BACKGROUND:We investigated the impact of the implementation of a network of reference centers for sarcomas (NETSARC) on the care and survival of sarcoma patients in France since 2010. PATIENTS AND METHODS:NETSARC (netsarc.org) is a network of 26 reference sarcoma centers with specialized multidisciplinary tumor boards (MDTBs), funded by the French National Cancer Institute (INCa) since 2010. Its aims are to improve the quality of diagnosis and care of sarcoma patients. Patients' characteristics, treatments, and outcomes are collected in a nationwide database. The objective of this analysis was to compare the survival of patients in three periods: 2010-2012 (non-exhaustive), 2013-2015, and 2016-2020. RESULTS:A total of 43 975 patients with sarcomas, gastrointestinal stromal tumors (GISTs), or connective tissue tumors of intermediate malignancy were included in the NETSARC+ database since 2010 (n = 9266 before 2013, n = 12 274 between 2013 and 2015, n = 22 435 in 2016-2020). Median age was 56 years, 50.5% were women, and 13.2% had metastasis at diagnosis. Overall survival was significantly superior in the period 2016-2020 versus 2013-2015 versus 2010-2012 for the entire population, for patients >18 years of age, and for both metastatic and non-metastatic patients in univariate and multivariate analyses (P < 0.0001). Over the three periods, we observed a significantly improved compliance to clinical practice guidelines (CPGs) nationwide: the proportion of patients biopsied before surgery increased from 62.9% to 72.6%; the percentage of patients presented to NETSARC MDTBs before first surgery increased from 31.7% to 44.4% (P < 0.0001). The proportion of patients with R0 resection on first surgery increased (from 36.1% to 46.6%), while R2 resection rate decreased (from 10.9% to 7.9%), with a better compliance and improvement in NETSARC centers. CONCLUSIONS:The implementation of the national reference network for sarcoma was associated with an improvement of overall survival and compliance to guidelines nationwide in sarcoma patients. Referral to expert networks for sarcoma patients should be encouraged, though a better compliance to CPGs can still be achieved.

Treatment of sarcomas within networks of reference center is associated with improved outcome. We report on the nationwide impact of the NETSARC+ network on sarcoma survival since 2010 in France. NETSARC+ is a national network of 26 reference sarcoma centers with multidisciplinary tumor boards (MDTB) active since 2010, in charge of mandatory pathology review, and collection of patients characteristics in the netsarc.org nationwide database. Exhaustivity of cases collection was reached since 2013. The characteristics of patients with follow-up are presented, as well as the management procedures and overall survival in 3 periods:2010-12 (Period 1, non-exhaustive), 2013-15 (period 2), and 2016-20 (period 3). Patient series is considered exhaustive in periods 2 and 3. 43,975 patients with sarcomas and tumors of intermediate malignancy were included in the NETSARC+ database since 2010 (n=9,266 [2010-12], n=12,247 [2013-15], n=22,435 [2016-20]). Median age is 59 years, 50.5% are women, 13.2% were metastatic at diagnosis. The 3 most frequent histotypes were liposarcomas, leiomyosarcomas, and UPS. Over the 3 periods, the percentage of patients 1) biopsied before surgery increased from 63% to 76%, 2) presented to the MDTB before the 1st treatment increased from 32% to 45%, 3) operated in reference centers increased from 55% to 59%, 4) re-operated after 1st surgery decreased from 13% to 9% (p<0.0001 for all tests across the 3 periods, and for comparisons between the 2 exhaustive periods 2 vs 3). With a median follow-up of 14 months in the whole series, the overall survival was significantly superior in the series of patients operated in the period 2017-20 vs 2013-2016 vs 2010-12 (p<0.0001). Comparison of survival in the two most recent exhaustive periods showed a superior survival for patients in 2016-20 vs 2013-15 periods (HR=0.82) in patients aged >18 (HR=0.81), both metastatic (HR=0.68) and non-metastatic (HR=0.82) (p<0.0001 for all). A 24% reduction of the relative risk of death at 12 months was observed in the 2016-20 period. The implementation of the NETSARC+ national reference network since 2010 in France is associated with an improvement of the overall survival nationwide in sarcoma patients.

La prise en charge des IOA repose sur la chirurgie et une antibiothérapie personnalisée et prolongée. À la sortie d’hospitalisation, le risque d’interruption anticipée du traitement est conséquent et multifactoriel (non-adhésion du patient, difficultés d’approvisionnement, survenue d’effets indésirables (EI)). Afin d’améliorer l’information du patient sur l’importance de la régularité de prise de ses antibiotiques pour endiguer l’IOA, des entretiens pharmaceutiques ont été mis en place. Ce travail a pour objectif de décrire le dispositif mis en place pour accompagner et sécuriser la sortie des patients et d’évaluer son intérêt. Un travail pluridisciplinaire (anesthésistes, infectiologues et pharmacien) a abouti à la réalisation de fiches antibiotiques validées par notre centre de référence des IOA (CRIOA). Ces dernières sont constituées d’un plan de prise personnalisable, des conduites à tenir pour les principaux EI, des mises en garde sur les principales interactions médicamenteuses (IM) et des modalités d’obtention des antibiotiques (rétrocession hospitalière ou officine de ville). L’entretien éducatif est réalisé en amont de la sortie par le pharmacien responsable du service de chirurgie orthopédique. Les différents points sont repris de manière personnalisée et s’accompagnent de la réalisation d’un bilan des IM. Au moment de la sortie, la prescription du patient est validée par le pharmacien hospitalier. Toutes les interventions pharmaceutiques issues de cette analyse sont colligées. Entre janvier et juillet 2021, 84 entretiens pharmaceutiques ont été réalisés (âge moyen 54 ans, sexe-ratio H/F 1,5). Huit patients étaient sous monothérapie, 70 sous bithérapie et 6 sous trithérapie. Les antibiotiques les plus prescrits étaient la lévofloxacine (n = 60), la rifampicine (n = 27) et la clindamycine (n = 17). La durée totale prévue d’antibiothérapie était de 15 jours (n = 6), 6 semaines (n = 55), 12 semaines (n = 19), 6 mois (n = 1) ou indéterminée (n = 3), antibiothérapie suppressive. Sur l’ordonnance de sortie, les patients avaient en moyenne 3,6 lignes de traitement et 27 IM ont pu être prévenues et expliquées au patient. L’analyse de la prescription de sortie a permis d’intercepter 8 erreurs médicamenteuses concernant les antibiotiques (7 omissions et 1 sous-dosage). Les entretiens pharmaceutiques permettent de proposer des conduites à tenir et de limiter les IM ; ils devraient permettre également de favoriser l’adhésion médicamenteuse. Ce dispositif est aussi l’occasion de renforcer le lien ville-hôpital. Depuis août 2021, il s’accompagne d’un appel systématique au pharmacien de l’officine des patients avec envoi des fiches antibiotiques et justification de schémas posologiques non usuels, mais validés en CRIOA. À travers ce programme, le pharmacien se positionne comme un acteur majeur du circuit patient, et ce, d’autant plus dans la prise en charge complexe des IOA.

COVID-19 pandemic has disorganized cancer care management, with a significant decrease in diagnosed common cancer cases such as colon or breast. In France, the management of STS is organized by a network of multidisciplinary tumor boards (MTD) covering the French territory. We describe the number of incident STS cases, delay between diagnosis and 1st surgical procedure, and rate of neoadjuvant treatments in 2019 versus 2020. Eligible cases were confirmed cases of STS (diagnosed within or outside the accredited network) in adult patients; arising in limbs, girdles, superficial and internal trunk. Osseous, and visceral (e.g., GIST) were excluded. The data collected in the national database (NETSARC+) describe the activity of the 25 labelled MTD dedicated to sarcoma management. We present the data using percentages, mean and standard deviation (DS). Incident cases slightly decreased: 1,463 in 2019 versus 1,415 in 2020. Mean age, rate of male patients, tumor size, rate of Grade 1 tumors and M1 at diagnosis were similar: 62.2 (DS: 17.3) versus 63.3 (DS: 16.7); 54.8% versus 52.4%; 104 mm (DS: 79.2) versus 105.3 (DS: 77.5); 14.2% versus 14.1%; and 10.0% versus 10.5%, respectively. In 2019, 68.8% of STS were operated compared to 73.8% in 2020. The mean delay between diagnosis and surgery was 70.4 days (DS: 86.7) versus 72.2 (DS: 76.8). Surgery was performed in accredited centers in 53.5% in 2019 compared to 61.2% in 2020. Outside the network, the rate of R0 resection was 19.9% versus 27.8%. Inside accredited centers, the rate of R0 resection was 60.9 versus 69.8%. In parallel, the use of neoadjuvant treatment was 21.0% in 2019 and 26.4% in 2020. During COVID-19, we observed a slight decrease in STS incidence, while patients’ characteristics did not differ between 2019 and 2020. Both the rate of patients operated in accredited centers and R0 resections increased. There was no neoadjuvant treatment increase nor surgery delay. The accredited network therefore appears particularly robust in the event of major Health crisis.

Desmoid tumors (DT) are characterized by an unpredictable course. Most of the existing literature consists of retrospective studies. In a previous double-blind phase 3 trial comparing sorafenib and placebo, the 2-year Progression Free Survival (PFS) rate of the placebo group was 36% (Gounder NEJM 2018). However, assigned patients had already progressive or recurrent DT. The primary endpoint of this observational phase 2 study was to evaluate PFS and treatments at progression of newly diagnosed sporadic DT.

Although STSs are rare, the incidences among different geographic and ethnical populations have not been investigated thoroughly. Differences in cancer incidences may signal different underlying biology.

Le but de ce travail a été d’établir les rapports entre le syndrome des tunnels médian et ulnaire et les douleurs d’épaule, compte tenu de leur fréquence. Il s’agit d’une étude rétrospective non randomisée de 596 neurolyses dont 209 cas présentaient une douleur de l’épaule. Deux sous-groupes ont été étudiés. Le groupe 1 était constitué de : 109 cas de douleurs du moignon de l’épaule antérieure ou externe (77 femmes et 32 hommes), et le groupe 2 était composé de : 100 cas de douleurs postérieures de l’épaule ou de la scapula (64 femmes et 36 hommes). L’âge moyen des patients était de 55 ans pour le groupe 1 versus 49 ans pour le groupe 2. Le motif de consultation initial était : un syndrome du canal carpien (66 % groupe 1, 32 % groupe 2) ; un syndrome du canal carpien et du tunnel ulnaire (16 % groupe 1, 17 % groupe 2) ; une tendinopathie de l’épaule (3 % groupe 1, 27 % groupe 2). Les douleurs étaient principalement nocturnes (88 %) et associées à des acroparesthésies des doigts (médio-ulnaires : 60 % dans le groupe 1 et 69 % dans le groupe 2). La majorité des patients ont eu un EMG qui montrait un syndrome du canal carpien (62 % groupe 1, 41 % groupe 2), un syndrome canalaire au niveau du tunnel ulnaire (6 % groupe 1, 17 % groupe 2) ou les deux associés (15 % groupe 1 et 13 % groupe 2) ou bien un examen normal (17 % groupe 1, 26 % groupe 2). Les patients ont été opérés en fonction de la clinique, de l’électromyogramme et du résultat du test infiltratif thérapeutique. Il a été pratiqué une neurolyse du médian (33 cas groupe 1, 5 cas groupe 2), du nerf ulnaire (4 cas groupe 1, 12 cas groupe 2) et des deux (72 cas dans le groupe 1, 83 cas dans le groupe 2). Les critères d’évaluation des résultats étaient l’atteinte clinique et/ou électromyographique et l’effet de la neurolyse sur la douleur atypique, à l’aide du logiciel R®. Nous avons constaté une corrélation significative entre les scapulalgies et l’atteinte cubitale au coude dans le groupe 2 et l’atteinte du nerf médian au canal carpien dans le groupe 1. La projection de la douleur cubitale n’a jamais été étudiée. Le syndrome du nerf médian au poignet serait plus pourvoyeur de douleurs antérieures de l’épaule alors que le tunnel cubital au coude engendrerait plus de douleurs postérieures au niveau de la scapula. Étude rétrospective comparative, bicentrique, niveau de preuve : 3. The purpose of this work was to determine the relationship between upper limb tunnel syndromes and shoulder pain, considering their frequency in this population. This was a non-randomized retrospective study of 596 surgical release interventions, including 209 with associated shoulder pain. Two sub-groups were studied: group 1 (n = 109) included 77 women and 32 men who presented anterior or lateral shoulder pain ; group 2 (n = 100) included 64 women and 36 men who presented posterior shoulder pain or scapular pain. Mean age was 55 years in group 1 and 49 years in group 2. Initially, these patients sought medical care for: a carpal tunnel syndrome (66% of group 1 and 32% of group 2); a carpal tunnel syndrome associated with an ulnar entrapment syndrome (16% of group 1 and 17% of group 2); and shoulder tendinopathy (3% of group 1 and 27% of group 2). Pain predominated at night (88%) and was associated with digital paresthesia (median and ulnar: 60% of group 1 and 69% of group 2). Among patients who had an EMG, most had a carpal tunnel syndrome (62% of group 1, 41% of group 2) or a normal exam (17% of group 1, 26% of group 2). Surgery was performed as indicated by the clinical presentation and the EMG and injection test results. Surgical was performed to release the median nerve (33 cases in group 1, 5 in group 2) or the ulnar nerve (4 cases in group 1, 12 in group 2) or both nerves (72 cases in group 1 and 83 in group 2). Clinical and EMG outcome and the impact of the release on pain were analyzed using R software. Posterior scapular pain was significantly correlated with cubital impingement at the elbow in group 2 and with median nerve impingement in the carpal tunnel in group 1. The projection of cubital pain has not been studied previously. A medial nerve syndrome at the wrist would lead to anterior shoulder pain and a cubital tunnel syndrome at the elbow would lead to posterior scapular pain. Retrospective comparative two-center study, level of proof: 3.

Plus de 80,000 prothèses totales de genou (PTG) sont posées chaque année en France pour gonarthrose. Dans 20 % des cas, les patients ne sont pas satisfaits des résultats fonctionnels. L'objectif principal de l'essai EDEX a été de comparer l'efficacité d'un programme préopératoire d'éducation et de rééducation aux soins usuels sur l'indépendance fonctionnelle et les limitations d'activité post-opératoires chez les patients ayant reçu une PTG pour gonarthrose. Nous avons mené une étude prospective, multicentrique, randomisée, contrôlée, en 2 bras parallèles. Les participants ont été recrutés dans 3 centres tertiaires français. Le ratio d'allocation a été de 1 :1. Le groupe expérimental a reçu 4 séances supervisées préopératoires d'éducation et de rééducation délivrées par une équipe multidisciplinaire composée de kinésithérapeutes, ergothérapeutes, psychologues, diététiciens et assistants sociaux. Le groupe expérimental a reçu les soins usuels prescrits par leur chirurgien. Les critères de jugement principaux étaient : le pourcentage de patients atteignant l'indépendance fonctionnelle le jour de leur sortie, définie par un niveau 3 sur les 4 épreuves du test de Zavadak et les limitations d'activité au cours des 6 mois suivant la chirurgie, évaluée par l'aire sous la courbe de la sous-échelle fonction du questionnaire auto-administré Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Au total, 262 patients ont été randomisés : 131 dans le groupe expérimental et 131 dans le groupe comparateur. Leur âge moyen était de 68,6 (8,0) ans et l'intensité moyenne de la douleur de 54,3 (22,2) points sur 100. 43/131 (32,8 %) des participants du groupe expérimental n'ont assisté à aucune des 4 sessions supervisées. Le jour de leur sortie, 34/101 (33,7 %) patients ont atteint l'indépendance fonctionnelle dans le groupe expérimental et 25/95 (26,3 %) dans le groupe comparateur (OR [IC à 97,5 %] de 1,3 [0,8 à 2,3], p = 0,15 et différence de risque absolu [IC à 97,5 %] de 8,9 [−5,0 à 22,7] %e. À 6 mois, l'aire sous la courbe du score WOMAC fonction était de 38,1 (16,5) mm2 dans le groupe expérimental et 40,6 (17,8) mm2 dans le groupe comparateur (différence absolue [IC à 97,5 %] de −2,2 [−7,3 à 3,0] mm2, p = 0,31). Le programme multidisciplinaire préopératoire d'éducation et de rééducation testé ne permet pas d'améliorer l'indépendance fonctionnelle précoce ni de réduire les limitations d'activité postopératoires chez les patients ayant reçu une PTG pour gonarthrose. Le faible taux de participation aux sessions supervisées (34,3 %) ne permet pas de conclure à l'absence d'efficacité de l'intervention.

Objectives. - One-stage replacement arthroplasty for treatment of periprosthetic joint infection (PJI) results in similar cure rate than two-stage (around 85-92%), but antibiotic therapy duration is not well established. The aim of this study was to evaluate the efficacy of a short six-week antibiotic course in periprosthetic joint infections after onstage exchange. Patients and methods. - Retrospective, observational study conducted at Orthopaedic Department of Cochin Hospital, Paris, between 1st January 2010 and 31 December 2015. Patients with a microbiologically proven PJI, treated with one-stage replacement and 6 weeks (+/1week) of antimicrobial therapy were included. Pearson's-chi(2) and Wilcoxon tests were used to compare categorical and continuous variables. Results. - Fifty patients with periprosthetic joint infections (42 hip, 8 knee PJI) treated with one-stage replacement arthroplasty were included. Median age was 69.3 years (IQR 24.5-97.4). Infections occurred after a mean of 36 months (IQR 1-216). Bone biopsy cultures were positive for Staphylococcus spp. in 29 patients (58%), Cutibacterium acnes in 19 (38%), Gram-negative bacilli in 6 (12%). Polymicrobial infections occurred in 12 (24%). Intravenous antibiotics were administered for a median of 11 days (IQR 4-45) and 46 patients (92%) were switched to an oral therapy. Medium follow-up was of 32 months (IQR 12-101). Overall remission rate was 90%. Conclusions. - A six-week course of antibiotics in knee and hip PJIs treated with one-stage RA has a satisfactory remission rate in this open study. (C) 2020 Elsevier Masson SAS. All rights reserved.

BACKGROUND:NETSARC (netsarc.org) is a network of 26 sarcoma reference centers with specialized multidisciplinary tumor boards (MDTB) aiming to improve the outcome of sarcoma patients. Since 2010, presentation to an MDTB and expert pathological review are mandatory for sarcoma patients nationwide. In the present work, the impact of surgery in a reference center on the survival of sarcoma patients investigated using this national NETSARC registry.PATIENTS AND METHODS:Patients' characteristics and follow-up are prospectively collected and data monitored. Descriptive, uni- and multivariate analysis of prognostic factors were conducted in the entire series (N = 35 784) and in the subgroup of incident patient population (N = 29 497).RESULTS:Among the 35 784 patients, 155 different histological subtypes were reported. 4310 (11.6%) patients were metastatic at diagnosis. Previous cancer, previous radiotherapy, neurofibromatosis type 1 (NF1), and Li-Fraumeni syndrome were reported in 12.5%, 3.6%, 0.7%, and 0.1% of patients respectively. Among the 29 497 incident patients, 25 851 (87.6%) patients had surgical removal of the sarcoma, including 9949 (33.7%) operated in a NETSARC center. Location, grade, age, size, depth, histotypes, gender, NF1, and surgery outside a NETSARC center all correlated to overall survival (OS), local relapse free survival (LRFS), and event-free survival (EFS) in the incident patient population. NF1 history was one of the strongest adverse prognostic factors for LRFS, EFS, and OS. Presentation to an MDTB was associated with an improved LRFS and EFS, but was an adverse prognostic factor for OS if surgery was not carried out in a reference center. In multivariate analysis, surgery in a NETSARC center was positively correlated with LRFS, EFS, and OS [P < 0.001 for all, with a hazard ratio of 0.681 (95% CI 0.618-0.749) for OS].CONCLUSION:This nationwide registry of sarcoma patients shows that surgical treatment in a reference center reduces the risk of relapse and death.

Background Clinical practice guidelines indicate that tumors Methods NETSARC is a network of 26 reference sarcoma centers with specialized multidisciplinary tumor boards (MDTB), funded by the French NCI (INCa). 1720 of 27894 (6.2%) incident patients had a sarcoma with a documented size Results As compared to larger sarcoma, Sarcinf3 were less frequently deep seated, from internal trunk, from visceral or bone sites, metastatic at diagnosis and grade 3 (p Conclusions In this nationwide series of 1720 pts with sarcomas Legal entity responsible for the study The authors. Funding Has not received any funding. Disclosure All authors have declared no conflicts of interest.

Background We investigated the impact of secondary surgery (2Surg) after a first R1 or R2 resection in the 10931 pts with STS of the limb or trunk wall included in the nationwide NETSARC database from 2010 to 2017. Methods NETSARC (netsarc.org) is a network of 26 reference sarcoma centers with specialized multidisciplinary tumor boards (MDT), funded by the French NCI (INCa). Since 2010, presentation to an MDTB and second pathological review are mandatory for sarcoma pts. Statistics were performed with SPSS23.0. LRFS, metastasis-free survival (MFS), OS compared with the logrank test. Results In 5295 (49.4%) patients, sarcoma were located on the lower limb, 3670 (33.6%) on trunk wall, 1966 (18.0%) on upper limb. Local RFS (LRFS) and RFS (p Conclusions In this nationwide series of limb or trunk wall STS, 2Surg after a R1 or R2 primary excision was associated with an improved OS only when pts had been operated first outside a reference center. 2Surg in a NETSARC center was associated with a better OS. Legal entity responsible for the study Jean-Yves Blay. Funding INCA (NetSarc, RREPS, RESOS, LYRICAN (INCA-DGOS-INSERM 12563), ARC fundation, Ligue de L’Ain contre le Cancer, INCA (NetSARC, RREPS, RESOS and LYRICAN (INCA-DGOS-INSERM 12563), InterSARC), La Ligue contre le Cancer, Ligue de L’Ain contre le Cancer, la Fondation ARC, EURACAN (EC 739521). Disclosure All authors have declared no conflicts of interest.

La compression du nerf fibulaire commun (NFC) au col de la fibula et la compression du nerf tibial postérieur (NTP) au tunnel tarsien sont les syndromes canalaires les plus fréquents au membre inférieur. Il s’agit d’une étude rétrospective bicentrique en centre hospitalo-universitaire et en centre libéral, mono-opérateur de 119 neurolyses entre 2015 et 2018. Il y avait 68 femmes et 38 hommes avec un âge moyen de 55 ans. Les patients présentaient des douleurs diffuses du membre inférieur dans 88 % des cas dont 37 % au pied et 30 % au genou. Il existait des paresthésies dans 42 % associées aux douleurs ou isolées. La douleur moyenne préopératoire, mesurée par une échelle numérique analogique (ENA), était à 6/10 (0 à 9). Ces douleurs étaient anciennes (34 mois en moyenne) et résistaient au traitement médical. Dans 36 % des cas, elles étaient apparues dans les suites d’une intervention chirurgicale (arthroscopie genou 14 %, prothèse totale de hanche 9 %, prothèse totale de genou 5 %, chirurgie de la cheville 4 %) ou après un traumatisme dans 13 % des cas. Le diagnostic a été retenu sur la symptomatologie, le syndrome irritatif nerveux (81 % des cas), le résultat du test thérapeutique (37 patients infiltrés) et le résultat de l’électroneuromyogramme (90 % anormaux). Parmi les 106 patients, 93 ont été opérés d’une neurolyse simple associée du NFC au col de la fibula et du NTP dans son trajet au tunnel tarsien avec ouverture de l’abducteur de l’hallux et 13 de manière bilatérale. Dans 4 cas, la neurolyse était faite sur un site (1 NFC et 3 NTP isolés). Huit patients (7 %) ont présenté une désunion de cicatrice à la cheville avec évolution favorable par traitement local. Nous avons eu une récidive sur une neurolyse du NFC reprise par une neurolyse du NFC et NTP. Un patient a eu un équin de cheville postopératoire pendant 2 mois. La neurolyse a eu un effet « magique » constant (disparition des douleurs au réveil). À la première consultation postopératoire (Journée 21), 26 neurolyses présentaient encore des douleurs différentes (ENA moyenne 3/10). Certains ont été infiltrés par du Diprostène®. Au dernier recul de 20 mois, l’ENA moyenne était à 2/10 (de 0 à 8), les douleurs persistantes étant attribuées à une « régénération nerveuse ». La neurolyse associée du NFC et du NTP semble efficace sur le traitement des douleurs du membre inférieur.

Las fracturas patológicas presentan particularidades diagnósticas y terapéuticas que no deben pasarse por alto para evitar el riesgo de comprometer al menos el pronóstico funcional, o incluso el pronóstico vital del paciente en caso de tumor maligno. El carácter patológico de una fractura debe sospecharse ante cualquier anamnesis que se salga de lo habitual, en particular en ausencia de traumatismo, basándose en la simple exploración física y la radiografía ósea. A continuación, se confirman el carácter patológico y el diagnóstico causal mediante pruebas complementarias orientadas por la exploración inicial. Entre las distintas causas posibles de fractura patológica, se pueden identificar tres grupos de patologías. La fractura que se produce en un hueso tumoral, en la mayoría de los casos en una metástasis, la fractura en una enfermedad ósea adquirida y la que se produce en una patología ósea congénita. En la mayoría de los casos, la biopsia ósea realizada según unas reglas estrictas es un prerrequisito de cualquier tratamiento de una fractura en un hueso tumoral. Cuando se establece el diagnóstico etiológico de la patología, conviene definir una estrategia terapéutica clara y saber si la prioridad terapéutica corresponde a la fractura o a la patología subyacente. En los casos de tumores óseos malignos, esta estrategia debe establecerse obligatoriamente en una reunión de concertación pluridisciplinaria. Conviene tratar de forma simultánea la fractura y la patología causal. El tratamiento de la fractura se basa en unas reglas claras y se adapta al contexto de cada patología. En caso de osteosíntesis de fractura en una metástasis, siempre hay que tratar de obtener la consolidación y la radioterapia postoperatoria es la norma.

Background: We report on the characteristics and determinants of outcome of the 35784 pts included in the nationwide NETSARC/RREPS study since its inception. Methods: NETSARC (netsarc.org) is a network of 26 reference sarcoma centers with specialized multidisciplinary tumor boards (MDTB), funded by the French National Cancer Institute to improve the outcome of sarcoma patients. Since 2010, presentation to an MDTB and second pathological review are mandatory for sarcoma patients. Patients' characteristics and follow-up are collected in a database regularly monitored. Descriptive, uni and multivariate analysis of prognostic factors were conducted in the incident (n = 29497) pts population as well as on pts diagnosed before 1/1/2010 (n = 6287), presented to an MDTB after 1/1/10. Results: We first investigated predisposing and associated conditions: among the 35784, previous cancer, previous RT, NF1, Li-Fraumeni, were reported in 12.5%, 3.6%, 0.7%, 0.1% of pts respectively. 71 of the 35784 (0.2%) pts had 2 or 3 different diagnosis of sarcomas: 28%, 7%, 6%, 3% of these pts had an history of previous cancer, NF1, Li-Fraumeni, Ollier disease (p < 0.001). Prognostic factors of pts outcome at initial diagnosis were then analyzed: male gender, age, size, depth, grade 3, NF1, previous RT were all associated with a worse overall (OS) and progression free survival (PFS) in the incident pts population in univariate and multivariate analysis, while GIST, intermediate malignancy histologies, and surgery in a Netsarc center (HR:0,63) were positively correlated with OS and PFS (p < 0.001 for all). Similar results were obtained in the 6287 pts diagnosed before 2010 for OS. In pts in advanced phase, survival was superior to that reported in the literature with a median of 27 months for all sarcomas but GIST. Median OS was not reached for GIST and tumor of intermediate malignancy (58% and 76% at 5 years respectively). NF1, previous RT, and treatment outside a reference center were again associated with a worse OS in multivariate analysis. Conclusions: In this nationwide registry of sarcoma patients, unreported prognostic characteristics sarcoma pts were identified.Treatment in a reference center reduces the risk of relapse and death. Legal entity responsible for the study: NETSARC and French Sarcoma Group. Funding: French NCI ( INCA). Disclosure: J-Y. Blay: Research support and honoraria: Roche, Novartis, Bayer, GSK, Lilly, MSD, BMS, Ignyta, Deciphera, PharmaMar. All other authors have declared no conflicts of interest.

Aims The primary aim of this study was to determine the morbidity of a tibial strut autograft and characterize the rate of bony union following its use. Patients and Methods We retrospectively assessed a series of 104 patients from a single centre who were treated with a tibial strut autograft of >5 cm in length. A total of 30 had a segmental reconstruction with continuity of bone, 27 had a segmental reconstruction without continuity of bone, 29 had an arthrodesis and 18 had a nonunion. Donor-site morbidity was defined as any event that required a modification of the postoperative management. Union was assessed clinically and radiologically at a median of 36 months (IQR, 14 to 74). Results Donor-site morbidity occurred in four patients (4%; 95% confidence interval (CI) 1 to 10). One patient had a stress fracture of the tibia, which healed with a varus deformity, requiring an osteotomy. Two patients required evacuation of a haematoma and one developed anterior compartment syndrome which required fasciotomies. The cumulative probability of union was 90% (95% CI 80 to 96) at five years. The type of reconstruction (p = 0.018), continuity of bone (p = 0.006) and length of tibial graft (p = 0.037) were associated with the time to union. Conclusion The tibial strut autograft has a low risk of morbidity and provides adequate bone stock for treating various defects of long bones.