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Biomedical subjects

F R Eilber

Publications and source records attributed to F R Eilber.

At least 37 records · Page 2Linked to original sources
PubMed1994

151 endoprosthetic reconstructions for patients with primary tumors involving bone.

As part of the UCLA limb salvage program, 151 patients received 151 endoprostheses for primary tumors involving bone. Follow-up of all patients was to death (56), revision (21), or a minimum two years for the 74 additional survivors (range: 24-114 months; mean: 52 months). Endoprosthetic replacements were of the distal femur (81), proximal femur (19), proximal humerus (13), proximal tibia (11), scapula (11), total femur (8), total humerus (4), intercalary prostheses (2), and one each of the distal humerus and the pelvis. There were three soft tissue sarcomas, five benign bone lesions, and 143 primary malignant tumors of bone. MSTS function was good-excellent in 78%. There were 64 local complications in 55 patients (36%). Mechanical failure occurred in 24 patients (15.9%), local recurrence occurred in ten (6.6%), minor wound healing problems in nine (5.9%), and infection in eight (5.3%). Few systemic complications were reported. Function appeared to be location dependent. All of the 29 patients with benign or low grade malignant tumors (parosteal, IA, IB) have survived. Of the 116 patients with stage IIA and IIB disease, 59% survived three years, and a Kaplan-Meier analysis projects that 56% are expected to survive at five years. Only 17 (11%) of these 151 endoprostheses have been revised; an additional four (3%) eventually came to amputation. The Kaplan-Meier analysis revealed that 91% of the prostheses survived three years and 83% survived five years. The Cox Proportional Hazards model revealed that for patients with stage IIA and IIB disease, the risk of death is four times the risk of the need for revision at five years. Although endoprosthetic reconstructions have their own unique complications, they have proven durable in this series of patients. Local problems usually can be managed without amputation, and patient satisfaction is high.

Bone Neoplasms↗
PubMed1994

Thoracotomy in the management of metastatic soft-tissue sarcomas in adults.

The multidisciplinary management of metastatic soft-tissue sarcomas in adults is capable of salvaging approximately half of the afflicted patients. This management includes preoperative chemotherapy for three months, thoracic surgery, continued chemotherapy, and the use of intrapleural mitoxantrone for once-present malignant pleural effusions or suspected pleural seeding of tumor. Thus, there is a definite role for the inclusion of thoracic surgery in the management of patients with soft-tissue sarcomas in whom pulmonary metastases develop.

Adolescent↗
PubMed1994

The role of thoracic surgery in the management of metastatic osteogenic sarcoma.

Fifty percent of patients with osteogenic sarcoma who develop pulmonary metastases are salvageable with continued effective chemotherapy and thoracotomies, as long as good local control is achieved in the primary tumor. In patients presenting with simultaneous primary tumor and pulmonary metastatic disease, the cure rate is potentially as high as it is in those patients who present with primary tumor alone. However, in the latter patients, curative surgery must be done to obtain permanent local control for the primary tumor, and thoracotomy must be performed to remove residual disease to ensure against recurrent disease.

Adolescent↗
PubMed1993

Expandable endoprosthetic reconstruction of the skeletally immature after malignant bone tumor resection.

The mainstay of local control of primary bone malignancies in the skeletally immature has been amputation or, in selected cases, rotationplasty. The development of expandable endoprostheses has permitted an alternative approach for local control in the growing child. Between January 1985 and December 1987, 12 skeletally immature patients with primary malignant bone tumors were treated with extremity reconstruction with cemented custom-expandable endoprostheses after wide resection of their lesions. All patients were observed until death (four) or revision (two) with a minimum two-year follow-up period for the survivors (average, 3.1 years). Seven patients have undergone a total of 11 expansions and one patient was lengthened with a revision-expandable prosthesis. Four patients have not needed expansion. Eight patients have had a total of ten complications. Seven of the ten complications (70%) were prosthesis related and associated with failure of the expansion mechanism. The Musculoskeletal Tumor Society (MSTS) overall rating was good to excellent in seven patients (58%), fair in three (25%), and poor in two (17%). In five distal femoral arthroplasties and one total femoral arthroplasty where the tibial bearing component was cemented through the physis, tibial and epiphyseal growth was observed to be normal and equal to the nonoperative side. This suggests that partial central epiphyseal and physeal ablation does not cause physeal arrest. Although the high rate of expansion mechanism failure necessitates redesign, preliminary results suggest that expandable endoprostheses do offer an alternative to amputation and rotationplasty as a means of local control and extremity reconstruction in children with primary malignant bone tumors.

Adolescent↗
PubMed1992

Surgical treatment and chemotherapy for pulmonary metastases from osteosarcoma.

Between 1971 and 1991, 247 patients with stage I osteosarcoma were treated at UCLA. Patients were treated in four sequential groups, with group 1 receiving surgery alone, and groups 2 through 4 receiving various adjuvant chemotherapeutic regimens. The incidence of lung metastases in these patients decreased from 92% (group 1) to 31% (group 4), while the proportion of patients undergoing pulmonary resection increased (17% vs 82%). Overall 5-year survival rate among patients with pulmonary metastases increased from 0 in group 1 to 41% (actuarial) in group 4. No clinical factor correlated significantly with outcome using univariate analysis, although there was a trend toward prolonged survival in those with longer disease-free intervals. Adjuvant chemotherapy and resection of pulmonary metastases have transformed a uniformly fatal condition into one with a reasonable expectation of long-term survival.

Adolescent↗
PubMed1991

Reirradiation for extremity soft tissue sarcomas. Local control and complications.

The treatment for patients who have locally recurrent soft tissue sarcoma of the extremity after surgery and radiation therapy is primarily amputation. A second course of radiation and local excision is usually not considered because of two major concerns: radiation complications and inability to achieve local disease control. This study examines the clinical course of 32 patients who received a second course of radiation for soft tissue sarcoma. Four groups of patients were defined by the sequence of radiation (preoperative and postoperative) and surgery. Despite high cumulative doses of radiation, complications requiring amputation were rare. Local tumor control was achieved with a second course of preoperative radiation and wide local excision in 15 of 18 (84%). However, local excision and a second course of postoperative radiation resulted in eight of 14 (57%) local failure and cannot be recommended as a comparable therapy to amputation.

Adult↗
PubMed1991

Endoprosthetic replacement for stage IIB osteosarcoma.

Over an eight-year period, 100 patients with IIB osteosarcoma have been managed. Eighty-one were treated with limb-salvage procedures, 78 of which involved reconstruction utilizing endoprostheses. Only 19 patients received amputation as the primary treatment for local control. Since 1984, all patients received preoperative and post-operative adjuvant chemotherapy. Those patients who received chemotherapy had a statistically significant improvement in five-year survival over those who did not (57% and 32%, respectively, p = 0.014). The functional results were good overall, with excellent results seen in distal femoral reconstruction. Twenty-eight of the 78 patients treated with endoprosthetic reconstruction experienced 30 complications (36%). Mechanical failure was the most common complication (10%) but was generally correctable. The local recurrence rate was 5% and the infection rate was 3%. Local complications were manageable. A statistical analysis revealed that the relative risk of patient death was 2.5 times higher than prosthesis failure for the 78 patients with endoprosthetic reconstruction. The intermediate-term results, with a median follow-up period of 43 months, remains encouraging.

Adolescent↗
PubMed1991

Endoprosthetic reconstruction after bone tumor resections of the proximal tibia.

The advent of successful adjuvant chemotherapy and radiation therapy protocols for primary malignant tumors and the development of custom-designed metallic endoprostheses has now made possible a successful limb salvage procedure for malignancies of the proximal tibia. Use of the transposed medial gastrocnemius flap, as proposed by Dr. Jean Duboussett of Paris, has been critical to the soft-tissue reconstruction that routinely permits an excellent active and passive range of motion for these patients. This article describes the operative techniques and technical considerations necessary for a successful proximal tibial endoprosthesis reconstruction.

Bone Neoplasms↗
PubMed1991

Soft tissue sarcomas of the extremity and retroperitoneum: advances in management.

The treatment of soft tissue sarcomas continues to pose significant challenges. The past decade has seen a dramatic increase in multimodality therapy for these tumors, with a resultant decrease in the number of amputations performed for extremity lesions. Even with combined modality treatment, however, the prognosis remains grim for most patients with retroperitoneal sarcomas, in which delay in diagnosis and tumor proximity to vital structures hinder the chances for cure. Improved protocols for the treatment of retroperitoneal sarcomas must be developed if we are to match the successes achieved with extremity tumors. As efforts to decrease local recurrence of extremity sarcomas have been largely successful, a new challenge to decrease the frequency of systemic metastases has emerged. Although aggressive surgical approaches to recurrent and metastatic sarcomas can result in long-term survival in some cases, better treatments are needed for those patients whose resections fail or those who are not candidates for resection. Combined modality treatments and new modalities, such as adoptive immunotherapy, need to be carefully evaluated in this group of patients. Enormous strides have been made in the treatment of osteogenic sarcomas and some pediatric soft tissue sarcomas. Additional research into basic tumor biology, as well as major intergroup studies of therapy, will be necessary if we are to duplicate those achievements in the more refractory adult soft tissue sarcomas.

Combined Modality Therapy↗
PubMed1990

Progress in the recognition and treatment of soft tissue sarcomas.

Over the past 10 years there has been significant progress made in the recognition and treatment of soft tissue sarcomas. With the advent of CAT scans and MRI, preoperative delineation of soft tissue tumors has become readily available. The diagnostic use of these modalities in patients presenting with an ill-defined asymptomatic mass has been extremely helpful in terms of screening patients to decide whether or not a biopsy is indicated. These techniques have also provided a much clearer delineation of the anatomic extent of the primary tumor, which has been of great assistance both in radiation therapy treatment calculations as well as in preoperative surgical planning. The recognition that tumor grade is the dominant prognostic variable has resulted in the more common use of a grading system, and a more uniform reporting and stratification of end results. Recent studies with immunohistochemical staining have proven of value in determining the histogenesis of many tumors that in the past were difficult to classify accurately. Most recently the use of flow cytometry suggests that this will also be a valuable adjunct in determining tumor grade and thereby prognosis. The most recent investigations of molecular biologic evaluation of genetic DNA and RNA sequences, as well as of oncogenes are extremely interesting from a diagnostic standpoint and in demonstrating the potential of molecular biologic evaluation for understanding the origin of these tumors. Multimodality therapy with surgery, radiation, chemotherapy, or all three has resulted in a marked improvement in local tumor control for patients with soft tissue sarcomas. The combination of modalities has allowed smaller surgical excisions of the tumor and thereby preservation of the extremity and much of its function. There are currently several different methods of multimodality therapy used including neoadjuvant therapy and postoperative therapy, both of which have been proven efficacious. Chemotherapy is now playing an increased role in clinical investigation and treatment. The availability of Adriamycin, DTIC, cisplatin, and most recently ifosfamide has added several chemotherapeutic agents for use by the clinician. Combination chemotherapy and radiation is of value in the neoadjuvant setting, and several studies are now underway to determine whether postoperative adjuvant chemotherapy is of similar value in reducing systemic spread of disease. Finally, surgical resection of pulmonary metastases has been proven of value in 20% to 25% of patients who subsequently develop metastatic disease. As a result of these advances in several different treatment disciplines, the overall survival rate and quality of life of patients with soft tissue sarcoma have improved markedly over the past 10 years.(ABSTRACT TRUNCATED AT 400 WORDS)

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1990

Limb salvage therapy for soft tissue sarcomas of the foot.

From 1974 to 1988, 20 patients with soft tissue sarcomas of the foot underwent attempted limb preservation at UCLA. Eighteen patients had localized tumor and two had metastases. Sixteen patients had previously untreated tumors and four patients had experienced 2-4 local recurrences before definitive management. Eleven patients had grade 3 sarcomas and nine had grade 2 sarcomas. Fourteen patients had an excisional biopsy and six had an incisional biopsy. At the time of definitive local treatment, nine patients had palpable tumor ranging from 2-10 cm (median 5 cm). Sixteen patients received sequential preoperative chemotherapy and irradiation followed by attempted conservative resection. Four patients underwent immediate conservative resection followed by postoperative irradiation. Preoperative chemotherapy was administered over 3 days intraarterially, intravenously or by a combination of routes. Fifteen patients received 60-90 mg doxorubicin and one received 120 mg doxorubicin plus 220 mg cisplatinum. Preoperative irradiation was delivered in 350 cGy fractions to total doses of 3500 cGy (one patient), 2800 cGy (8) or 1750 cGy (7). Postoperative irradiation doses were 4140-6480 delivered in 180-200 cGy fractions. Fifteen of 16 preoperatively treated patients had limb salvage surgery. Four of these 15 had positive histopathologic margins and none received postoperative irradiation. One patient required a primary amputation due to gross involvement of the os calcis. Three of four patients undergoing immediate conservative excision had positive margins and one had gross residual disease. Five patients received chemotherapy following local treatment: 3 adjuvantly and 2 for metastatic disease. Follow-up for salvage patients ranged from 6 to 99 months (median 36). Local control was achieved in 17 of 19 (90%). Two patients recurred in-field at 24 and 30 months. Fourteen of 15 preoperatively treated and salvaged patients maintained local control. Three of four managed with excision and postoperative irradiation were controlled. The actuarial local control at 3 years was 83%. One patient recurred in the inguinal lymph nodes and three patients died of metastatic disease. The actuarial survival and relapse-free survival at 3 years were 83% and 63%. Eleven patients developed acute complications and four had late complications. Of 14 patients surviving with local control, function was good or excellent in 86%. No patient has required an amputation for complications or a dysfunctional foot. Limb salvage therapy for a selected patient with a soft tissue sarcoma of the foot can reasonably be expected to result in a high probability of local control and useful function without compromising survival.

Adolescent↗
PubMed1989

Patterns of recurrence after resection of osteosarcoma of the extremity. Strategies for treatment of metastases.

We studied recurrence patterns in 255 patients with high-grade osteosarcoma of the extremity and the efficacy of the treatment of these recurrences. One hundred seven patients developed metastatic disease: 77 had isolated pulmonary metastases, 17 had simultaneous metastases to lung and elsewhere, and 13 had metastases to other sites. Of the 77 patients with metastases confined to the lung, 51 (66%) underwent thoracotomy for resection of the metastases, and 13 (17%) are long-term disease-free survivors. Patients with simultaneous metastases to lung and other sites, and patients with metastases to sites other than lung, have a poor prognosis with only one long-term disease-free survivor in these groups. Thoracotomy has a limited role in the treatment of metastatic disease. Improvements in aggressive, systemic chemotherapy are essential for improving the prognosis in these patients.

Adolescent↗
PubMed1989

Preoperative intra-arterial chemotherapy.

The major factors affecting prognosis of patients with soft tissue sarcomas are local control, size of the primary tumor, and the grade of the tumor. The only factor that can be influenced following appropriate diagnostic procedures is local control. Surgery alone, even radical surgery or amputation, is insufficient to control large, poorly differentiated tumors in many cases. Preoperative therapy has been shown to be a highly effective method for local disease control. Intra-arterial therapy appears to have several advantages in the treatment of extremity sarcomas. (1) Intra-arterial therapy results in at least a sixfold increase in the concentration of drug in the blood perfusing the tumor. If combined with proximal occlusion of blood flow (balloon occlusion or tourniquet occlusion), the concentration of drug being delivered to the tumor may increase by 30-fold [32]. This high local concentration of chemotherapy is achieved in most cases without the high systemic toxicity that would be required by intravenous therapy. (2) Chemotherapy infusion prior to surgery allows administration of cytotoxic therapy through an undisturbed blood supply. This allows for an improved effect of therapy at the tumor margin, which is the area at risk for seeding the wound at the time of extirpative surgery. This may facilitate limb salvage in patients with bulky tumors. (3) Responses to this preoperative therapy allows an in vivo evaluation of the efficacy of the drug against the individual tumor. This may aid in determining efficacy of using the drug for postoperative adjuvant therapy. (4) Preoperative therapy allows treatment of the tumor while awaiting construction of custom prostheses, especially in patients with osteosarcomas of the extremities.(ABSTRACT TRUNCATED AT 250 WORDS)

Combined Modality Therapy↗
PubMed1989

Adjuvant chemotherapy for osteosarcoma.

From this review of chemotherapy trials, several observations can be made. Osteosarcoma is a complex disease involving multiple histologies, each with a different prognosis. Prognostic factors that have been shown to be important include anatomic location of the primary tumor, stage at presentation (patients with metastatic or local recurrent disease fair far worse than those with primary disease), age at onset (children fair worse than the teenager with osteosarcoma), and location within the extremity (patients with more distal tumors fairing better than patients with more proximal tumors). There is convincing evidence for the efficacy of chemotherapeutic agents such as methotrexate in high doses (at least 8 g/m2 for adults, 12 g/m2 for children), Adriamycin, and cisplatin. The combination of Adriamycin and cisplatin appears to be more beneficial relative to either one of these agents alone. The efficacy of the combination of BCD as a triple-drug regimen, although useful in several different trials, has not been convincingly shown. Finally, from several of the recent randomized trials, it appears, that chemotherapeutic regimens containing an Adriamycin and cisplatin combination appear to be superior to those that do not include this combination. However, these observations are made from a historical perspective and have not been conclusively proven by randomized prospective investigations. The observations concerning the natural history of the disease and the activity of various chemotherapeutic agents suggest certain clinical practice algorithms. Essential staging procedures would include a bone scan looking for multifocal or metastatic disease, and CT scans of the chest looking for metastases to the lung. From all studies, it is apparent that surgery is mandatory for the primary tumor and should be an integral portion of all treatment methods. Chemotherapy should be considered for all patients with osteosarcoma, and the essential drugs in the regimen appear at present to minimally include high-dose methotrexate, Adriamycin, and cisplatin. It would also appear from several of these reports that not only is the adjuvant use of these chemotherapeutic agents indicated, but that the preoperative use of these agents has had significant advantages. The neoadjuvant chemotherapy begins the essential systemic chemotherapy at a very early stage, allows histologic assessment of treatment effect, permits altering drug regimens postoperative, and in many reported trials has allowed less than amputative surgery (limb salvage) to be performed. Finally, close follow-up of patients with osteosarcoma has therapeutic value.(ABSTRACT TRUNCATED AT 400 WORDS)

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1988

Resection of malignant bone tumors of the pelvic girdle without extremity amputation.

Fifty-three patients with malignant tumors of the pelvis ossea were evaluated for location of tumor, extent of resection, postoperative function, local recurrence, and survival. Three tumors were unresectable, 17 required a wide local excision, 27 required resection of the hemipelvis without extremity amputation (internal hemipelvectomy), and six required a classical hemipelvectomy with amputation. The incidence of local recurrence was 11.8% for wide local excision, 7.4% for internal hemipelvectomy, and 33% for classical hemipelvectomy. Survival following wide local excision or internal hemipelvectomy was 58% and 41%, respectively, at five years compared with 17% for patients undergoing classical hemipelvectomy. Patients who underwent wide local excision had good to excellent functional results. Patients requiring internal hemipelvectomy initially required ambulatory supports, but many can now ambulate independently, with a neurologically intact extremity, despite a noticeably abnormal gait.

Adolescent↗
PubMed1988

Patterns of metastatic spread following resection of extremity soft-tissue sarcomas and strategies for treatment.

This study examines recurrence patterns in 255 patients with soft-tissue sarcoma treated with preoperative chemotherapy and radiation, followed by limb-sparing surgery. Eighty-five patients developed metastatic disease: 13 had isolated local recurrence, 43 had isolated pulmonary metastases, 11 had metastases to lung and elsewhere, and 18 had metastases to multiple sites. Of the patients with isolated pulmonary metastases, 19/43 had resection of the metastases, and 9 are disease free. All 13 patients with local recurrences had resection of the recurrence, and 9 remain disease-free. Patients with multiple sites of recurrence had a 2-year survival of less than 10%. Resection of metastases is beneficial to a small number of patients who develop metastatic disease.

Actuarial Analysis↗
PubMed1988

Therapeutic and functional results of limb salvage to treat sarcomas of the forearm and hand.

Twenty-six patients with soft tissue sarcomas of the forearm and hand were treated with limb salvage protocols involving surgical wide excision, chemotherapy, and radiation therapy. Six received immediate or delayed reconstructive surgery to improve function. The average delay from the time of the first medical consultation until the correct diagnosis was made was 4.5 months. The average follow-up period was 44 months; a 91% survival rate was observed, with an 8% rate of local recurrence. Functional abilities were assessed by a questionnaire concerning work, household activities, and overall satisfaction with the surgical result. Eight-six percent of the patients had an excellent functional result, and 84% reported excellent satisfaction with their operation.

Adolescent↗