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Biomedical subjects

Mark T Scarborough

Publications and source records attributed to Mark T Scarborough.

At least 19 recordsLinked to original sources
PubMed2006

Giant cell tumor of bone.

OBJECTIVE: To discuss the treatment and outcomes for giant cell tumor (GCT) of bone. MATERIALS AND METHODS: Review of the pertinent literature. RESULTS: GCT is a rare benign bone lesion most often found in the extremities of women in the third and fourth decades of life. Surgery is the mainstay of treatment and usually consists of intralesional curettage; local control rates range from 80% to 90% after this procedure. Patients with extensive, recurrent, and/or biologically more aggressive tumors may require wide excision. A small subset of patients with incompletely resectable GCTs or with lesions that are surgically inaccessible may be treated with moderate-dose radiotherapy (45-50 Gy) and have a 65% to 80% likelihood of being locally controlled. CONCLUSION: The majority of patients with GCTs are effectively treated with intralesional curettage. Wide excision or radiotherapy is necessary to cure a relatively limited subset of patients with extensive, aggressive, and/or incompletely resectable GCTs.

Bone Neoplasms↗
PubMed2006

Adjuvant radiotherapy in the management of soft tissue sarcoma involving the distal extremities.

OBJECTIVE: Treating soft tissue sarcoma (STS) of the distal extremity is challenging in terms of achieving local control and avoiding complications. It is now accepted that a limb conserving approach provides equivalent survival when compared with radical amputation. METHODS: Twenty-three patients with STS involving the hand-wrist or foot-ankle complex received adjuvant radiotherapy (RT) for limb conservation and were evaluated to determine if local control, survival, and functional ability were achieved. The median patient age was 64 and median time of follow-up was 11 years. The location of the sarcoma included the hand (n = 12) or foot (n = 11). Seven patients received preoperative RT (median dose, 50.40 Gy) and 16 patients received postoperative RT (median dose, 64.80 Gy). Patients treated preoperatively and 9 treated postoperatively received hyperfractionated RT at 1.2 Gy twice-daily. Seven patients treated postoperatively received conventional daily-fractionated treatment. RESULTS: Twenty of 23 patients received RT at first presentation; 3 were treated for locally recurrent disease. The 5- and 10-year rates of local control were 91%. The 10-year rates of cause-specific and absolute survival were 96% and 91%, respectively. The 5- and 10-year rates of distant metastases-free survival were 87%. The ultimate limb-conservation rate was 91%. No patient required an amputation because of local recurrence or treatment complications. Function of the hand or foot was maintained for all of the 21 patients for whom limb-conserving treatment was achieved. CONCLUSIONS: Combined modality therapy with limb-conserving surgery and adjuvant RT achieves excellent local control (91%) and potential overall survival (91%) rates with excellent functional outcome.

Aged↗
PubMed2005

Aggressive fibromatosis.

The purpose of this article is to review the pertinent literature and to define the optimal treatment of patients with aggressive fibromatosis. Data indicate the likelihood of local recurrence after surgery is high, particularly if margins are positive. Moderate-dose radiotherapy alone for gross disease or after a microscopically incomplete resection yields local control rates of approximately 75% to 80%. Treatment with pharmacologic agents results in objective response rates of approximately 40% to 50%; duration of response is variable. Thus, the optimal management for aggressive fibromatosis depends on tumor location and extent. Surgery is indicated if the lesion appears to be completely resectable with acceptable function and cosmesis. Radiotherapy is indicated for patients with unresectable tumors; those with positive margins after resection should be considered for adjuvant radiotherapy depending on the location and extent of the tumor. Pharmacologic treatment should be considered for patients with progressive disease after unsuccessful local-regional therapy.

Desmoid Tumors↗
PubMed2005

Radiotherapy in the treatment of dermatofibrosarcoma protuberans.

OBJECTIVE: To evaluate the role of postoperative radiotherapy (RT) for patients with dermatofibrosarcoma protuberans (DFSP). METHODS AND MATERIALS: Ten patients were treated with surgery and postoperative RT and had follow-up from 21 to 185 months. Nine patients had DFSP and 1 patient had a fibrosarcomatous component (DFSP-FS). No patient had gross disease at the time of RT. RESULTS: Nine patients with DFSP remained disease free after surgery and postoperative RT. The patient with DFSP-FS experienced a local recurrence after surgery, external beam RT, and a brachytherapy boost, and died with disease. There were no severe complications. CONCLUSION: Postoperative RT may reduce the risk of local recurrence in patients with DFSP who have a high risk of residual disease after surgery.

Adult↗
PubMed2004

Dermatofibrosarcoma protuberans.

In the current review, the authors set out to discuss the natural history and treatment of dermatofibrosarcoma protuberans (DFSP), a rare indolent cutaneous tumor. Approximately 10-15% of all DFSPs contain areas of fibrosarcoma (DFSP-FS), and such cases tend to exhibit more aggressive behavior. The optimal treatment for DFSP is resection with wide margins; the likelihood of local control associated with this procedure exceeds 90%. The probability of regional or distant metastases is </= 5%. Patients with positive or close surgical margins have an elevated risk of local recurrence after resection alone; however, postoperative radiotherapy results in local control rates of >/= 85% in such patients. Postoperative radiotherapy also is indicated in the rare event that a patient has unresectable macroscopic disease. Experience with the use of radiotherapy alone to treat macroscopic disease is limited.

Dermatofibrosarcoma↗
PubMed2004

Changes in inorganic phosphate and force production in human skeletal muscle after cast immobilization.

Cast immobilization is associated with decreases in muscle contractile area, specific force, and functional ability. The pathophysiological processes underlying the loss of specific force production as well as the role of metabolic alterations are not well understood. The aim of this study was to quantify changes in the resting energy-rich phosphate content and specific force production after immobilization. (31)P-magnetic resonance spectroscopy, three-dimensional magnetic resonance imaging, and isometric strength testing were performed in healthy subjects and patients with an ankle fracture after 7 wk of immobilization and during rehabilitation. Muscle biopsies were obtained in a subset of patients. After immobilization, there was a significant decrease in the specific plantar flexor torque and a significant increase in the inorganic phosphate (P(i)) concentration (P < 0.001) and the P(i)-to-phosphocreatine (PCr) ratio (P < 0.001). No significant change in the PCr content or basal pH was noted. During rehabilitation, both the P(i) content and the P(i)-to-PCr ratio decreased and specific torque increased, approaching control values after 10 wk of rehabilitation. Regression analysis showed an inverse relationship between the in vivo P(i) concentration and specific torque (r = 0.65, P < 0.01). In vitro force mechanics performed on skinned human muscle fibers demonstrated that varying the P(i) levels within the ranges observed across individuals in vivo (4-10 mM) changed force production by approximately 16%. In summary, our findings clearly depict a change in the resting energy-rich phosphate content of skeletal muscle with immobilization, which may negatively impact its force generation.

Ankle Injuries↗
PubMed2004

Bone-forming tumors of the upper extremity and Ewing's sarcoma.

This article presents an overview of bone-forming tumors that occur in the upper extremity. Osteoid osteoma, osteoblastoma, osteosarcoma, and Ewing's sarcoma are covered. Each tumor type is described, and suggestions are made for diagnostic workup and differential diagnosis. Locations in the upper extremity where each tumor typically occurs are given. Preferred treatment regimens and incidence of recurrence are also presented.

Arm↗
PubMed2004

Giant cell tumor of the pelvis and sacrum: 17 cases and analysis of the literature.

The optimal treatment of giant cell tumors of the pelvis and sacrum is controversial. Our current patient series was combined with cases identified in a review of the literature published in the past 50 years, yielding a combined group of 239 lesions for study. Recurrence rates were 49% for patients who had radiation therapy alone, 47% for patients who had surgery with intralesional margins, 46% for patients who had surgery with intralesional margins and radiation therapy, and 0% for patients who had surgery with wide margins. Six percent of patients had benign lung metastases develop, 2% of patients had secondary malignancies, 2% of patients died in the perioperative period, and less than 1% of patients had multicentricity. Radiation-induced sarcoma developed in 11% of patients who received radiation for primary or recurrent lesions. Larger doses of radiation therapy did not decrease the rate of local recurrence. Recurrence after surgery and radiation was not lower than after either treatment alone. Local recurrence was more likely in the patients with sacral tumors (48%) than in the patients with pelvic tumors (34%). Disease status was worse in the patients with sacral lesions (23% died of disease) than in the patients with pelvic lesions (6% died of disease).

Adolescent↗
PubMed2004

Muscle adaptations with immobilization and rehabilitation after ankle fracture.

UNLABELLED: INTRODUCTION/ PURPOSE: The widespread occurrence of muscular atrophy during immobilization and its reversal presents an important challenge to rehabilitation medicine. We used 3D-magnetic resonance imaging (MRI) in patients with surgically-stabilized ankle mortise fractures to quantify changes in plantarflexor and dorsiflexor muscle size during immobilization and rehabilitation, as well as to evaluate changes in force generating capacity (specific torque). METHODS: Twenty-individuals participated in a 10 wk rehabilitation program after 7 wk of immobilization. MRIs were acquired at baseline, 2, and 7 wk of immobilization, and at 5 and 10 wk of rehabilitation. Isometric plantarflexor muscle strength testing was performed at 0, 5, and 10 wk of rehabilitation. RESULTS: Dorsiflexors and plantarflexors atrophied 18.9% and 24.4% respectively, the majority of which occurred during the first 2 wk of immobilization (dorsiflexors: 9.6%; plantarflexors: 14.1%). Likewise, more than 50% of hypertrophy during rehabilitation occurred within the first 5 wk of rehabilitation for both the dorsiflexors (12.9%) and plantarflexors (13.2%), when compared to the total amount of hypertrophy over 10 wk of rehabilitation (dorsiflexors: 17.6%, plantarflexors: 22.5%). There were no significant differences in hypertrophy or atrophy of the dorsiflexor or plantarflexor muscles, despite a rehabilitation emphasis on the plantarflexors. Patients had significantly lower plantarflexor specific torque (torque/CSA) than healthy, control subjects immediately after cast immobilization, which did not return to normal after 10 wk of rehabilitation (P < 0.05). CONCLUSION: Our investigation of the consequences of limb immobilization on rehabilitation outcomes in patients can be applied directly to optimizing rehabilitation programs. Although muscle hypertrophy occurred early during rehabilitation, plantarflexor muscle function (specific torque) should remain the focus of rehabilitation programs because although CSA recovered quickly, specific torque still lagged behind that of control subjects.

Adaptation, Physiological↗
PubMed2004

The biopsy.

The biopsy of a musculoskeletal lesion is an important event, the outcome of which guides patient management and helps determine patient prognosis. The principles of biopsy include complete radiologic staging before the biopsy, thorough prebiopsy planning including consultation with the pathologist and radiologist, determining the most appropriate method of biopsy (fine needle, core needle, open surgical biopsy), placing the biopsy tract appropriately, and making sure the biopsy tract can be removed at the time of resection, avoiding contamination of uninvolved structures, avoiding transverse incisions, preventing pathologic fracture, handling biopsy tissue appropriately, and considering referral before biopsy. The common errors of biopsy include sampling errors, postbiopsy hematomas, the use of transverse incisions, tumor implantation, and the treatment of an unsuspected sarcoma with prophylactic fixation. Thoughtful prebiopsy planning and careful completion of the biopsy can result in an expedient and accurate diagnosis. If the treating physician lacks significant expertise in performing biopsy and management of patients with musculoskeletal lesions, then referral to a musculoskeletal oncologist before biopsy should be considered.

Biopsy↗
PubMed2003

Radiation therapy for giant cell tumors of bone.

For giant cell tumors of bone, does radiotherapy provide a safe and effective treatment? This retrospective review includes 24 patients with 26 histologically diagnosed tumors treated with megavoltage radiotherapy between March 1972 and July 1996. Of the 10 recurrent tumors, five had an intralesional resection, two had a biopsy, and three had no biopsy before radiotherapy. Of the 16 previously untreated tumors, one was irradiated after a marginal resection, five after an intracapsular resection, and 10 after biopsy alone. The total doses ranged from 35 to 55 Gy (median, 43 Gy) in fractions of 1.67 to 2.33 Gy per day. Twenty of 26 tumors (77%) were controlled locally. All of the local recurrences occurred within the irradiated field. Five of six patients with local recurrence were treated successfully with additional surgery. Salvage surgery after local recurrence required amputation of an extremity in three patients and a total knee replacement in one patient. The ultimate local control rate was 96% with one patient alive with progressive disease. Lung metastases in one patient were treated successfully with surgery, chemotherapy, and radiotherapy. In one patient a radiation-induced sarcoma developed 22 years after treatment. The authors conclude that radiation therapy is a safe and effective treatment option for benign giant cell tumors of bone. A total dose greater than 40 Gy is the only variable found to significantly influence local control.

Adolescent↗
PubMed2003

Grade 2 chondrosarcoma: stage I or stage II tumor?

We analyzed chondrosarcomas of bone to assess whether Grade 2 tumors are more appropriately grouped with Grade 1 chondrosarcomas or Grade 3 and dedifferentiated chondrosarcomas (Musculoskeletal Tumor Society Stage I or Stage II). A retrospective chart review identified 109 patients who presented with nonmetastatic chondrosarcoma. Data were gathered on each tumor's histologic grade, extent (intracompartmental versus extracompartmental), resection margin status, and site (axial versus appendicular). The cohort included 60 males and 49 females with a mean age of 50 years. Forty tumors were located in the axial skeleton and the remainder were distributed throughout the appendicular skeleton. Fifty-three tumors were Grade 1, 40 tumors were Grade 2, eight tumors were Grade 3, and eight tumors were dedifferentiated. Statistical analysis established grade as the only significant variable for this group of patients; extracompartmental tumor spread also correlated with outcome, but not independent of the grade. Margin status and site were not statistically significant with respect to outcome. Chi-square analysis also established that Grade 2 tumors are grouped more appropriately with the Grade 1 chondrosarcomas as Musculoskeletal Tumor Society Stage I neoplasms. These data should be considered when developing the surgical plan, particularly for patients with Grade 2 appendicular chondrosarcomas.

Adolescent↗
PubMed2002

External beam radiotherapy for primary and adjuvant management of aggressive fibromatosis.

PURPOSE: To review a large single-institution experience in the management of aggressive fibromatosis to determine the effectiveness of external beam radiotherapy (EBRT) and identify the presentation and treatment variables predictive of locoregional control. METHODS AND MATERIALS: Between 1975 and 2000, 72 patients were treated with EBRT for a pathologically confirmed diagnosis of aggressive fibromatosis. Thirty patients were treated at the primary presentation and 42 at the time of a locoregional recurrence. Minimal 2-year follow-up data were available for 65 patients (median 6 years). Megavoltage irradiation with 60Co to 20 MV photons or electron therapy was used for all patients. Most patients were treated after attempted complete surgical resection; 16 patients underwent pretreatment biopsy alone. The prescribed treatment was standard (1.8 Gy) daily fractions in 42 cases and 1.2 Gy fractions b.i.d. in 23 cases. The median prescribed dose was 54 Gy. The prognostic variables and treatment results were evaluated by Kaplan-Meier actuarial analysis. RESULTS: Locoregional control was achieved in 52 of 65 patients. The 5-year actuarial locoregional control was 83%. Locoregional failure occurred in 13 patients (11 in patients with recurrent tumors). Only two failures occurred within the irradiation fields; nine failures occurred at the field margins. Eleven patients were salvaged by surgery: wide excision in nine and amputation in two. The only prognostic factor significant for locoregional control was primary vs. recurrent presentation (p = 0.0193). The 5-year locoregional control rates for irradiation at initial presentation and at recurrence were 96% and 75%, respectively. The variables without significance for locoregional control included primary tumor location, surgical procedures performed, resection margins, and gross vs. microscopic residual tumor at irradiation. Lymphedema was the most common late effect, occurring in 7 patients, 5 with prior treatment. Bone fracture occurred in 3 patients; all 3 had fibromatosis involving the bone at presentation but without recurrence at the time of fracture. CONCLUSION: EBRT is effective treatment for aggressive fibromatosis. The probability of locoregional control decreases with multiple prior recurrences.

Adolescent↗
PubMed2002

The effect of contaminated surgical margins revisited.

The current study was done to assess the oncologic outcomes after inadvertent intraoperative contamination in the treatment of musculoskeletal sarcomas, to determine the prognostic significance of these events. Forty-three patients with malignant lesions and either positive margins or intraoperative tumor penetration are included in the study. There were 12 bone lesions and 31 soft tissue lesions. The final margin was intracapsular in 11 patients, contaminated marginal in 13 patients, and contaminated wide in 19 patients. Thirty-two patients received radiation therapy with doses from 4560 to 7000 cGy. The mean followup was 69 months (range, 24-179 months). In patients in whom the surgical margin was contaminated, additional tissue was removed with the goal being to obtain tumor-free surgical margins. Local recurrence occurred in four of 32 patients (12.5%) with no gross residual tumor. There was a significant difference in the recurrence rate between a wide (0 of 19) versus a marginal or intracapsular margin (nine of 24) based on the final surgical margin. High-grade lesions were more likely to recur than low-grade lesions, and soft tissue lesions were more likely to recur than bone lesions. Similar to previous reports, treatment of inadvertent contamination with reexcision and irrigation of the wound results in a similar recurrence rate to cases without contamination. Efforts should be made to achieve a wide final margin. Adjuvant therapies should be used whenever feasible.

Adolescent↗
PubMed2002

Preoperative radiotherapy in the treatment of soft tissue sarcomas.

The goal of the current study was to analyze the oncologic results and wound complications in patients with soft tissue sarcomas treated with preoperative radiation therapy and en bloc resection. A standard protocol of preoperative radiotherapy was administered followed by en bloc resection in 209 patients. The protocol included needle or incisional biopsy, prospective staging, a consistent dose of radiotherapy, standardized prospective evaluation of surgical margins, and long-term followup. The target radiotherapy dose was 50.4 cGy. Twenty-nine patients had low-grade lesions, and 180 had high-grade lesions. The mean followup was 55 months. The significant wound complication rate was 22% (moderate 14%, major 7%, and amputation 1%). Wound complications were significantly higher in patients with lower extremity lesions when compared with patients with upper extremity or axial lesions, and in patients with lesions larger than 5 cm. The local recurrence rate was 11% in patients who did not have prior surgery, and 37% in patients who had prior surgery at an outside institution (17% overall). Local recurrence was increased significantly in patients who had prior surgery. At latest followup, 78 patients (47%) were continuously disease-free, six (4%) were alive with no evidence of disease, nine (5%) were alive with disease, 63 (38%) died of disease, and 11 (7%) died of another cause. The 2- and 5-year disease-specific survival rates were 77% and 67%, respectively. Overall survival was 56%. A significant decrease in survival was seen in patients who had a local recurrence, and in patients with high-grade lesions. Preoperative radiotherapy can be given safely with a wound complication rate not significantly higher than that reported for other forms of radiotherapy delivery. Local recurrence tends to be higher if surgical intervention is done before tertiary center referral. Distant disease continues to be the cause of the high mortality in these patients.

Adolescent↗
PubMed2002

Radiation therapy for low-grade soft tissue sarcoma.

One hundred eight patients with low-grade soft tissue sarcoma treated at the authors' institution from 1984 to 1999 were reviewed retrospectively. Low-grade sarcomas were defined as those designated as Grade I of III or Grade I or II of IV. Patients who presented with recurrent tumors or who had multiple procedures at outside institutions were excluded. The patient's gender, age at diagnosis, histologic diagnosis, site and depth of primary involvement, and specimen size at resection were noted. Involvement of periosteum, bone, and neurovascular structures also was recorded. The decision to use radiation therapy was made case-by-case. Indications for preoperative radiation therapy included tumor adjacent to the neurovascular bundle or bone where a marginal surgical margin was anticipated. Indications for postoperative radiation therapy included followup resection of an unsuspected malignancy. Patients were evaluated according to treatment rendered. Sixty-six patients were treated with surgery alone, whereas 42 patients had excision of the tumor in conjunction with radiation therapy. The overall local control rate was 97.2% (105 of 108). There were no statistically significant differences in local recurrence, wound complication, fibrosis, or survival between the two groups. Patients treated with radiation therapy had an increased incidence of postoperative lymphedema. Kaplan-Meier 10-year survival rates were approximately 90% for both groups.

Adolescent↗