Management of Giant Cell Tumour: A Nigerian Experience

Giant cell tumours (GCT) are the commonest bone tumours worldwide. It is rarely malignant but when it does it progresses to fibrosarcoma with high mortality. Otherwise it causes poor cosmesis, disability and pathological fractures. A total of 19 cases of histologically established Giant cell tumour of the bone were reviewed prospectively in a 5 year study. 14 cases were benign, 4 malignant and one was a malignant transformation. Lesions around the knee accounted for 42.2% of the cases, but the radius was the commonest single bone affected with 26.3%. Eleven patients had curettage, five of them had autogenous bone grafting while the remaining six had bone grafting and plate augmentation. One patient had fore-quarter amputation while seven had tumour resection. There was no recurrence recorded among those that had currretage and autogenous bone grafting. 33% of those that had curettage and bone cementing as well as 16.6% of those that had resection presented with recurrence. One patient died within 3 months of surgery due to metastasis to the lungs, liver and spleen. Mean follow up was 9.2 months (range of 2 to 60 months). With early presentation, curretage and bone grafting is often effective; late presentation however has an increased risk of recurrence due to soft tissue involvement, dearth of investigative tools and financial constraints. Nigerian Journal of Surgical Sciences Vol. 17 (2) 2007: pp. 91-9

Extremity Soft Tissue Sarcoma: A Review of 19 Cases.

Background: Although soft tissue sarcoma is a rare tumour, it accounts for a significant proportion of malignancies seen in many orthopaedic practices. The objectives of this study are to evaluate the pattern of presentation of extremity soft tissue sarcoma and the treatment outcome in our patients. Method: This is a 3 year prospective study in patients presenting with extremity soft tissue sarcoma at the oncology unit of the National Orthopedic Hospital Lagos. Data, such as age, sex, presenting complaints, anatomic location of lesions, histologic type of tumour, and treatment outcome were retrieved from prepared proforma. The average follow up period was 22.8 months. Results: Nineteen patients were studied. The age range of the patients was 3 to 69 years, male to female ratio of 1.7: 1. Most tumours were located in the thigh and the leg, and malignant fibrous histiocytoma was the most common histologic diagnosis. Whilst all the patients presented with stages II and III diseases, limb salvage was only possible in 52.6% of these patients. Surgery was always combined with adjuvant radiotherapy. A survival rate of 69% and a recurrence rate of 16% were recorded over the period of the study. Conclusion: Delayed presentation limited the scope of limb salvage surgery in centers such as ours, but appropriate tumour excision and adjuvant radiotherapy remains the mainstay of the management. Nigerian Journal of Orthopaedics and Trauma Vol. 6 (2) 2007: pp. 77-7

Challenges in the diagnosis and management of musculoskeletal tumours in Nigeria

The management of musculoskeletal tumours is important because of the high mortality rates associated with the available treatment modalities. A 5-year prospective study of bone and soft-tissue tumours is presented, along with the difficulties encountered in diagnosis and treatment. There were 71 patients (male:female ratio of 1.7:1, age range 5–85 years, mean age 32 years) with an average duration of 24.7 weeks (range 1 day to 34 years) before presentation. No patient had computed tomography (CT) scanning or magnetic resonance imaging (MRI) due to financial constraints, 95% had biopsies and X-rays, 15% could afford chemotherapy/ror chemotherapy is a sad consequence. 50% agreed to amputation. In the soft-tissue sarcoma group, only one of three patients could pay for limb-sparing surgery. In the benign group, 65% had limb-sparing surgeries and 15% had amputation. Fifty percent (50%) of patients were lost to follow up within 3 months and 39% of the malignant group died within the same period. Musculoskeletal tumours are a reality in our environment and a significant portion of our population have financial limitations. Ignorance and cultural beliefs promote late presentation to our hospitals, which are poorly equipped to give optimal care, despite the presence of trained personnel

Life or limb: an international qualitative study on decision making in sarcoma surgery during the COVID-19 pandemic.

The COVID-19 pandemic is unprecedented as a global crisis over the last century. How do specialist surgeons make decisions about patient care in these unprecedent times? Between April and May 2020, we conducted an international qualitative study. Sarcoma surgeons from diverse global settings participated in 60 min interviews exploring surgical decision making during COVID-19. Interview data were analysed using an inductive thematic analysis approach. Participants represented public and private hospitals in 14 countries, in different phases of the first wave of the pandemic: Australia, Argentina, Canada, India, Italy, Japan, Nigeria, Singapore, Spain, South Africa, Switzerland, Turkey, UK and USA. From 22 invited sarcoma surgeons, 18 surgeons participated. Participants had an average of 19 years experience as a sarcoma surgeon. 17/18 participants described a decision they had made about patient care since the start of the pandemic that was unique to them, that is, without precedence. Common to 'unique' decisions about patient care was uncertainty about what was going on and what would happen in the future (theme 1: the context of uncertainty), the impact of the pandemic on resources or threat of the pandemic to overwhelm resources (theme 2: limited resources), perceived increased risk to self (theme 3: duty of care) and least-worst decision making, in which none of the options were perceived as ideal and participants settled on the least-worst option at that point in time (theme 4: least-worst decision making). In the context of rapidly changing standards of justice and beneficence in patient care, traditional decision-making frameworks may no longer apply. Based on the experiences of surgeons in this study, we describe a framework of least-worst decision making. This framework gives rise to actionable strategies that can support decision making in sarcoma and other specialised fields of surgery, both during the current crisis and beyond