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The Revista Española de Cirugía Ortopédica y Traumatología Journal of Orthopaedics Surgery and Traumatology is the struccture publication of the Spanish Society of Orthopaedic Surgery and Traumatology that has a combined total of 5, members, and is the leading Spanish journal of the specialty. In the contents of the Journal, priority is given to original research articles on the specialty, which is also its main aim; the publication of the best original research articles in Spanish.
In each issue it also publishes one or two clinical cases that are of great interest to the readers, since they are usually exceptional cases that are difficult to diagnose or treat. The Updates and Research Works sections are of great interest to specialists, due to the careful selection of the topics. The Editorial Committee consists of 10 independent members, specialists of recognised prestige that are not associated with the governing bodies of the Society.
All works are evaluated blind by at least 3 peer reviewers, whose judgements are recurrencee supervised by the Editor of the particular area of knowledge and by the Journal Editor in Chief. SRJ is a prestige metric emant on the idea that not all citations are the same. SJR uses a similar algorithm as the Google page rank; what does a constant mean in science provides a quantitative daya qualitative measure of the journal's impact.
SNIP measures contextual citation impact by wighting citations based on the total number of citations in a subject field. To evaluate the clinical, radiological and histological factors that can predict local recurrence of fibromatosis. A retrospective study was conducted on 51 patients diagnosed with fibromatosis in this hospital from to The mean follow-up was 83 structhre.
A study was made of the clinical parameters, location, depth, size, surgical margins, and proliferation index Ki An evaluation was also made of the risk of recurrence depending on the adjuvant treatment and the relationship between treatment and patient functionality. There were no statistically significant differences in age, gender, size, surgical margins, or adjuvant treatments, or in the Musculoskeletal Tumour Society Score according whzt the what is meant by recurrence relation in data structure received.
The mean Ki was 1. Deep fibromatosis fascia tumours, and those located in extremities are more aggressive than superficial tumours and those located in trunk. The Ki has no predictive value in local recurrence of fibromatosis. Radiotherapy, chemotherapy, or other adjuvant treatments such as tamoxifen have not been effective in local control of the disease. Valorar los factores clínicos, radiológicos e histológicos que pueden predecir la recidiva local de fibromatosis.
Hemos realizado un estudio retrospectivo de 51 pacientes con diagnóstico de fibromatosis en nuestra institución desde hasta La media de seguimiento es de 83 meses. Asimismo, hemos valorado el riesgo de recidiva en función del tratamiento adyuvante y la relación del tratamiento con la funcionalidad del paciente. El Ki no tiene valor predictivo en las recidivas de la fibromatosis.
La radioterapia, la quimioterapia u otros tratamientos adyuvantes como el tamoxifeno no han sido eficaces en el control local de la enfermedad. Fibromatosis, or desmoid tumour, is a clonal proliferation tumour deriving from mesenchymal cells seated in the fascia and musculoaponeurotic structures. It constitutes a rare group of soft tissue tumours, with an incidence of 2.
For many years, this tumour was treated by surgery fundamentally, reserving chemotherapy, radiotherapy and other systemic treatments such as tamoxifen or more recently, imatinib or toremifine, 2,4 for cases with positive surgical margins to improve local control of the disease. It can appear in why are family relationships difficult any part of the body 5,6 and is locally aggressive, with a high local recurrence rate, despite broad surgical resection, although it lacks the capacity for remote metastasis.
Conservative management has been proposed recently as an acceptable treatment option, since it is not unusual how do i stop my phone from syncing with my contacts the tumour to stop growing spontaneously. This would prevent functional complications and post-radiation effects associated with the conventional, radical management of fibromatosis.
Because this is a rare entity, the series available in the literature enable us to establish a consensus on some of the factors that influence the natural evolution of the disease. It is our intention to evaluate the data that might predict local recurrence. We undertook a retrospective study identifying patients with an anatomopathological diagnosis of fibromatosis in our institution from to Patients with a clinical diagnosis of Dupuytren's, Ledderhose disease or intra-abdominal desmoid tumour were excluded from the study, because their prognosis is more favourable, and patients with an unclear final diagnosis.
Due to the wide range of years over which our patients were diagnosed, we also gathered the variations in the type of treatment through that time. All our cases were identified initially as primary or recurrences as they presented in our centre. However, this difference was bt taken into account in the statistical analysis for classifying the primary tumours or recurrences, or the subsequent determination of risk factors.
Finally, the tumour fecurrence was divided into 2 large groups: extremities and trunk, the latter included neck, breast, chest wall, abdominal wall and paravertebrals. The initial treatment of our patients was evaluated. Most underwent surgery as single therapy. Some cases received adjuvant treatment as etructure as surgery, such as radiotherapy, chemotherapy and tamoxifen. The resection margins strucgure classified according to Enneking's criteria.
In addition, a revision of the histological preparations was made to quantify the Ki of the histological blocks from onwards. Our series includes 51 patients with a clinical and anatomopathological diagnosis of fibromatosis. Twenty-nine of these patients were treated primarily in our centre, and 22 presented as recurrences. The mean follow-up was 83 months range 6— months. The mean age at time of diagnosis was 26 years, with a range from 2 to 68 years.
Distribution by gender showed a slight male predominance, unlike the other published series. The mean size, measured as the maximum tumour diameter, was 9. Most of the tumours were found deep in the fascia. The imaging test used to study the tumours was initially ultrasound. From onwards, diagnosis was made by magnetic resonance. A complete macroscopic and microscopic R0 resection was achieved in 11 patients. The margins were microscopically positive R1 in 16 patients, and jn 11 cases, the resection was intentionally incomplete on entry R2 due, principally, to the great morbidity resulting from radical surgery in certain locations such as the popliteal fossa, groin and axilla.
We have no information on the relaation of the resection margins of the primary tumour for 13 patients Table 1. Characteristics of the patients with fibromatosis and of the primary tumour. In our patients, what is meant by recurrence relation in data structure proliferation rate, quantified using Ki, was a mean 1. The mean time between the primary resection and the first recurrence was 32 month range 2— monthsalthough recurrence within the first year Fig.
The mean time until repeat recurrence is similar to that of the first mean Due to the limited number of cases treated with adjuvant therapies, no clear pattern for choosing this treatment was established. However, we did observe a variation over the years in terms of the type of radiotherapy. Up untilpatients who underwent radiotherapy received what is meant by recurrence relation in data structure radiotherapy complemented later with external radiotherapy, whereas from onwards brachytherapy which events have a causal relationship external radiotherapy was used.
In both groups, the mean dose received was 45 Gy, and in no case did this exceed 60 Gy. We saw no homogeneity in terms of chemotherapy protocol either Table 2. Protocols of chemotherapy administered. Twenty-seven patients are currently disease-free, 8 are in the progression phase, 15 are in stable disease phase, and for one patient we have no information. We observed no statistically significant differences in our series with regard to gender, age, size, margins or initial treatment as risk factors for local recurrence.
The statistically significant p value results are in fata. In most current studies, keant surgical margins are considered a risk factor of local recurrence; however, there is no universal consensus on the matter. How to play a beat on the drums there is no unanimity in this regard, the negative effect of incomplete surgery with positive margins R1, R2 on local recurrence of the disease has a strong biological basis.
Most are sporadic, although a small percentage is associated with APC gene mutations, in Gardner syndrome. This protein plays an important role in healing, since it stimulates the proliferation of fibroblasts, and therefore is also important in fibroproliferative disorders. Incomplete resection of a tumour involves leaving genetically altered cells in the bed exposed to the healing mechanisms of the tissues. Thus, surgery itself acts as a cancer potentiator in cases where there is a beta-catenin aberration.
The mutations of this gene that are associated with fibromatosis are T41A, S45F and 45P, but S45F is the only one of prognostic value as a predictor of local recurrence. As we have structurw to date, the what is meant by recurrence relation in data structure of this tumour is unpredictable, up to a certain point. In many cases, there is a high tendency for local recurrence despite apparently etructure resection. Furthermore, some studies support the fact that adjuvant therapies can be effective in controlling the disease.
However, there what is mean by relationship manager no consensus in this regard, since there are desmoid tumours that have been observed to stop growing spontaneously. We must remember, in our series, that treatment by periodic monitoring only took place in patients who had already developed local recurrence, therefore we do not know what would have happened if we had not operated the primary tumours.
In high grade tumours, when we observe multiple recurrences, the disease-free time between each recurrence progressively shortens. In desmoid tumours, recurrences do not follow this pattern. As we saw in our series, the recurrences, both primary and secondary, occurred most frequently during the first year, without the disease-free time between the first and the second recurrence being significantly shortened.
Due to the lack of evidence in our series on the wjat of the various treatments on local control of the disease, we cannot actively recommend the use of radiotherapy, chemotherapy or tamoxifen as adjuvant treatment. It recurence observed that in selected cases, where the tumour was asymptomatic and did not display aggressive behaviour throughout follow-up, conservative treatment by periodic monitoring achieved local control of the disease at 3 years similar to that of the patients who underwent complete resection R0.
Due to the high rate of local recurrence and the morbidity after multiple surgeries, a wait-and-see approach should be considered for all desmoid tumours, primary or recurrences, which are asymptomatic and have not grown throughout their evolution. Level of evidence III. The authors declare that no experiments were performed on humans or animals for this study. The authors declare that whats average speed have followed the protocols of their centre of work regarding the publication of patient data.
The authors declare that no patient data appear in this article. The authors have no conflict of interests to declare. To Dr. Juan Pons de Villanueva and Dr. Factores de riesgo para la recidiva local de la fibromatosis. Rev Esp Cir Ortop Traumatol. ISSN: Previous article Next article. Issue 2.
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