and 7 of 11 (63.6%) malign lesions were located of the distal radius. The MSTS scores were 27.6±1.72 and 24.5±1.77 for benign and malign lesions, respectively. Local recurrence has occurred in three giant cell tumors and one Ewing sarcoma. Conclusion: This study represents that curettage remains the feasible and first choice for benign lesions of the radius. Although the anatomy of the forearm is complex, limb-sparing surgery is possible with biological reconstruction methods in malignant tumors.

Anahtar Kelimeler

• Radius
• primary bone tumor
• benign
• sarcoma
• incidence

Kaynakça

1. 1. Öztürk R, Arıkan ŞM, Bulut EK, et al. Distribution and evaluation of bone and soft tissue tumors operated in a tertiary care center. Acta Orthop Traumatol Turc 2019; 53: 189-94.
2. 2. Bergovec, Kubat O, Smerdelj M, et al. Epidemiology of musculoskeletal tumors in a national referral orthopedic department. A study of 3482 cases. Cancer epidemiol 2015; 39: 298-302.
3. 3. Pradhan A, Reddy KIA, Grimer RJ, et al. Osteosarcomas in the upper distal extremities: Are their oncological outcomes similar to other sites? Eur J Surg Oncol 2015; 41: 407-12.
4. 4. Liu YP, Li KH, Sun BH Which treatment is the best for giant cell tumors of the distal radius? A meta-analysis. Clin Orthop Relat Res 2012; 470: 2886-94.
5. 5. Mozaffarian K, Modjallal M, Vosoughi AR Treatment of giant cell tumor of distal radius with limited soft tissue invasion: curettage and cementing versus wide excision. J Orthop Sci 2018; 23: 174-9.
6. 6. Qi DW, Wang P, Ye ZM, et al. Clinical and radiographic results of reconstruction with fibular autograft for distal radius giant cell tumor. Orthop Surg 2016; 8: 196-204.
7. 7. Muramatsu K, Ihara K, Yoshida K, et al. T Musculoskeletal sarcomas in the forearm and hand: standard treatment and microsurgical reconstruction for limb salvage. Anticancer Res 2013; 33: 4175-82.
8. 8. Enneking WF, Spanier SS, Goodman MA: The classic: A system for the surgical staging of musculoskeletal sarcoma. Clin Orthop Relat Res. 2003; 415: 4-18.

9. 9. Daecke W, Bielack S, Martini AK, et al. Osteosarcoma of the hand and forearm: experience of the Cooperative Osteosarcoma Study Group. Ann Surg Oncol 2005; 12: 322-31.
10. 10. Zou C, Lin T, Wang B, et al. Managements of giant cell tumor within the distal radius: a retrospective study of 58 cases from a single center. J Bone Oncol 2019; 14: 100211.
11. 11. Kang L, Manoso MW, Boland PJ. Features of grade 3 giant cell tumors of the distal radius associated with successful intralesional treatment J Hand Surg 2010; 35: 1850-7
12. 12. Okada K, Wold LE, Beabout JW, et al. Osteosarcoma of the hand: a clinicopathologic study of 12 cases. Cancer 1993; 72: 719-25.
13. 13. Crowe MM, Houdek MT, Moran SL, et al. Aneurysmal bone cysts of the hand, wrist, and forearm J Hand Surg 2015; 40: 2052-7.
14. 14. Salunke AA, Chen Y, Chen X, et al. Does pathological fracture affect the rate of local recurrence in patients with a giant cell tumour of bone? A meta-analysis. Bone Joint J 2015; 97: 1566-71.
15. 15. Germain MA, Mascard E, Dubousset J, et al. Free vascularized fibula and reconstruction of long bones in the child—our evolution. Microsurgery: Official Journal of the International Microsurgical Society and the European Federation of Societies for Microsurgery. 2007; 27: 415-9.
16. 16. Innocenti M, Baldrighi C, Menichini G. Long term results of epiphyseal transplant in distal radius reconstruction in children. Handchir Mikrochir Plast Chir 2015; 47: 83-9.