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Current management of giant-cell tumor of bone in the denosumab era 国際誌

Akihito Nagano, Hiroshi Urakawa, Kazuhiro Tanaka, Toshifumi Ozaki

Japanese Journal of Clinical Oncology 52 ( 5 ) 411 - 416 2022年5月

担当区分：最終著者記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：Oxford University Press (OUP)

Abstract

Giant-cell tumor of bone is a rare, locally aggressive and rarely metastasizing primary bone tumor. The mainstay of treatment remains controversial and is decided by the balance between adequate surgical margin and sufficient adjacent joint function. Although curettage with a high-speed burr and local adjuvants can maintain normal joint function, many reports have revealed a high local recurrence rate. Conversely, en bloc resection and reconstruction with prostheses for highly aggressive lesions have reportedly lower local recurrence rates and poorer functional outcomes. Denosumab—a full human monoclonal antibody that inhibits receptor activator of nuclear factor-kappa β ligand—was approved by the Food and Drug Authority in 2013 for use in surgically unresectable or when resection is likely to result in severe morbidity for skeletally mature adolescents and adults with giant-cell tumor of bone. However, subsequent studies have suggested that the local recurrence rate would be increased by preoperative use of denosumab. In systematic reviews of the local recurrence rate after preoperative use of denosumab, conclusions vary due to the small sample sizes of the studies reviewed. Therefore, controversy regarding the treatment of giant-cell tumor of bone is ongoing. Here, this review elucidates the management of giant-cell tumor of bone, especially with the local adjuvant and neoadjuvant use of denosumab, and presents the current, evidence-based treatment for giant-cell tumor of bone.

DOI： 10.1093/jjco/hyac018

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Increased cleft width during knee flexion is useful for the diagnosis of medial meniscus posterior root tears. 国際誌

Takaaki Hiranaka, Takayuki Furumatsu, Shinichi Miyazawa, Keisuke Kintaka, Naohiro Higashihara, Masanori Tamura, Ximing Zhang, Haowei Xue, Toshifumi Ozaki

Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA 2022年5月

担当区分：最終著者記述言語：英語掲載種別：研究論文（学術雑誌）

PURPOSE: This study aimed to evaluate changes in the cleft width, defined as the distance between the lateral edge of the medial tibial plateau and that of the medial meniscus (MM) posterior root, using open magnetic resonance imaging (MRI) in patients with MM posterior root tear (MMPRT). METHODS: This study included 25 patients (20 women and 5 men; mean age: 65.2 years) who were diagnosed with MMPRT and underwent pullout repair. Upon coronal imaging, the cleft width was evaluated at the 10° and 90° flexed knee positions. The difference in the cleft width (defined as the cleft width at 90° minus the cleft width at 10°) was also calculated. Upon sagittal imaging, the MM posterior extrusion (MMPE) at 90° was also evaluated. Separate univariate linear regression models were used to determine the association between the time from injury to MRI and radiographic measurements. RESULTS: The mean cleft width at 10° and 90° was 4.9 ± 2.6 mm and 7.4 ± 3.7 mm, respectively; the mean difference in cleft width was 2.5 ± 1.5 mm, and the mean MMPE at 90° was 3.7 ± 1.3 mm. There was a significant difference in cleft width at 10° and 90° (p < 0.001). The time from injury to MRI was significantly associated with the cleft width at 10° (R = 0.42; p = 0.023), cleft width at 90° (R = 0.59; p = 0.002), the difference in the cleft width (R = 0.62; p = 0.008), and MMPE at 90° (R = 0.53; p = 0.008). CONCLUSION: This study demonstrates that the cleft width is significantly larger during knee flexion than during knee extension. Increased cleft width during knee flexion ("graben" sign) may help diagnose MMPRT, especially in cases where the cleft sign is unclear during knee extension. LEVEL OF EVIDENCE: III.

DOI： 10.1007/s00167-022-06983-8

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Application of mesh plate for the treatment of an osteochondral fracture of the medial femoral condyle with medial wall fracture: A case report. 国際誌

Yusuke Mochizuki, Norio Yamamoto, Tomoyuki Noda, Toshifumi Ozaki

Acta orthopaedica et traumatologica turcica 56 ( 3 ) 228 - 231 2022年5月

担当区分：最終著者記述言語：英語掲載種別：研究論文（学術雑誌）

Osteochondral fractures of the medial femoral condyle accompanied by medial wall fracture are rare. Surgeons often have difficulty in selecting the most appropriate treatment, especially the plating technique for internal fixation since the available femoral locking plates are made to fit the femoral lateral condyle and there is no anatomical plate for the medial condyle. We, herein, report a case of a 44-year- old female patient who suffered from an osteochondral fracture of the medial femoral condyle accompanied by medial wall fracture treated by a low-profile mesh plate contoured to fit around the fracture site. Bone union was achieved at postoperative week 12 and the patient was able to return to her normal activities. At the 16-month follow-up exam, the patient's functional and clinical outcomes were satisfactory. Her Oxford knee score was 47 points, and the Western Ontario and McMaster Universities Arthritis Index scores were 2 points for pain and 5 points for physical function. We believe that the mesh plate has several advantages. This is the first report of using a mesh plate for the femur, and we were able to achieve good results. We conclude that treatment with a mesh plate can be applied in well- selected patients with medial femoral condyle osteochondral fracture and has the potential to be applied to the treatment of fractures in various regions in the future.

DOI： 10.5152/j.aott.2022.21325

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術前肺がん患者のサルコペニア・がんロコモと術後合併症の関連性

堅山佳美, 千田益生, 中田英二, 濱田全紀, 国定俊之, 藤原智洋, 尾崎敏文

The Japanese Journal of Rehabilitation Medicine ( 特別号 ) S35 - S35 2022年5月

リハビリテーション専門病院での両下肢切断者の治療結果

濱田全紀, 堅山佳美, 千田益生, 茂山幸雄, 坂本吉宏, 徳弘昭博, 尾崎敏文

The Japanese Journal of Rehabilitation Medicine ( 特別号 ) S255 - S255 2022年5月

臓器移植とリハビリテーション医療

千田益生, 濱田全紀, 堅山佳美, 濱崎比果瑠, 尾崎敏文

The Japanese Journal of Rehabilitation Medicine ( 特別号 ) S277 - S277 2022年5月

リハビリテーション専門病院での両下肢切断者の治療結果

濱田全紀, 堅山佳美, 千田益生, 茂山幸雄, 坂本吉宏, 徳弘昭博, 尾崎敏文

The Japanese Journal of Rehabilitation Medicine ( 特別号 ) S255 - S255 2022年5月

術前肺がん患者のサルコペニア・がんロコモと術後合併症の関連性

堅山佳美, 千田益生, 中田英二, 濱田全紀, 国定俊之, 藤原智洋, 尾崎敏文

The Japanese Journal of Rehabilitation Medicine ( 特別号 ) S35 - S35 2022年5月

骨軟部腫瘍患者の術前ストレススクリーニング

伊勢真人, 藤原智洋, 堅山佳美, 中田英二, 濱田全紀, 國定俊之, 千田益生, 尾崎敏文, 田島文博

The Japanese Journal of Rehabilitation Medicine ( 特別号 ) S629 - S629 2022年5月

臓器移植とリハビリテーション医療

千田益生, 濱田全紀, 堅山佳美, 濱崎比果瑠, 尾崎敏文

The Japanese Journal of Rehabilitation Medicine ( 特別号 ) S277 - S277 2022年5月

Mechanical Study of Various Pedicle Screw Systems including Percutaneous Pedicle Screw in Trauma Treatment. 国際誌

Yoshiaki Oda, Tomoyuki Takigawa, Yasuo Ito, Haruo Misawa, Tomoko Tetsunaga, Koji Uotani, Toshifumi Ozaki

Medicina (Kaunas, Lithuania) 58 ( 5 ) 2022年4月

担当区分：最終著者記述言語：英語掲載種別：研究論文（学術雑誌）

Background and Objectives: Spine surgery using a percutaneous pedicle screw placement (PPSP) is widely implemented for spinal trauma. However, percutaneous systems have been reported to have weak screw-rod connections. In this study, conventional open and percutaneous systems were biomechanically evaluated and compared. Material and Methods: The experiments were performed in two stages: the first stage was a break test, whereas the second stage was a fatigue test. Four systems were used for the experiments. System 1 was intended for conventional open surgery (titanium rod with a 6.0 mm diameter, using a clamp connecting mechanism). System 2 was a percutaneous pedicle screw (PPS) system for trauma (titanium alloy rod with a 6.0 mm diameter, using ball ring connections). System 3 was a PPS system for trauma (cobalt-chromium alloy rod with a 6.0 mm diameter, using sagittal adjusting screw connections). System 4 was a general-purpose PPS system (titanium alloy rod with a 5.5 mm diameter, using a mechanism where the adapter in the head holds down the screw). Results: Stiffness values of 54.8 N/mm, 43.1 N/mm, 90.9 N/mm, and 39.3 N/mm were reported for systems 1, 2, 3, and 4, respectively. The average number of load cycles in the fatigue test was 134,393, 40,980, 1,550,389, and 147,724 for systems 1 to 4, respectively. At the end of the test, the displacements were 0.2 mm, 16.9 mm, 1.2 mm, and 8.6 mm, respectively. System 1, with a locking mechanism, showed the least displacement at the end of the test. Conclusion: A few PPS systems showed better results in terms on stiffness and life than the open system. The experiments showed that mechanical strength varies depending on the spinal implant. The experiments conducted are essential and significant to provide the mechanical strength required for surgical reconstruction.

DOI： 10.3390/medicina58050565

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A randomized phase III trial of denosumab before curettage for giant cell tumor of bone. JCOG1610

Hiroshi Urakawa, Akihito Nagano, Ryunosuke Machida, Kazuhiro Tanaka, Tomoko Kataoka, Yuta Sekino, Yoshihiro Nishida, Mitsuru Takahashi, Toshiyuki Kunisada, Masanori Kawano, Yukihiro Yoshida, Tatsuya Takagi, Kenji Sato, Toru Hiruma, Hiroshi Hatano, Satoshi Tsukushi, Akio Sakamoto, Toshihiro Akisue, Koji Hiraoka, Toshifumi Ozaki

JAPANESE JOURNAL OF CLINICAL ONCOLOGY 2022年4月

Grade of Subchondral Insufficiency Fracture of the Knee and the Presence of a Posterior Shiny-Corner Lesion are Correlated with Duration of Medial Meniscus Posterior Root Tear in Women.

Yuki Okazaki, Takayuki Furumatsu, Takaaki Hiranaka, Yusuke Kamatsuki, Eiji Nakata, Tomonori Tetsunaga, Kentaro Yamane, Toshifumi Ozaki

Acta medica Okayama 76 ( 2 ) 121 - 127 2022年4月

担当区分：最終著者記述言語：英語掲載種別：研究論文（学術雑誌）

Bone marrow edema (BME) after meniscus injury and risk factors for subchondral insufficiency fracture of the knee (SIFK) have been reported. However, their association with medial meniscus posterior root tear (MMPRT) remains unknown. We investigated the association of BME volume (BME-V), posterior shinycorner lesion (PSCL), and SIFK with MMPRT to examine the correlations between BME-V and medial meniscus extrusion (MME), PSCL and duration from injury to the time of magnetic resonance imaging (duration), and SIFK and duration. Twenty-nine patients who underwent surgery for MMPRT were included (mean age, 59.2; range, 39-84). The presence of PSCL, femoral BME-V (cm3), and SIFK grade (1-4) were evaluated. Preoperative factors, such as MME (mm) and duration (weeks), were investigated using multivariate linear/ logistic regression analyses. Multivariate linear regression analysis revealed duration as a significant factor for high-grade SIFK (p<0.01). Multivariate logistic regression analysis revealed duration as a significant factor for the presence of PSCL (odds ratio=0.94, p<0.05). A long duration of MMPRT leads to severe MME and highgrade SIFK (3 and 4), often resulting in knee arthroplasty. Early diagnosis of MMPRT and pullout repair can prevent severe MME and high-grade SIFK.

DOI： 10.18926/AMO/63405

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The role of perioperative chemotherapy in primary high-grade extremity soft tissue sarcoma: a risk-stratified analysis using PERSARC

Ibtissam Acem, Winan J. van Houdt, Dirk J. Grünhagen, Winette T.A. van der Graaf, Anja J. Rueten-Budde, Hans Gelderblom, Cornelis Verhoef, Michiel A.J. van de Sande, Will Aston, Han Bonenkamp, Ingrid M.E. Desar, Peter C. Ferguson, Marta Fiocco, Robert J. van Ginkel, Anthony M. Griffin, Rick L. Haas, Jos A. van der Hage, Andrew J. Hayes, Lee M. Jeys, Akira Kawai, Johnny Keller, Minna K. Laitinen, Katja Maretty-Kongstad, Koichi Ogura, Toshifumi Ozaki, Rob Pollock, Veroniek M. van Praag, Stefan Sleijfer, Myles J. Smith, Maria A. Smolle, Emelie Styring, Joanna Szkandera, Kazuhiro Tanaka, Per-Ulf Tunn, Madeleine Willegger, Reinard Windhager, Jay S. Wunder, Olga Zaikova

European Journal of Cancer 165 71 - 80 2022年4月

骨軟部腫瘍患者におけるがん遺伝子パネル検査によるgermline findingの同定

中田英二, 藤原智洋, 国定俊之, 二川摩周, 平沢晃, 尾崎敏文

中部日本整形外科災害外科学会雑誌 65 ( 春季学会 ) 125 - 125 2022年4月

術前術後CTと術中に計測した骨盤傾斜の角度の差についての比較検討

小浦卓, 鉄永智紀, 佐藤嘉洋, 廣瀬一樹, 尾崎敏文, 山田和希

中国・四国整形外科学会雑誌 34 ( 1 ) 1 - 5 2022年4月

脊椎手術を受ける患者から骨粗鬆症治療が必要な患者を見つけ出す

高尾真一郎, 三澤治夫, 鉄永倫子, 魚谷弘二, 小田孔明, 尾崎敏文

中部日本整形外科災害外科学会雑誌 65 ( 春季学会 ) 111 - 111 2022年4月

内側楔状骨背側脱臼骨折の1例

福岡史朗, 依光正則, 畑利彰, 佐藤浩平, 上原健敬, 尾崎敏文

中部日本整形外科災害外科学会雑誌 65 ( 春季学会 ) 199 - 199 2022年4月

尺骨突き上げ症候群に対する尺骨骨幹部短縮骨切り術と遠位部短縮骨切り術の治療成績の比較

齋藤太一, 根津智史, 島村安則, 西田圭一郎, 尾崎敏文

日本手外科学会雑誌 39 ( 1 ) O66 - 5 2022年4月

Management of elderly patients with bone and soft tissue sarcomas: JCOG Bone and Soft Tissue Tumor Study Group 国際誌

Kazuhiro Tanaka, Toshifumi Ozaki

Japanese Journal of Clinical Oncology 52 ( 6 ) 526 - 530 2022年3月

担当区分：最終著者記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：Oxford University Press (OUP)

Abstract

Approximately, 40% of bone sarcomas and 60% of soft tissue sarcoma arise in patients aged ≥65 years. However, because sarcoma is very rare, there is little evidence regarding the management of elderly patients with sarcoma. Age has been reported as a prognostic factor in patients with sarcomas. The standard therapy for all localized bone and soft tissue sarcomas is surgical resection, even in elderly patients. Radiation or ion-beam therapy can be considered for unresectable sarcomas. Although adjuvant chemotherapy is standard for osteosarcoma, the usefulness of adjuvant chemotherapy for elderly patients has not been verified; therefore, it may not be recommended for elderly patients with osteosarcoma. For elderly patients with advanced osteosarcoma, if general conditions permit, doxorubicin- and/or ifosfamide-based regimens as well as molecular-targeted therapies, including sorafenib, regorafenib and everolimus, may be considered, although these drugs have not been approved for sarcoma in Japan. Adjuvant chemotherapy with doxorubicin plus ifosfamide is recommended for patients with high-risk localized soft tissue sarcoma if they are aged ≤70 years. For first-line treatment of advanced soft tissue sarcoma in elderly patients, doxorubicin monotherapy is considered to be the standard regimen, and pazopanib can be an alternative. For second-line treatment, gemcitabine-based regimens, pazopanib, trabectedin and eribulin may be options for elderly patients with advanced soft tissue sarcoma.

DOI： 10.1093/jjco/hyac027

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