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Revista Española de Cirugía Ortopédica y Traumatología (English Edition)
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Original Article
Hemipelvectomy for the treatment of high-grade sarcomas: Pronostic of chondrosarcomas compared to other histological types
Hemipelvectomías tras sarcomas de localización pélvica de alto grado: pronóstico en condrosarcomas frente a otros tipos histológicos
J. Arnal-Burróa,b,
Corresponding author
Juanarnal@hotmail.com

Corresponding author.
, J.A. Calvo-Haroa,b,c, C. Igualada-Blazqueza,b, P. Gil-Martíneza,b, M. Cuervo-Dehesaa,b, J. Vaquero-Martína,b,c
a Servicio de Cirugía Ortopédica y Traumatología, Hospital General Universitario Gregorio Marañón, Madrid, Spain
b Servicio de Cirugía General, Hospital General Universitario Gregorio Marañón, Madrid, Spain
c Departamento de Cirugía, Universidad Complutense de Madrid, Madrid, Spain
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both functional and emotionally&#46; In the last 2 decades&#44; limb-preserving procedures &#40;internal hemipelvectomies&#41; have demonstrated their effectiveness due to the development of diagnostic techniques and adjuvant and neoadjuvant therapies&#46;<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">4</span></a> At present&#44; it is not possible to find protocols and guides for the management of these entities and&#44; unlike in other medical disciplines&#44; we can see that the number of published works is scarce&#46; There are hardly any series with homogeneous cohorts in terms of diagnosis and stage that may serve to set the bases for a standardised management&#46;<a class="elsevierStyleCrossRefs" href="#bib0195"><span class="elsevierStyleSup">1&#44;5&#44;6</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">The objective of this work is to present the long term survival and functional prognosis following hemipelvectomy in primary sarcomas located in the pelvis and locally advanced&#44; differentiating between the histological variety of chondrosarcoma and the rest of sarcomas&#46; The study also verified whether&#44; as in previous series&#44; chondrosarcoma presented better survival when including only high-grade sarcomas&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Material and methods</span><p id="par0015" class="elsevierStylePara elsevierViewall">We conducted a descriptive&#44; epidemiological and functional study&#44; comparing 2 cohorts according to their histological type&#58; chondrosarcoma versus the rest of histological types&#46; The study population were all consecutive patients treated at our centre by hemipelvectomy due to primary sarcomas located in the pelvis&#44; including soft tissues&#44; all of them of high grade and locally advanced&#44; between January 2006 and December 2012&#46; In order to obtain a sample homogeneity that facilitated the analysis of both the oncological and functional results&#44; we included in the study all high grade and locally advanced sarcomas in which surgical resection compromised the stability of the pelvic ring&#46; We excluded low grade sarcomas &#40;G1&#41;&#44; primary pelvic sarcomas with distant metastasis&#44; and cases of pelvic metastasis of tumours with a primary origin in other locations&#46; We also excluded sarcomas subsidiary of local treatment with a procedure other than hemipelvectomy&#46; Thus&#44; we decided to exclude pelvic Ewing sarcoma&#44; which could be treated with radical radiotherapy in cases where obtaining adequate surgical margins was doubtful&#46;<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">7</span></a> Moreover&#44; we also excluded sarcomas treated by partial resection which did not affect the integrity of the pelvic ring&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">During the study period we attended a total of 15 patients&#44; 4 females and 11 males&#44; with a mean age of 46 years &#40;range&#58; 17&#8211;78 years&#41;&#44; with no specific decade predominating in the age distribution&#46; Of these cases&#44; 6 had been treated previously at other centres and 5 had been referred to our centre with a diagnosis of local recurrence following several surgical interventions in all cases&#44; albeit none of them through hemipelvectomy&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">At the time of diagnosis&#44; we recorded the histological type&#44; the stage according to the Enneking classification<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">8</span></a> and the location according to the affected bone structure<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">9</span></a>&#58; ilium bone &#40;P1&#41;&#44; periacetabular region &#40;P2&#41;&#44; pubis &#40;P3&#41;&#44; sacrum &#40;P4&#41;&#44; proximal femur &#40;H1&#41; and combinations thereof&#46; For the treatment&#44; we considered the type of hemipelvectomy conducted and the surgical margins obtained&#44; as well as the surgical complications&#46; The type of resection was classified according to Enneking and Durham&#44;<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">8</span></a> dividing the resection into 4 types and the combinations thereof&#44; whilst the surgical margins were divided according to MSTS<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">7</span></a> into intralesional&#44; marginal&#44; wide and radical&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">We carried out a prospective monitoring of this cohort for a minimum of 20 months&#44; analysing the overall survival&#44; appearance of local recurrence and distant metastasis&#44; as well as functionality&#44; comparing chondrosarcoma against the rest of sarcomas&#46; The functional assessment employed the Musculoskeletal Tumour Society &#40;MSTS&#41; scale for lower limbs<a class="elsevierStyleCrossRefs" href="#bib0240"><span class="elsevierStyleSup">10&#44;11</span></a> &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">12</span></a> The assessment was carried out systematically upon admission and after 1&#44; 3&#44; 6&#44; 12&#44; 24 and 36 months&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Results</span><p id="par0035" class="elsevierStylePara elsevierViewall">The most frequent histological diagnosis was chondrosarcoma &#40;46&#37;&#41;&#44; and the most frequently affected region was the periacetabular &#40;73&#37; cases&#41;&#44; followed by involvement of the obturator ring &#40;53&#37; cases&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46; In 86&#46;6&#37; of cases&#44; the initial stage at the time of diagnosis was stage IIb&#46; We carried out 10 internal hemipelvectomies &#40;66&#46;66&#37;&#41; and 5 external hemipelvectomies &#40;33&#46;34&#37;&#41;&#46; Of the latter&#44; 4 were sarcomas that persisted after previous treatments carried out at other centres &#40;1 leiomyosarcoma&#44; 1 synovial sarcoma&#44; 1 osteosarcoma&#44; 1 high grade pleomorphic sarcoma&#41;&#46; In 86&#46;66&#37; of cases &#40;13 patients&#41; we carried out acetabular resection &#40;resection II&#41; including the hip joint &#40;resection IIa&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 1</a>&#41;&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0040" class="elsevierStylePara elsevierViewall">We did not find any differences in terms of stages between the chondrosarcoma and non-chondrosarcoma groups&#46; The main difference between both groups was the presence of prior surgery at another centre in 4 of the 9 sarcomas of the mixed group&#44; versus 2 of the 6 chondrosarcomas&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">In the chondrosarcoma group we carried out internal hemipelvectomy in 83&#37; of cases&#44; compared to 55&#37; in the non-chondrosarcoma group&#46; A total of 6 patients had been treated previously at other centres&#44; and we were only able to perform internal hemipelvectomy in 2 cases &#40;33&#37;&#41;&#46; Among patients in whom the initial surgical treatment was carried out at our centre&#44; internal hemipelvectomy was performed in 88&#37; of cases&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">The resection margins were wide except in 1 case&#44; where the resection was marginal&#46; We performed reconstructive surgery of the pelvic ring in 3 cases&#44; all of them in a second procedure &#40;8 and 11 months after the hemipelvectomy&#41;&#44; in 2 cases through allograft and total hip arthroplasty and in the other with a tailored pelvic reconstruction component and total hip arthroplasty<a class="elsevierStyleCrossRefs" href="#bib0245"><span class="elsevierStyleSup">11&#8211;13</span></a> &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>&#41;&#46; The majority of cases suffered complications&#44; with the most frequent being those related to the surgical wound &#40;infection and dehiscence&#41; &#40;80&#37; cases&#41;&#46; Two thirds of these cases were polymicrobial&#44; including Gram negative strains&#44; with the most predominant being <span class="elsevierStyleItalic">Pseudomona aeruginosa</span> and <span class="elsevierStyleItalic">Enterobacter cloacae</span>&#44; as well as anaerobic Gram positive cocci of the <span class="elsevierStyleItalic">Peptostreptococcus</span> gender&#46; Cases in which a single microorganism was isolated included <span class="elsevierStyleItalic">Staphylococcus aureus</span> in 2 cases and multiresistant <span class="elsevierStyleItalic">Acinetobacter baumannii</span> in the other&#46; All infections were resolved with prolonged antibiotic therapy and surgical debridement&#46;</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0055" class="elsevierStylePara elsevierViewall">It is worth highlighting 1 case of intraoperative death secondary to the appearance of ventricular tachycardia in a patient diagnosed with osteosarcoma referred to our centre for surgical treatment following disease progression in spite of neoadjuvant treatment&#46; Two of the cases undergoing internal hemipelvectomy with periacetabular resection suffered neurapraxia of the sciatic nerve&#44; in 1 case resolved 3 months after the intervention and in the other case remaining as a limitation for active extension of the ankle and foot with recovery of plantar sensitivity and flexor musculature&#46; It is also worth commenting the appearance of 2 complications related to the urinary tract&#44; 1 vesical fistula and 1 case of urethral fistulisation&#44; both in patients treated previously by radical radiotherapy and suffering prostate carcinoma&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">Monitoring lasted for a mean period of 30 months&#44; with a range between 20 and 80 months&#46; The overall survival was 46&#37;&#44; with a 1-year survival of nearly 80&#37; and a decrease down to 54&#37; at 2 years&#46; After this point&#44; survival remained constant until the end of follow-up &#40;<a class="elsevierStyleCrossRef" href="#fig0020">Fig&#46; 4</a>a&#41;&#46; Taking into account the histological type&#44; survival was better in chondrosarcomas compared to the rest of sarcomas &#40;67&#37; vs 43&#37;&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0020">Fig&#46; 4</a>b&#41;&#46; We observed progression of the disease in 60&#37; of cases in spite of surgical treatment&#44; presenting as local recurrence in 2 cases &#40;13&#37;&#41;&#44; distant disease in 5 cases &#40;33&#37;&#41;&#44; and local recurrence with distant disease in another 2 cases&#46; The most frequent location of metastatic disease was the lung&#46; However&#44; whilst in the chondrosarcoma group the progression with distant disease took place in 2 cases &#40;33&#37;&#41;&#44; in the non-chondrosarcoma group it took place in 5 cases &#40;55&#37;&#41;&#46;</p><elsevierMultimedia ident="fig0020"></elsevierMultimedia><p id="par0065" class="elsevierStylePara elsevierViewall">The functional evaluation registered that patients began from a point with no excessive clinical and functional involvement &#40;mean value<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>20 points&#59; score 66&#37;&#41;&#44; given the scarce manifestation of tumours in this location&#46; In the postoperative period&#44; patients reported a lower functional score&#44; which gradually improved over the following months&#44; remaining without significant variations after 1 year&#46; Functional involvement was greater in the external hemipelvectomy group compared to the internal&#44; with no differences according to the histological type being observed &#40;<a class="elsevierStyleCrossRef" href="#fig0025">Fig&#46; 5</a>&#41;&#46;</p><elsevierMultimedia ident="fig0025"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Discussion</span><p id="par0070" class="elsevierStylePara elsevierViewall">Although hemipelvectomies represent the main therapeutic option in the treatment of sarcomas located in the pelvis&#44; it is not easy to find other publications with which to compare our results&#44; as there are very few series based on this surgical procedure&#46; There are even fewer if we rule out cases due to other causes&#44; like trauma&#44; gynaecological tumours and carcinomas in general&#46; Those works dealing with sarcomas in this location&#44; entities with a natural evolution leading to a fatal prognosis&#44; focus on a specific surgical technique or a particular aspect of the treatment&#46; The relevant series&#44; around 30&#44; are all retrospective analyses of the experience at different hospitals&#44; with series ranging from 4 to 5 patients to little over 100&#44; given the scarce incidence of these sarcomas&#46; In some cases&#44; they are limited by the combination of treatments&#44; which occasionally present results comparable to surgical treatment&#44; without having been able to prove their superiority&#44; as in the case of Ewing sarcoma&#44;<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">7</span></a> which in turn is one of the most frequent sarcomas treated by hemipelvectomy in many of the published series&#46; Although the main treatment is still surgical resection&#44; some centres propose radical radiotherapy in cases in which obtaining wide resection margins is doubtful&#46;<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">13</span></a></p><p id="par0075" class="elsevierStylePara elsevierViewall">In our cohort&#44; the exclusion of disseminated sarcomas and those sarcomas with a possibility of nonsurgical treatment&#44; such as Ewing sarcoma&#44; was applied in order to avoid selection bias and with an awareness of the limitation of the sample size for extrapolation of results&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">The prospective time design enabled us to record the functional condition of patients in a more precise manner&#44; which improved the understanding of the impact of these interventions&#46; Our cohort had an age range comparable to that in other works reviewed&#44; with a homogeneous age distribution after the second decade of life&#46; Excluding Ewing sarcoma made the number of children and young adults scarce in this series&#44; which is the main difference with other works that did include it&#46; The majority of published series<a class="elsevierStyleCrossRefs" href="#bib0260"><span class="elsevierStyleSup">14&#8211;18</span></a> identify chondrosarcoma as the most frequent pelvic bone sarcoma&#44; followed by osteosarcoma and Ewing sarcoma&#46; This distribution was maintained in our series&#44; as we found 40&#37; of chondrosarcomas versus 60&#37; of other histological types&#46; It is worth noting the exclusion of low grade tumours from our cohort&#44; in order to improve sample homogeneity&#46; This fact is in contrast with the majority of published series&#46;<a class="elsevierStyleCrossRefs" href="#bib0270"><span class="elsevierStyleSup">16&#44;18&#8211;22</span></a></p><p id="par0085" class="elsevierStylePara elsevierViewall">Obtaining safe surgical margins&#44; marked by variables such as tumour extension or possibility of responding to adjuvant treatment&#44; was the main conditioning factor when considering limb-preserving surgery&#46;<a class="elsevierStyleCrossRefs" href="#bib0285"><span class="elsevierStyleSup">19&#44;23</span></a> In this series we carried out limb-preserving surgery or internal hemipelvectomy in 66&#37; of cases&#46; One of the key findings was the higher incidence of internal hemipelvectomy when the diagnosis was of chondrosarcoma and if patients had not been treated previously at other centres&#46; If we add to this the progression of the disease in all patients referred after undergoing previous surgical procedures&#44; it appears that their initial referral to reference centres was appropriate&#46;<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">16</span></a></p><p id="par0090" class="elsevierStylePara elsevierViewall">The series reflects a high percentage of surgical complications&#44; similar to that reported by most published series&#46;<a class="elsevierStyleCrossRefs" href="#bib0240"><span class="elsevierStyleSup">10&#44;18&#44;19&#44;24&#8211;28</span></a> It is worth highlighting higher rates of infection and dehiscence than other publications&#44; although resolved in all cases through debridement and antibiotic therapy&#46; If we add to this the existence of works reflecting an increase in the rate of complications on reconstruction arthroplasties among these patients in up to 60&#8211;70&#37; of cases&#44;<a class="elsevierStyleCrossRefs" href="#bib0290"><span class="elsevierStyleSup">20&#44;25&#44;27&#44;29&#8211;34</span></a> this justifies the low percentage of cases in our series undergoing reconstructive surgery after internal hemipelvectomy&#46; Prosthetic infection and tumour recurrence were identified as the most frequent causes of failure&#44; occasionally leading to a conversion to external surgery &#40;5&#46;3&#37;&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0360"><span class="elsevierStyleSup">34</span></a> The rate of infection in reconstructive surgery in one procedure was 13&#37; higher compared to just resection&#46;<a class="elsevierStyleCrossRefs" href="#bib0290"><span class="elsevierStyleSup">20&#44;29&#44;35</span></a> This was a significant source of controversy and patient selection is vital when considering reconstructive surgery after resection of a tumour&#46; Some authors&#44; like Puri et al&#46;&#44; did not find any differences in functionality between patients with or without reconstruction&#44; but did find them based on the resection performed&#44; with similar results to those reported in our series&#46;<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">18</span></a> In our case&#44; functionality in patients with reconstruction was not analysed&#44; as this was performed very close to the end of the monitoring period&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">Overall survival is one of the most variable data points identified in the different publications &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">Table 2</a>&#41;&#46; The causes were manifold&#44; mainly the mix of prognostic variables acting as modifying factors&#46; The histological type was a variable to be taken into account in the majority of hemipelvectomy series published&#46; Pelvic resections in chondrosarcomas present higher overall survival than pelvic resections published in series of osteosarcomas or malign tumours with no histological distinction&#59; a similar conclusion to that reached by the present work&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0100" class="elsevierStylePara elsevierViewall">However&#44; it is not easy to find homogenous samples that avoid mixing histological grades &#40;with low grade cases often being included&#41;&#44; as well as staging&#46; These are the 2 prognostic factors with most extensive evidence&#46;<a class="elsevierStyleCrossRefs" href="#bib0200"><span class="elsevierStyleSup">2&#44;3&#44;14&#44;15&#44;21&#44;22&#44;31&#44;36&#44;37</span></a> In our cohort&#44; survival between the first and second year decreased from nearly 80&#37; to 54&#37;&#44; reaching 46&#37; at the end of the follow-up period&#44; thus reflecting a stability in the rate of overall survival after the second year&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">If we compare survival in series like that by Guo&#44;<a class="elsevierStyleCrossRef" href="#bib0375"><span class="elsevierStyleSup">37</span></a> which dealt with osteosarcomas&#44; the survival figure is very similar to ours &#40;44&#37;&#41;&#46; The mixed series by Sherman<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">2</span></a> is an adequate example of how survival decreases from 100&#37; in stage Ia to 31&#37; in stage IIb&#44; the stage corresponding to most of our patients&#46; In their series&#44; Mankin et al&#46; concluded that there were significant differences in survival when comparing stage I with stages II and III &#40;81&#37; vs 45&#37;&#41;&#44; without any significant differences being identified between stage II and stage III&#46;<a class="elsevierStyleCrossRef" href="#bib0380"><span class="elsevierStyleSup">38</span></a></p><p id="par0110" class="elsevierStylePara elsevierViewall">Other works&#44; like those by Pring<a class="elsevierStyleCrossRef" href="#bib0295"><span class="elsevierStyleSup">21</span></a> and Angelini&#44;<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">14</span></a> dealing exclusively with chondrosarcomas&#44; report much higher figures&#44; as is also the case with the subgroup of chondrosarcomas in our series&#44; always with the sample size limitation preventing the differences identified from reaching significant values&#46; We believe that&#44; since the grade&#44; and consequently the stage&#44; have been proven to have a higher causal association with prognosis than histological diagnosis&#44; samples should be obtained taking these factors into account&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">The functional assessment and evolution coincide with those of other published works&#46;<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">11</span></a> Patients undergoing internal hemipelvectomy displayed higher values than those in whom it was necessary to perform external hemipelvectomy &#40;15 points&#44; equivalent to a score of 50&#37;&#44; in internal hemipelvectomies vs 12 points&#44; equivalent to a score of 40&#37; in external hemipelvectomies&#41;&#46; Although this is also reported by other published series&#44;<a class="elsevierStyleCrossRef" href="#bib0295"><span class="elsevierStyleSup">21</span></a> some works have not observed any differences&#46;<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">10</span></a></p><p id="par0120" class="elsevierStylePara elsevierViewall">Therefore&#44; hemipelvectomy would be indicated for the treatment of high grade&#44; locally advanced pelvic sarcomas&#44; regardless of their histological type&#44; although with a higher number of internal hemipelvectomies and better overall survival in chondrosarcomas&#46; As main limitations of the study it is worth mentioning the inclusion of only high grade locally advanced sarcomas&#44; preventing the assessment and analysis of survival based on histological grade&#44; as well as the sample size&#44; which prevented the level of statistical significance from reaching 95&#37;&#46; It seems necessary to carry out reviews of pure series of high grade sarcomas&#44; as this was the prognostic factor with the highest causal association&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Ethical responsibilities</span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Protection of people and animals</span><p id="par0125" class="elsevierStylePara elsevierViewall">The authors declare that this investigation did not require experiments on humans or animals&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Confidentiality of data</span><p id="par0130" class="elsevierStylePara elsevierViewall">The authors declare that they have followed the protocols of their workplace on the publication of patient data&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Right to privacy and informed consent</span><p id="par0135" class="elsevierStylePara elsevierViewall">The authors declare that this work does not reflect any patient data&#46;</p></span></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Financing</span><p id="par0140" class="elsevierStylePara elsevierViewall">In case the work entitled &#8220;Hemipelvectomy for the treatment of high-grade sarcomas&#58; Prognosis in chondrosarcomas compared to other histological types&#8221; is published&#44; the signing authors transfer all rights to the Spanish Journal of Traumatology and Orthopaedic Surgery &#40;Revista Espa&#241;ola de Cirug&#237;a Ortop&#233;dica y Traumatolog&#237;a&#41;&#44; which will own all the material submitted&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">The signing authors state that the article submitted is an original work&#46; The authors have not received any financial aid to carry out this work and have not signed any agreement entitling them to receive benefits or payment from any commercial entity&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">No commercial entity has made or will make any payments to any foundations&#44; educational institutions or any other non-profit organisation to which the authors are affiliated&#46;</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Conflict of interest</span><p id="par0160" class="elsevierStylePara elsevierViewall">The authors have no conflict of interests to declare&#46;</p></span></span>"
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          "identificador" => "xpalclavsec608376"
          "palabras" => array:5 [
            0 => "Hemipelvectom&#237;a"
            1 => "Sarcoma alto grado"
            2 => "Sarcoma p&#233;lvico"
            3 => "Condrosarcoma p&#233;lvico"
            4 => "Supervivencia"
          ]
        ]
      ]
    ]
    "tieneResumen" => true
    "resumen" => array:2 [
      "en" => array:3 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introduction</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">The low incidence and histological heterogeneity of primary sarcomas located in the pelvis make it difficult to find homogeneous cohorts&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Objective</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">To describe the life and functional prognosis depending on the histological type of sarcoma in a series of locally advanced high-grade pelvis located sarcomas treated by hemipelvectomy&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Methods</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">A descriptive epidemiological and functional study was conducted on 15 cases treated between 2006 and 2012&#46; Survival analysis&#44; functional assessment&#44; and a comparative study by histological type were performed&#44; comparing chondrosarcomas to other histological diagnoses&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Results</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">The most frequent histological type was chondrosarcoma &#40;46&#37;&#41;&#44; and the most frequent location was P2 &#40;periacetabular&#41; &#40;73&#37;&#41;&#46; An internal hemipelvectomy was performed in 66&#37; of cases&#44; with a higher incidence &#40;83&#37;&#41; in chondrosarcomas&#46; Overall two-year survival was 54&#37;&#44; with higher survival in the chondrosarcoma group &#40;67&#37;&#41; than in the other sarcomas &#40;43&#37;&#41;&#46; Functional status depended on the type of intervention&#44; with no differences in histological type or the performance of the reconstruction&#46;</p></span> <span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Discussion and conclusions</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Hemipelvectomy is a surgical procedure that is indicated for the treatment of locally advanced high grade pelvis located sarcomas&#44; regardless of histological type&#46; The incidence of limb preservation and overall survival is higher in chondrosarcomas compared to other sarcomas&#46;</p></span>"
        "secciones" => array:5 [
          0 => array:2 [
            "identificador" => "abst0005"
            "titulo" => "Introduction"
          ]
          1 => array:2 [
            "identificador" => "abst0010"
            "titulo" => "Objective"
          ]
          2 => array:2 [
            "identificador" => "abst0015"
            "titulo" => "Methods"
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          3 => array:2 [
            "identificador" => "abst0020"
            "titulo" => "Results"
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          4 => array:2 [
            "identificador" => "abst0025"
            "titulo" => "Discussion and conclusions"
          ]
        ]
      ]
      "es" => array:3 [
        "titulo" => "Resumen"
        "resumen" => "<span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Introducci&#243;n</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">La baja incidencia y la heterogeneidad histol&#243;gica de los sarcomas p&#233;lvicos primarios dificulta el an&#225;lisis y publicaci&#243;n de cohortes homog&#233;neas&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Objetivo</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Describir el pron&#243;stico vital y funcional dependiendo del tipo histol&#243;gico en una serie de sarcomas primarios de localizaci&#243;n p&#233;lvica de alto grado localmente avanzados tratados mediante hemipelvectom&#237;a&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Material y m&#233;todos</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Estudio descriptivo&#44; epidemiol&#243;gico y funcional de 15 casos tratados entre 2006-2012&#46; Se realiz&#243; an&#225;lisis de supervivencia&#44; valoraci&#243;n funcional y estudio comparativo en funci&#243;n del tipo histol&#243;gico&#44; comparando los condrosarcomas frente al resto de diagn&#243;sticos histol&#243;gicos&#46;</p></span> <span id="abst0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Resultados</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">El tipo histol&#243;gico m&#225;s frecuente en la serie fue el condrosarcoma &#40;46&#37;&#41;&#44; y la localizaci&#243;n m&#225;s frecuente la zona P2 &#40;periacetabular&#41; &#40;73&#37;&#41;&#46; Se realiz&#243; una hemipelvectom&#237;a interna en el 66&#37; de los casos&#44; siendo mayor &#40;83&#37;&#41; en el caso de los condrosarcomas&#46; La supervivencia global a los 2 a&#241;os fue del 54&#37;&#44; siendo m&#225;s elevada en el grupo condrosarcoma &#40;67&#37;&#41; que en el resto &#40;43&#37;&#41;&#46; La situaci&#243;n funcional dependi&#243; del tipo de intervenci&#243;n&#44; sin encontrar diferencias en funci&#243;n del tipo histol&#243;gico ni de la realizaci&#243;n de reconstrucci&#243;n&#46;</p></span> <span id="abst0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Discusio¿n y conclusiones</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">La hemipelvectom&#237;a como procedimiento quir&#250;rgico est&#225; indicada para el tratamiento de los sarcomas primarios de localizaci&#243;n p&#233;lvica de alto grado localmente avanzados independientemente del tipo histol&#243;gico&#46; La incidencia de conservaci&#243;n del miembro y la supervivencia global es mayor en los condrosarcomas frente al resto de tipos histol&#243;gicos&#46;</p></span>"
        "secciones" => array:5 [
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            "titulo" => "Introducci&#243;n"
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            "titulo" => "Objetivo"
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          2 => array:2 [
            "identificador" => "abst0040"
            "titulo" => "Material y m&#233;todos"
          ]
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            "identificador" => "abst0045"
            "titulo" => "Resultados"
          ]
          4 => array:2 [
            "identificador" => "abst0050"
            "titulo" => "Discusio¿n y conclusiones"
          ]
        ]
      ]
    ]
    "NotaPie" => array:1 [
      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Arnal-Burr&#243; J&#44; Calvo-Haro JA&#44; Igualada-Blazquez C&#44; Gil-Mart&#237;nez P&#44; Cuervo-Dehesa M&#44; Vaquero-Mart&#237;n J&#46; Hemipelvectom&#237;as tras sarcomas de localizaci&#243;n p&#233;lvica de alto grado&#58; pron&#243;stico en condrosarcomas frente a otros tipos histol&#243;gicos&#46; Rev Esp Cir Ortop Traumatol&#46; 2015&#59;60&#58;67&#8211;74&#46;</p>"
      ]
    ]
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          "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">MSTS functional scale for lower limbs&#46;<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">12</span></a></p>"
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          "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Distribution of anatomical location of sarcomas in the pelvis&#46;</p>"
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          "en" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Radiographic result of 2 hemipelvectomies&#59; with and without reconstruction&#46;</p>"
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          "en" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">&#40;a&#41; Overall postoperative survival&#46; &#40;b&#41; Survival according to histology&#46;</p>"
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        "identificador" => "tbl0010"
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        "tipo" => "MULTIMEDIATABLA"
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                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Patient&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Histology&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Type of hemipelvectomy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Chondrosarcoma&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">I&#43;IIA&#43;III&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Chondrosarcoma&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">IIA&#43;III &#40;external&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Chondrosarcoma&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">I&#43;IIA&#43;III&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Chondrosarcoma&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">IIA&#43;III&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Chondrosarcoma&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">I&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Chondrosarcoma&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">I&#43;IIA&#43;III&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Osteosarcoma&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">I&#43;IIA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Osteosarcoma&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">IIA&#43;III &#40;external&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Fibrosarcoma&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">III&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">High grade bone pleomorphic sarcoma&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">IIA&#43;III &#40;external&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">High grade bone pleomorphic sarcoma&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">IIA&#43;III&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Synovial sarcoma&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">I&#43;IV&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">13&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Synovial sarcoma&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">IIA&#43;III &#40;external&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">14&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Leiomyosarcoma&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">I&#43;IIA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">15&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Leiomyosarcoma&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">IIA&#43;III &#40;external&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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        "descripcion" => array:1 [
          "en" => "<p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">Casuistry&#46; Histology and type of surgical intervention&#46;</p>"
        ]
      ]
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        "identificador" => "tbl0015"
        "etiqueta" => "Table 2"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
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        "tabla" => array:1 [
          "tablatextoimagen" => array:1 [
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              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Author&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Number of patients&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Type of tumour&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Survival&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Ham et al&#46;<a class="elsevierStyleCrossRef" href="#bib0345"><span class="elsevierStyleSup">31</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">21&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Mixed&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">9&#37; external90&#37; internal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Guo<a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">19</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">21&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Osteosarcoma&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">44&#37; &#40;5 years&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Sherman et al&#46;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">2</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">60&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Mixed&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">45&#37; overall&#40;100&#37; Ia&#44; 31&#37; IIb&#44; 0&#37; III&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Guo<a class="elsevierStyleCrossRef" href="#bib0375"><span class="elsevierStyleSup">37</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">45&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Chondrosarcoma&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">62&#37; 5 years&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Mankin and Hornicek<a class="elsevierStyleCrossRef" href="#bib0380"><span class="elsevierStyleSup">38</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">206&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Mixed&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleSmallCaps">I</span>&#58; 81&#37;&#44; <span class="elsevierStyleSmallCaps">II</span> and <span class="elsevierStyleSmallCaps">III</span>&#59; 45&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Fuchs et al&#46;<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">3</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">43&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Osteosarcoma&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">38&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Kawai et al&#46;<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">15</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">102&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Mixed&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">55&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Sheth et al&#46;<a class="elsevierStyleCrossRef" href="#bib0300"><span class="elsevierStyleSup">22</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">67&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Chondrosarcoma&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">52&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Apffelstaedt<a class="elsevierStyleCrossRef" href="#bib0320"><span class="elsevierStyleSup">26</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">53&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Mixed&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">39&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Pring et al&#46;<a class="elsevierStyleCrossRef" href="#bib0295"><span class="elsevierStyleSup">21</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">64&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Chondrosarcomas&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">69&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Angelini<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">14</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">296&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Chondrosarcomas&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">92&#37; &#40;5 years&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Puri et al&#46;<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">18</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">91&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Mixed&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">67&#37; &#40;5 years&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Arnal Burr&#243;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">15&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Mixed high grade&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">46&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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          "en" => "<p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">Survival following pelvic sarcomas according to different authors&#46;</p>"
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