Primary malignant tumours of the scapula—a review of 29 cases
- 458 Downloads
- 12 Citations
Abstract
Purpose
Primary malignant bone tumours of the scapula are very rare. Apart from limited small series and some case reports, international literature on flat bone sarcoma is exiguous and not much is known about the oncological outcome.
Methods
A retrospective analysis of 29 patients diagnosed with a primary malignant tumour of the scapula was performed. The mean age was 40 years. The average time of follow-up was 60 months. Diagnoses included chondrosarcoma in 11 patients, Ewing’s sarcoma/PNET in six, osteosarcoma in three, and others in nine.
Results
Five patients (19 %) had no surgery. Wide resection was performed in 18 patients (74 %) and marginal and intralesional resection in three patients (13 %) each. Fifteen patients underwent resection without bony reconstruction, seven patients underwent a Tikhoff-Linberg procedure, and two patients received a custom-made scapula prosthesis. Six patients were diagnosed with metastasis after a mean time of nine months after surgery, while three patients suffered local recurrence at an average of six months after surgery. Disease-specific survival was 70 % at one year and 47 % at five years. The mean MSTS score was 69 % and was highest for patients with scapular prosthesis.
Conclusion
The overall prognosis of primary malignant bone tumours of the scapula remains to be inferior compared to extremity sarcoma. Endoprosthetic reconstruction, however, shows promising functional results even in cases of total scapulectomy.
Keywords
Scapula Tumour ReconstructionNotes
Conflict of Interest
The authors did not receive any outside funding or grants in support of their research for or preparation of this work. Neither they nor a member of their immediate families received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity.
Synopsis
A single-centre study of 29 patients with a primary malignant tumour of the scapula was performed. This research article demonstrates the surgical as well as the oncological outcome.
References
- 1.Gibbons CL, Bell RS, Wunder JS, Griffin AM, O’Sullivan B, Catton CN, Davis AM (1998) Function after subtotal scapulectomy for neoplasm of bone and soft tissue. J Bone Joint Surg Br 80:38–42PubMedCrossRefGoogle Scholar
- 2.Hayashi K, Karita M, Yamamoto N, Shirai T, Nishida H, Takeuchi A, Kimura H, Miwa S, Tsuchiya H (2011) Functional outcomes after total scapulectomy for malignant bone or soft tissue tumours in the shoulder girdle. Int J Clin Oncol 16:568–573. doi: 10.1007/s10147-011-0229-z PubMedCrossRefGoogle Scholar
- 3.Mayil Vahanan N, Mohanlal P, Bose JC, Gangadharan R, Karthisundar V (2007) The functional and oncological results after scapulectomy for scapular tumours: 2-16-year results. Int Orthop 31:831–836. doi: 10.1007/s00264-006-0261-1 PubMedCrossRefPubMedCentralGoogle Scholar
- 4.Depalma AF (1954) Scapulectomy and a method of preserving the normal configuration of the shoulder. Clin Orthop 4:217–224PubMedGoogle Scholar
- 5.Mavrogenis AF, Mastorakos DP, Triantafyllopoulos G, Sakellariou VI, Galanis EC, Papagelopoulos PJ (2009) Total scapulectomy and constrained reverse total shoulder reconstruction for a Ewing’s sarcoma. J Surg Oncol 100:611–615. doi: 10.1002/jso.21340 PubMedCrossRefGoogle Scholar
- 6.Wittig JC, Bickels J, Wodajo F, Kellar-Graney KL, Malawer MM (2002) Constrained total scapula reconstruction after resection of a high-grade sarcoma. Clin Orthop Relat Res 397:143–155Google Scholar
- 7.O’Connor MI, Sim FH, Chao EY (1996) Limb salvage for neoplasms of the shoulder girdle. Intermediate reconstructive and functional results. J Bone Joint Surg Am 78:1872–1888PubMedGoogle Scholar
- 8.Wittig JC, Bickels J, Kollender Y, Kellar-Graney KL, Meller I, Malawer MM (2001) Palliative forequarter amputation for metastatic carcinoma to the shoulder girdle region: indications, preoperative evaluation, surgical technique, and results. J Surg Oncol 77:105–113, discussion 114PubMedCrossRefGoogle Scholar
- 9.Syme J (1864) Excision of the scapula. Monograph Edmonston and Douglas, EdinburghGoogle Scholar
- 10.Malawer MM SD, Eckardt JJ (1998) Shoulder girdle and proximal humerus. In: Simon MA, Springfield D (eds) Surgery for bone and soft-tissue tumours Philadelphia. Lippincott-Raven Publishers, Philadelphia, pp 299–321Google Scholar
- 11.Adam YG, Rosen A, Oland J, Halevy A (1983) Scapulectomy revisited: soft part sarcomas of the posterior shoulder. Isr J Med Sci 19:176–179PubMedGoogle Scholar
- 12.Burwell HN (1965) Resection of the shoulder with humeral suspension for sarcoma involving the scapula. J Bone Joint Surg Br 47:300–303PubMedGoogle Scholar
- 13.James ES (1957) Subtotal removal of the scapula for aneurysmal bone cyst. J Bone Joint Surg Br 39-B:128–130PubMedGoogle Scholar
- 14.Papaioannou AN, Francis KC (1965) Scapulectomy for the treatment of primary malignant tumours of the scapula. Clin Orthop Relat Res 41:125–132PubMedCrossRefGoogle Scholar
- 15.Peltier LF (1972) Radical local excision in the treatment of malignant tumours of the shoulder girdle (the Tikhov-Linberg operation): report of a case. J Surg Oncol 4:376–379PubMedCrossRefGoogle Scholar
- 16.Pant R, Yasko AW, Lewis VO, Raymond K, Lin PP (2005) Chondrosarcoma of the scapula: long-term oncologic outcome. Cancer 104:149–158. doi: 10.1002/cncr.21114 PubMedCrossRefGoogle Scholar
- 17.Capanna R, van Horn JR, Biagini R, Ruggieri P, Ferruzzi A, Campanacci M (1990) The Tikhoff-Linberg procedure for bone tumours of the proximal humerus: the classical “extensive” technique versus a modified “transglenoid” resection. Arch Orthop Trauma Surg 109:63–67PubMedCrossRefGoogle Scholar
- 18.Voggenreiter G, Assenmacher S, Schmit-Neuerburg KP (1999) Tikhoff-Linberg procedure for bone and soft tissue tumours of the shoulder girdle. Arch Surg 134:252–257PubMedCrossRefGoogle Scholar
- 19.Pritsch T, Bickels J, Wu CC, Squires MH, Malawer MM (2007) Is scapular endoprosthesis functionally superior to humeral suspension? Clin Orthop Relat Res 456:188–195. doi: 10.1097/01.blo.0000238840.26423.b6 PubMedCrossRefGoogle Scholar
- 20.Tang X, Guo W, Yang R, Ji T, Sun X (2011) Reconstruction with constrained prosthesis after total scapulectomy. J Shoulder Elbow Surg 20:1163–1169. doi: 10.1016/j.jse.2010.12.014 PubMedCrossRefGoogle Scholar
- 21.Malawer MM, Meller I, Dunham WK (1991) A new surgical classification system for shoulder-girdle resections. Analysis of 38 patients. Clin Orthop Rel Res 267:33–44Google Scholar
- 22.Malawer MM (1991) Tumours of the shoulder girdle. Technique of resection and description of a surgical classification. Orthop Clin North Am 22:7–35PubMedGoogle Scholar
- 23.Enneking WF, Dunham WK (1978) Resection and reconstruction for primary neoplasms involving the innominate bone. J Bone Joint Surg Am 60:731–746PubMedGoogle Scholar
- 24.Funovics PT, Bucher F, Toma CD, Kotz RI, Dominkus M (2011) Treatment and outcome of parosteal osteosarcoma: biological versus endoprosthetic reconstruction. J Surg Oncol 103:782–789. doi: 10.1002/jso.21859 PubMedCrossRefGoogle Scholar
- 25.Enneking WF, Dunham W, Gebhardt MC, Malawar M, Pritchard DJ (1993) A system for the functional evaluation of reconstructive procedures after surgical treatment of tumours of the musculoskeletal system. Clin Orthop Rel Res 286:241–246Google Scholar
- 26.Marcove RC, Lewis MM, Huvos AG (1977) En bloc upper humeral interscapulo-thoracic resection. The Tikhoff-Linberg procedure. Clin Orthop Rel Res 124:219–228Google Scholar
- 27.Badhwar R (1990) Reconstruction following limb-sparing en bloc resection of the shoulder girdle–Tikhoff-Linberg procedure. Indian J Cancer 27:31–37PubMedGoogle Scholar
- 28.Zhang K, Duan H, Xiang Z, Tu C (2009) Surgical technique and clinical results for scapular allograft reconstruction following resection of scapular tumours. J Exp Clin Cancer Res 28:45. doi: 10.1186/1756-9966-28-45 PubMedCrossRefPubMedCentralGoogle Scholar
- 29.Masamed R, Learch TJ, Menendez LR (2008) En bloc shoulder resection with total shoulder prosthetic replacement: indications and imaging findings. AJR Am J Roentgenol 191:482–489. doi: 10.2214/AJR.07.3286 PubMedCrossRefGoogle Scholar
- 30.Shin KH, Rougraff BT, Simon MA (1994) Oncologic outcomes of primary bone sarcomas of the pelvis. Clin Orthop Relat Res 304:207–217Google Scholar
- 31.Wirbel RJ, Schulte M, Mutschler WE (2001) Surgical treatment of pelvic sarcomas: oncologic and functional outcome. Clin Orthop Relat Res 390:190–205Google Scholar
- 32.Windhager R, Karner J, Kutschera HP, Polterauer P, Salzer-Kuntschik M, Kotz R (1996) Limb salvage in periacetabular sarcomas: review of 21 consecutive cases. Clin Orthop Relat Res 331:265–276Google Scholar