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  • 1
    Language: English
    In: Clinical orthopaedics and related research, 2015-03, Vol.473 (3), p.820-830
    Description: Prosthetic replacement is the most commonly used option for reconstruction of osteoarticular bone loss resulting from bone neoplasm resection or prosthetic failure. Starting in late 2001, we began exclusively using a single system for large-segment osteoarticular reconstruction after tumor resection; to our knowledge, there are no published series from one center evaluating the use of this implant.We investigated the following issues: (1) What is the overall survival, excluding local tumor recurrence, for these endoprostheses used for tumor reconstructions of the lower extremities (knee and hip)? (2) What types of failure were observed in these reconstructions? (3) Do the survival and complications vary according to site of implant?Between September 2001 and March 2012, we exclusively used this implant for tumor reconstructions. During that time, 278 patients underwent tumor reconstructions of the hip or knee, of whom 200 (72%) were available at a minimum 2 years followup. Seventy-eight patients were excluded from the study for insufficient followup as a result of early death (42) or loss at followup (36). The reconstruction types were the following: proximal femur (69 cases), distal femur (87), proximal tibia (32), and total knee (12). Failures were classified according to the Henderson classification. Nine patients among those with followup shorter than 2 years had presented one or more failures and they were included in our analysis but separately evaluated.Overall survival (no further surgical procedures of any type after primary surgery), excluding Type 5 failure (tumor recurrence), was 75.9% at 5 years and 66.2% at 10 years. Seventy-one failures occurred in 58 implants (29%). Mechanical failures accounted for 59.2% and nonmechanical failures for 40.8%. The first causes of failure of the implants were the result of soft tissue failure in 6%, aseptic loosening in 3%, structural failure in 7%, infection in 8.5%, and tumor recurrence in 4.5% of the whole series. Nine implants sustained two or more failures. Overall incidence of infection was 9.5%. No statistically significant differences were observed according to anatomical site.Like in the case with many such complex oncologic reconstructions, the failure rate at short- to midterm in this group was over 20%. Comparative trials are called for to ascertain whether one implant is superior to another. Infection and structural failure were the most frequent modes of failure in our experience.Level IV, therapeutic study. See Instructions for Authors for a complete description of levels of evidence.
    Subject(s): Surgical Orthopedics ; Medicine & Public Health ; Sports Medicine ; Orthopedics ; Surgery ; Conservative Orthopedics ; Medicine/Public Health, general ; Humans ; Middle Aged ; Reconstructive Surgical Procedures - methods ; Prostheses and Implants ; Male ; Bone Neoplasms - surgery ; Neoplasm Recurrence, Local - surgery ; Young Adult ; Prosthesis Failure ; Sarcoma - surgery ; Adolescent ; Aged, 80 and over ; Adult ; Female ; Aged ; Lower Extremity - surgery ; Child ; Implants, Artificial ; Prosthesis ; Health aspects ; Analysis ; Tumors ; Index Medicus ; Abridged Index Medicus ; Symposium ; 2013 Meetings of the Musculoskeletal Tumor Society and the International Society of Limb Salvage
    ISSN: 0009-921X
    E-ISSN: 1528-1132
    Source: PubMed Central
    Source: © ProQuest LLC All rights reserved〈img src="https://exlibris-pub.s3.amazonaws.com/PQ_Logo.jpg" style="vertical-align:middle;margin-left:7px"〉
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  • 2
    Language: English
    In: Scientific reports, 2020-02-07, Vol.10 (1), p.2155-2155
    Description: In the last decade, Raman Spectroscopy has demonstrated to be a label-free and non-destructive optical spectroscopy able to improve diagnostic accuracy in cancer diagnosis. This is because Raman spectroscopic measurements can reveal a deep molecular understanding of the biochemical changes in cancer tissues in comparison with non-cancer tissues. In this pilot study, we apply Raman spectroscopy imaging to the diagnosis and grading of chondrogenic tumors, including enchondroma and chondrosarcomas of increasing histologic grades. The investigation included the analysis of areas of 50×50 μm to approximately 200×200 μm , respectively. Multivariate statistical analysis, based on unsupervised (Principal Analysis Components) and supervised (Linear Discriminant Analysis) methods, differentiated between the various tumor samples, between cells and extracellular matrix, and between collagen and non-collagenous components. The results dealt out basic biochemical information on tumor progression giving the possibility to grade with certainty the malignant cartilaginous tumors under investigation. The basic processes revealed by Raman Spectroscopy are the progressive degrading of collagen type-II components, the formation of calcifications and the cell proliferation in tissues ranging from enchondroma to chondrosarcomas. This study highlights that Raman spectroscopy is particularly effective when cartilaginous tumors need to be subjected to histopathological analysis.
    Subject(s): Neoplasm Grading ; Humans ; Middle Aged ; Chondrosarcoma - pathology ; Adult ; Female ; Male ; Spectrum Analysis, Raman - methods ; Chondroma - diagnostic imaging ; Chondrosarcoma - diagnostic imaging ; Chondroma - pathology ; Spectrum Analysis, Raman - standards ; Cell proliferation ; Discriminant analysis ; Statistical analysis ; Spectrum analysis ; Collagen ; Extracellular matrix ; Diagnosis ; Raman spectroscopy ; Cancer ; Tumors ; Index Medicus
    ISSN: 2045-2322
    E-ISSN: 2045-2322
    Source: Nature Open Access
    Source: Academic Search Ultimate
    Source: PubMed Central
    Source: © ProQuest LLC All rights reserved〈img src="https://exlibris-pub.s3.amazonaws.com/PQ_Logo.jpg" style="vertical-align:middle;margin-left:7px"〉
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  • 3
    Language: English
    In: Journal of clinical oncology, 2012-06-10, Vol.30 (17), p.2112-2118
    Description: We compared two chemotherapy regimens that included methotrexate (MTX), cisplatin (CDP), and doxorubicin (ADM) with or without ifosfamide (IFO) in patients with nonmetastatic osteosarcoma of the extremity. Patients age ≤ 40 years randomly received regimens with the same cumulative doses of drugs (ADM 420 mg/m(2), MTX 120 g/m(2), CDP 600 mg/m(2), and IFO 30 g/m(2)) but with different durations (arm A, 44 weeks; arm B, 34 weeks). IFO was given postoperatively when pathologic response to MTX-CDP-ADM was poor (arm A) or given in the primary phase of chemotherapy with MTX-CDP-ADM (arm B). End points of the study included pathologic response to preoperative chemotherapy, toxicity, and survival. Given the feasibility of accrual, the statistical plan only permitted detection of a 15% difference in 5-year overall survival (OS). From April 2001 to December 2006, 246 patients were enrolled. Two hundred thirty patients (94%) underwent limb salvage surgery (arm A, 92%; arm B, 96%; P = .5). Chemotherapy-induced necrosis was good in 45% of patients (48% in arm A, 42% in arm B; P = .3). Four patients died of treatment-related toxicity (arm A, n = 1; arm B, n = 3). A significantly higher incidence of hematologic toxicity was reported in arm B. With a median follow-up of 66 months (range, 1 to 104 months), 5-year OS and event-free survival (EFS) rates were not significantly different between arm A and arm B, with OS being 73% (95% CI, 65% to 81%) in arm A and 74% (95% CI, 66% to 82%) in arm B and EFS being 64% (95% CI, 56% to 73%) in arm A and 55% (95% CI, 46% to 64%) in arm B. IFO added to MTX, CDP, and ADM from the preoperative phase does not improve the good responder rate and increases hematologic toxicity. IFO should only be considered in patients who have a poor histologic response to MTX, CDP, and ADM.
    Subject(s): Biological and medical sciences ; Medical sciences ; Diseases of the osteoarticular system ; Tumors of striated muscle and skeleton ; Tumors ; Osteosarcoma - drug therapy ; Femur - pathology ; Humans ; Child, Preschool ; Male ; Tibia - pathology ; Cisplatin - administration & dosage ; Humerus - pathology ; Disease-Free Survival ; Ifosfamide - administration & dosage ; Antineoplastic Combined Chemotherapy Protocols - therapeutic use ; Chemotherapy, Adjuvant - methods ; Adolescent ; Adult ; Female ; Methotrexate - administration & dosage ; Bone Neoplasms - drug therapy ; Child ; Doxorubicin - administration & dosage
    ISSN: 0732-183X
    E-ISSN: 1527-7755
    Source: Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals
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  • 4
    Language: English
    In: BMC cancer, 2018-10-20, Vol.18 (1), p.1003-1003
    Description: Sarcomas that arise from the scapula or periscapular soft tissues often require a total scapulectomy. This often implies a large complex tissue defect that needs adequate reconstruction of both bone and soft tissue. Although various methods have been developed, no optimal procedure has emerged. Postoperative complications are common and functional recovery is not always satisfactory. This study aims to present a new surgical technique that combines a custom-made scapular prosthesis with a functional latissimus dorsi flap. Two patients diagnosed with malignant tumour of the scapular region were surgically treated after proper multidisciplinary evaluation. The first patient underwent the procedure as a first surgery, the second as revision surgery. The new technique comprises three surgical stages: excisional surgery with soft tissue resection and scapulectomy, bone reconstruction with custom-made prosthesis, and soft tissue reconstruction using a latissimus dorsi rotational flap overturned on the prosthesis. The goal is to set up a new functional unit combining an anatomically shaped implant (manufactured using latest three-dimensional printing technology) and a muscular flap, and to maintain the neurovascular supply. The patients were followed up to evaluate functional outcome and complications. Both patients were alive with no evidence of disease. Functional results were satisfactory and the Musculoskeletal Tumor Society scores were 87% and 63%, respectively. No surgical complications such as implant breakage, joint collapse, wound dehiscence, or infection were observed. This new technique upgrades the role of the latissimus dorsi flap to a functional tool in combination with an anatomical, three-dimensionally printed, custom-made prosthesis, and provides adequate well-vascularized and healthy tissue to maximize the likelihood of successful limb salvage.
    Subject(s): Scapula - surgery ; Humans ; Middle Aged ; Reconstructive Surgical Procedures - methods ; Sarcoma, Ewing - diagnosis ; Sarcoma, Synovial - diagnosis ; Surgical Flaps - transplantation ; Sarcoma, Synovial - surgery ; Scapula - pathology ; Shoulder Prosthesis ; Superficial Back Muscles - transplantation ; Female ; Child ; Sarcoma, Ewing - surgery ; Case studies ; Orthopedic implants ; Usage ; Care and treatment ; Sarcoma ; Patient outcomes ; Research ; 3D printing ; Implants, Artificial ; Prosthesis ; Surgery ; Index Medicus ; Latissimus dorsi flap ; Scapulectomy ; Scapular custom-made prosthesis ; Oncology ; Orthopaedics
    ISSN: 1471-2407
    E-ISSN: 1471-2407
    Source: BioMedCentral Open Access
    Source: Academic Search Ultimate
    Source: PubMed Central
    Source: © ProQuest LLC All rights reserved〈img src="https://exlibris-pub.s3.amazonaws.com/PQ_Logo.jpg" style="vertical-align:middle;margin-left:7px"〉
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  • 5
    Language: English
    In: Journal of clinical pathology, 2016-03, Vol.69 (3), p.240-247
    Description: AimsDenosumab, a fully human monoclonal antibody directed against RANKL, has recently been introduced in the treatment strategy of giant cell tumour of bone (GCTB). Aim of this study was to investigate the phenotypical modifications induced by denosumab treatment in a series of 15 GCTB.MethodsThe tumours were characterised for histone 3.3 mutations, and studied immunohistochemically for the modifications of RANKL, RANK, SATB2 and RUNX2 expression, as well as of tumour proliferative activity and angiogenesis.ResultsNine of 11 tumours investigated presented a histone 3.3 mutation in H3F3A, and 2 of these for which the analysis was carried out in pretreatment and post-treatment specimens showed the same mutation in both. Denosumab induced the disappearance of osteoclast-like giant cells, leaving residual spindle neoplastic cells arranged in a storiform pattern, with deposition of trabecular collagen matrix and osteoid, which tended to maturation in the peripheral portions of the lesion. RANK and RANKL expression was variable, with no significant variation after treatment. Moreover, we did not observe any significant modification of the expression of the osteoblastic markers SATB2 and RUNX2. Denosumab treatment determined a significant reduction of the proliferative index and of tumour angiogenesis (p=0.001, Wilcoxon rank-sum test).ConclusionsThese results indicate that denosumab induces a partial maturation towards the osteoblastic phenotype of the neoplastic cells of GCTB, with production of fibrous and osteoid matrix, but with minor immunophenotypical changes. Finally, we first report an antiangiogenic activity of denosumab in GCTB, possibly mediated by a RANKL-dependent pathway.
    Subject(s): Immunohistochemistry ; Predictive Value of Tests ; RANK Ligand - metabolism ; Humans ; Middle Aged ; Neovascularization, Pathologic ; Male ; Bone Neoplasms - pathology ; Core Binding Factor Alpha 1 Subunit - metabolism ; Bone Neoplasms - metabolism ; Denosumab - therapeutic use ; Young Adult ; Giant Cell Tumor of Bone - drug therapy ; Giant Cell Tumor of Bone - pathology ; DNA Mutational Analysis ; Angiogenesis Inhibitors - therapeutic use ; Biomarkers, Tumor - metabolism ; Adult ; Female ; Bone Neoplasms - genetics ; Bone Neoplasms - drug therapy ; Receptor Activator of Nuclear Factor-kappa B - metabolism ; Giant Cell Tumor of Bone - genetics ; Matrix Attachment Region Binding Proteins - metabolism ; Bone Density Conservation Agents - therapeutic use ; Treatment Outcome ; Transcription Factors - metabolism ; Histones - genetics ; Giant Cell Tumor of Bone - metabolism ; Adolescent ; Aged ; Biomarkers, Tumor - genetics ; Cell Proliferation - drug effects ; Mutation ; Monoclonal antibodies ; Care and treatment ; Dosage and administration ; Diagnosis ; Denosumab ; Giant cell tumors ; Angiogenesis ; Genotype & phenotype ; Surgery ; Genomes ; Vascular endothelial growth factor ; Patients ; Deoxyribonucleic acid--DNA ; Tumors ; Index Medicus ; Abridged Index Medicus
    ISSN: 0021-9746
    E-ISSN: 1472-4146
    Source: Alma/SFX Local Collection
    Source: © ProQuest LLC All rights reserved〈img src="https://exlibris-pub.s3.amazonaws.com/PQ_Logo.jpg" style="vertical-align:middle;margin-left:7px"〉
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  • 6
    Language: English
    In: Clinical orthopaedics and related research, 2019-04, Vol.477 (4), p.775-776
    Subject(s): Lower Extremity ; Negative-Pressure Wound Therapy ; Sarcoma ; Humans ; Soft Tissue Neoplasms ; Index Medicus ; Abridged Index Medicus ; 2017 Musculoskeletal Tumor Society Proceedings
    ISSN: 0009-921X
    E-ISSN: 1528-1132
    Source: PubMed Central
    Source: © ProQuest LLC All rights reserved〈img src="https://exlibris-pub.s3.amazonaws.com/PQ_Logo.jpg" style="vertical-align:middle;margin-left:7px"〉
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  • 7
    Language: English
    In: Clinical orthopaedics and related research, 2018-08, p.1
    ISSN: 0009-921X
    E-ISSN: 1528-1132
    Source: PubMed Central
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  • 8
    Language: English
    In: World journal of surgical oncology, 2016-11-04, Vol.14 (1), p.281-281
    Description: The RANK ligand inhibitor denosumab is being investigated for treatment of giant cell tumor of bone, but the available data in the literature remains sparse and controversial. This study analyzes the results of combining denosumab with surgical treatment and highlights possible changes for the oncologic surgeon in daily practice. A total of 91 patients were treated surgically for giant cell tumor of bone between 2010 and 2014 in an institution, whereas 25 patients of the total additionally received denosumab and were part of this study. The average age of the patients was 35 years. Eleven patients received denosumab pre- and postoperatively, whereas with 14 patients, the denosumab treatment was applied either before (7 patients) or after (7 patients) the surgery. The average preoperative therapy duration was 3.9 months and the postoperative therapy 6 months by default. Sixteen patients presented a large tumor extension necessitating a resection of the involved bone or joint. In 10 of these patients, the indication for a resection procedure was abandoned due to the preoperative denosumab treatment and a curettage was performed. In the remaining six cases, the surgical indication was not changed despite the denosumab treatment, and two of them needed a joint replacement after the tumor resection. Also with patients treated with curettage, denosumab seems to facilitate the procedure as a new peripheral bone rim around the tumor was built, though a histologic analysis reveals viable tumor cells persisting in the denosumab-induced bone formation. After an average follow-up of 23 months, one histologically proven local recurrence occurred, necessitating a second curettage. A second patient showed a lesion in the postoperative imaging highly suspicious for local relapse which remained stable under further denosumab treatment. No adverse effect of the denosumab medication was observed in this study. Denosumab can be a help to the oncologic surgeon by reconstituting a peripheral rim and switching the stage from aggressive to active or latent disease. But as tumor cells remain in the new-formed bone, the surgical technique of curettage has to be changed from gentle to more aggressive to avoid higher local recurrence rates.
    Subject(s): Bone Neoplasms - therapy ; Follow-Up Studies ; Humans ; Middle Aged ; Male ; Denosumab - adverse effects ; Bone Neoplasms - pathology ; Denosumab - therapeutic use ; Neoplasm Recurrence, Local - pathology ; Young Adult ; Denosumab - administration & dosage ; Giant Cell Tumor of Bone - drug therapy ; Giant Cell Tumor of Bone - pathology ; Adult ; Female ; Retrospective Studies ; Bone Neoplasms - drug therapy ; Chemotherapy, Adjuvant ; Giant Cell Tumor of Bone - surgery ; Bone Density Conservation Agents - adverse effects ; Risk Assessment ; Bone Density Conservation Agents - therapeutic use ; Treatment Outcome ; Bone Density Conservation Agents - administration & dosage ; Bone Neoplasms - surgery ; Curettage - methods ; Giant Cell Tumor of Bone - therapy ; RANK Ligand - antagonists & inhibitors ; Adolescent ; Aged ; Index Medicus
    ISSN: 1477-7819
    E-ISSN: 1477-7819
    Source: BioMedCentral Open Access
    Source: Academic Search Ultimate
    Source: PubMed Central
    Source: © ProQuest LLC All rights reserved〈img src="https://exlibris-pub.s3.amazonaws.com/PQ_Logo.jpg" style="vertical-align:middle;margin-left:7px"〉
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  • 9
    Language: English
    In: Journal of clinical oncology, 2005-12-01, Vol.23 (34), p.8845-8852
    Description: To explore the effect of high-dose ifosfamide in first-line treatment for patients 〈 or = 40 years of age with nonmetastatic osteosarcoma of the extremity. From March 1997 to September 2000, 182 patients were evaluated. Primary treatment consisted of two blocks of high-dose ifosfamide (15 g/m2), methotrexate (12 g/m2), cisplatin (120 mg/m2), and doxorubicin (75 mg/m2). Postoperatively, patients received two cycles of doxorubicin (90 mg/m2), and three cycles each of high-dose ifosfamide, methotrexate, and cisplatin (120 to 150 mg/m2). Granulocyte colony-stimulating factor support was mandatory after the high-dose ifosfamide/cisplatin/doxorubicin combination. No disease progression was recorded during primary chemotherapy, 164 patients (92%) underwent limb-salvage surgery, four patients (2%) underwent rotation plasty, and 11 patients (6%) had limbs amputated. Three (1.6%) patients died as a result of treatment-related toxicity, and one died as a result of pulmonary embolism after pathologic fracture. Grade 4 neutropenia and thrombocytopenia followed 52% and 31% of all courses, respectively, and mild to severe nephrotoxicity was recorded in 19 patients (10%). The median received dose-intensity compared with protocol was 0.82. With a median follow-up of 55 months, the 5-year probability of event-free survival was 64% (95% CI, 57% to 71%) and overall survival was 77% (95% CI, 67% to 81%), whereas seven patients (4%) experienced local recurrence. The addition of high-dose ifosfamide to methotrexate, cisplatin, and doxorubicin in the preoperative phase is feasible, but with major renal and hematologic toxicities, and survival rates similar to those obtained with four-drug regimens using standard-dose ifosfamide. Italian Sarcoma Group/Scandinavian Sarcoma Group study I showed that in a multicenter setting, more than 90% of patients with osteosarcoma of the extremity can undergo conservative surgery.
    Subject(s): Biological and medical sciences ; Chemotherapy ; Medical sciences ; Antineoplastic agents ; Pharmacology. Drug treatments ; Tumors ; Prospective Studies ; Bone Neoplasms - therapy ; Follow-Up Studies ; Humans ; Antineoplastic Combined Chemotherapy Protocols - adverse effects ; Child, Preschool ; Male ; Bone Neoplasms - pathology ; Cisplatin - administration & dosage ; Dose-Response Relationship, Drug ; Renal Insufficiency - chemically induced ; Adult ; Female ; Child ; Extremities ; Doxorubicin - administration & dosage ; Ifosfamide - adverse effects ; Neoplasm Recurrence, Local ; Treatment Outcome ; Scandinavian and Nordic Countries ; Disease-Free Survival ; Methotrexate - adverse effects ; Ifosfamide - administration & dosage ; Antineoplastic Combined Chemotherapy Protocols - therapeutic use ; Adolescent ; Cisplatin - adverse effects ; Italy ; Methotrexate - administration & dosage ; Patient Compliance ; Osteosarcoma - therapy ; Doxorubicin - adverse effects ; Heart Failure - chemically induced ; Osteosarcoma - pathology ; Clinical Medicine ; Medical and Health Sciences ; Klinisk medicin ; Cancer and Oncology ; Medicin och hälsovetenskap ; Cancer och onkologi
    ISSN: 0732-183X
    ISSN: 1527-7755
    E-ISSN: 1527-7755
    Source: Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals
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  • 10
    Language: English
    In: Journal of surgical oncology, 2016-07, Vol.114 (1), p.50-55
    Description: Background and Objectives The clinical course of soft tissue myxofibrosarcoma is characterized by a high incidence of recurrences and there is no agreement on how to identify patients at major risk. An epithelioid histological variant has been described, with a possible worse prognosis. We reviewed our series to identify prognostic factors and assess clinical significance of the epithelioid variant. Methods We examined the clinico‐pathological features of a series of 75 patients affected by soft tissue myxofibrosarcoma at a mean follow‐up of 63 months (range 17–132). Results Disease specific survival and local recurrence free survival were, respectively, 84.8% and 76.8% at 5 years. Seven patients (8.6%) presented with the epithelioid variant with a survival of 62.5%. High grade and epithelioid morphology were negative prognostic factors for patient survival, high grade, and inadequate surgical margins for local recurrence. Radiotherapy had a local protective effect in high grade tumors. Conclusions Our experience confirms the difficulties in obtaining wide margins in myxofibrosarcoma and the high rate of recurrence. Local recurrences did not significantly affect survival and a limb‐sparing approach can be chosen also in recurrences. Patients affected by the epithelioid variant showed a worse prognosis. Chemotherapy should be considered as adjuvant treatment in this subtype. J. Surg. Oncol. 2016;114:50–55. © 2016 Wiley Periodicals, Inc.
    Subject(s): histopathology ; epithelioid variant ; soft tissue tumors ; prognosis ; myxofibrosarcoma ; Prognosis ; Follow-Up Studies ; Humans ; Middle Aged ; Fibrosarcoma - mortality ; Male ; Antineoplastic Agents - therapeutic use ; Myxosarcoma - pathology ; Neoplasm Recurrence, Local - etiology ; Fibrosarcoma - pathology ; Neoplasm Grading ; Aged, 80 and over ; Adult ; Female ; Neoadjuvant Therapy ; Chemotherapy, Adjuvant ; Radiotherapy, Adjuvant ; Myxosarcoma - mortality ; Epithelioid Cells - pathology ; Soft Tissue Neoplasms - therapy ; Limb Salvage ; Soft Tissue Neoplasms - mortality ; Neoplasm Recurrence, Local - prevention & control ; Myxosarcoma - therapy ; Margins of Excision ; Fibrosarcoma - therapy ; Treatment Outcome ; Soft Tissue Neoplasms - pathology ; Survival Analysis ; Aged ; Neoplasm Recurrence, Local - epidemiology ; Chemotherapy ; Analysis ; Cancer ; Index Medicus
    ISSN: 0022-4790
    E-ISSN: 1096-9098
    Source: Alma/SFX Local Collection
    Source: © ProQuest LLC All rights reserved〈img src="https://exlibris-pub.s3.amazonaws.com/PQ_Logo.jpg" style="vertical-align:middle;margin-left:7px"〉
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