Advances in Clinical and Experimental Medicine
2017, vol. 26, nr 5, August, p. 781–787
doi: 10.17219/acem/63744
Publication type: original article
Language: English
Download citation:
En bloc resection and prosthesis implantation to treat malignant fibrous histiocytoma of the humerus
1 Department of Orthopedics, Shuguang Hospital affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
Abstract
Background. Malignant fibrous histiocytoma (MFH) of the bone is a rare tumor. Most studies comparing limb salvage and amputation have reported that limb salvage had no adverse effect on the long-term survival of patients. This study evaluates the oncological outcomes of limb salvage procedures that were used for 15 patients with MFH of the humerus.
Objectives. The aim of this study was to assess the functional and oncological outcomes of patients with malignant fibrous histiocytoma of the humerus after en bloc resection and prosthesis implantation.
Material and Methods. A retrospective review of the charts of 15 patients who had undergone resection of malignant fibrous histiocytoma of the humerus followed by reconstruction with prosthesis was used in this study. A functional evaluation was based on Enneking’s modified system of the functional evaluation of surgical management for musculoskeletal tumors. Complications of the procedures were also analyzed.
Results. Eight men and 7 women at an average age of 52.9 years were included in the study. The tumor involved the distal humerus in 3 patients, the proximal humerus in 8 patients and the mid-shaft humerus in 4 patients. Excellent results were achieved in 4 patients, good to fair in 10 and poor in 1. One patient had local recurrence. Pulmonary metastases occurred in 6 patients.
Conclusion. Limb salvage surgery with chemotherapy is a viable treatment option for patients with malignant fibrous histiocytoma of the humerus.
Key words
malignant fibrous histiocytoma, limb salvage, prosthesis implantation
References (37)
- Schajowicz F. Tumours and tumour like lesions of bones and joints. New York, NY: Springer; 1994:427–438.
- Natarajan MV, Mohanlal P, Bose JC. Limb salvage surgery complimented by customised mega prostheses for malignant fibrous histiocytomas of bone. J Orthop Surg (Hong Kong). 2007;15(3):352–356.
- Enneking WF. A system of staging musculoskeletal neoplasms. Instr Course Lect. 1988;37:3–10.
- Enneking WF, Dunham W, Gebhardt MC, Malawar M, Pritchard DJ. A system for the functional evaluation of reconstructive procedures after surgical treatment of tumors of the musculoskeletal system. Clin Orthop Relat Res. 1993;(286):241–246.
- O’Brien JE, Stout AP. Malignant fibrous xanthomas. Cancer. 1964;17:1445–1455.
- Fletcher CDM, Unni KK, Mertens F. World health organization classification of tumours. Pathology and genetics of tumours of soft tissue and bone. Lyon, France: IARC Press; 2002;227–232.
- Nascimento AF, Raut CP. Diagnosis and management of pleomorphic sarcomas (so-called ”MFH”) in adults. J Surg Oncol. 2008;97(4):330–339.
- Lehnhardt M, Daigeler A, Homann HH, et al. MFH revisited: Outcome after surgical treatment of undifferentiated pleomorphic or not otherwise specified (NOS) sarcomas of the extremities – an analysis of 140 patients. Langenbecks Arch Surg. 2009;394(2):313–320.
- Kolk S, Cox K, Weerdesteyn V, et al. Can orthopedic oncologists predict functional outcome in patients with sarcoma after limb salvage surgery in the lower limb? A nationwide study. Sarcoma. 2014;2014:436598.
- Aksnes LH, Bauer HC, et al. Limb-sparing surgery preserves more function than amputation: A Scandinavian sarcoma group study of 118 patients. J Bone Joint Surg Br. 2008;90(6):786–794.
- Bains R, Magdum A, Bhat W, Roy A, Platt A, Stanley P. Soft tissue sarcoma - A review of presentation, management and outcomes in 110 patients. Surgeon. 2014 Sep 23. [Epub ahead of print].
- Rosenberg SA, Tepper J, Glatstein E, et al. The treatment of soft-tissue sarcomas of the extremities: Prospective randomized evaluations of (1) limb-sparing surgery plus radiation therapy compared with amputation and (2) the role of adjuvant chemotherapy. Ann Surg. 1982;196(3):305–315.
- Mei J, Zhu XZ, Wang ZY, Cai XS. Functional outcomes and quality of life in patients with osteosarcoma treated with amputation versus limb-salvage surgery: A systematic review and meta-analysis. Arch Orthop Trauma Surg. 2014;134(11):1507–1516.
- Eiser C. Assessment of health-related quality of life after bone cancer in young people: Easier said than done. Eur J Cancer. 2009;45(10):1744–1747.
- Barr RD, Wunder JS. Bone and soft tissue sarcomas are often curable – but at what cost?: A call to arms (and legs). Cancer. 2009;115(18):4046–4054.
- Tobias K, Gillis T. Rehabilitation of the sarcoma patient-enhancing the recovery and functioning of patients undergoing management for extremity soft tissue sarcomas. J Surg Oncol. 2015;111(5):615–621.
- Shehadeh A, El Dahleh M, Salem A, et al. Standardization of rehabilitation after limb salvage surgery for sarcomas improves patients’ outcome. Hematol Oncol Stem Cell Ther. 2013;6(3–4):105–111.
- Al-Absi E, Farrokhyar F, Sharma R, et al. A systematic review and meta-analysis of oncologic outcomes of pre- versus postoperative radiation in localized resectable soft-tissue sarcoma. Ann Surg Oncol. 2010;17(5):1367–1374.
- Gibbs JF, Huang PP, Lee RJ, et al. Malignant fibrous histiocytoma: an institutional review. Cancer Invest. 2001;19(1):23–27.
- Zagars GK, Ballo MT, Pisters PW, et al. Prognostic factors for patients with localized soft-tissue sarcoma treated with conservation surgery and radiation therapy: An analysis of 1225 patients. Cancer. 2003;97(10):2530–2543.
- Weitz J, Antonescu CR, Brennan MF. Localized extremity soft tissue sarcoma: Improved knowledge with unchanged survival over time. J Clin Oncol. 2003;21(14):2719–2725.
- Capanna R, Bertoni F, Bacchini P, Bacci G, Guerra A, Campanacci M. Malignant fibrous histiocytoma of bone. The experience at the Rizzoli Institute: Report of 90 cases. Cancer. 1984;54(1):177–187.
- Hollier LH. Extremity-saving surgery and reconstruction: From microsurgery reconstruction to transplantation. Semin Plast Surg. 2010;24(1):3.
- Luetke A, Meyers PA, Lewis I, Juergens H. Osteosarcoma treatment – where do we stand?: A state of the art review. Cancer Treat Rev. 2014;40(4):523–532.
- Nystrom LM, Reimer NB, Reith JD, et al. Multidisciplinary management of soft tissue sarcoma. Scientific World J. 2013;2013:852462.
- Enneking WF, Spanier SS, Goodman MA. A system for the surgical staging of musculoskeletal sarcoma. Clin Orthop Relat Res. 1980;(153):106–120.
- Bannasch H, Eisenhardt SU, Grosu AL, Heinz J, Momeni A, Stark GB. The diagnosis and treatment of soft tissue sarcomas of the limbs. Dtsch Arztebl Int. 2011;108(3):32–38.
- Muramatsu K, Ihara K, Yoshida K, Tominaga Y, Hashimoto T, Taguchi T. Musculoskeletal sarcomas in the forearm and hand: Standard treatment and microsurgical reconstruction for limb salvage. Anticancer Res. 2013;33(10):4175–4182.
- Ayerza MA, Farfalli GL, Aponte-Tinao L, Muscolo DL. Does increased rate of limb-sparing surgery affect survival in osteosarcoma? Clin Orthop Relat Res. 2010;468(11):2854–2859.
- Vasileios KA, Eward WC, Brigman BE. Surgical treatment and prognosis in patients with high-grade soft tissue malignant fibrous histiocytoma of the extremities. Arch Orthop Trauma Surg. 2012;132(7):955–961.
- Recommendations for the reporting of soft tissue sarcoma. Association of Directors of Anatomic and Surgical Pathology. Virchows Arch. 1999;434(3):187–191.
- Kandel R, Coakley N, Werier J, et al. Surgical margins and handling of soft-tissue sarcoma in extremities: A clinical practice guideline. Curr Oncol. 2013;20(3):e247–254.
- Chao AH, Mayerson JL, Chandawarkar R, Scharschmidt TJ. Surgical management of soft tissue sarcomas: Extremity sarcomas. J Surg Oncol. 2015;111(5):540–545.
- Clarkson PW, Griffin AM, Catton CN, et al. Epineural dissection is safe technique that facilitates limb salvage surgery. Clin Orthop Relat Res. 2005;438:92–96.
- Wada T, Usui M, Isu K, Yamawakii S, Ishii S. Reconstruction and limb salvage after resection for malignant bone tumour of the proximal humerus: A sling procedure using a free vascularised fibular graft. J Bone Joint Surg Br. 1999;81(5):808–813.
- Qadir I, Umer M, Baloch N. Functional outcome of limb salvage surgery with mega-endoprosthetic reconstruction for bone tumors. Arch Orthop Trauma Surg. 2012;132(9):1227–1232. doi: 10.1007/s00402-012-1542-3.
- Mayilvahanan N, Paraskumar M, Sivaseelam A, Natarajan S. Custom mega-prosthetic replacement for proximal humeral tumours. Int Orthop. 2006;30(3):158–162.


