Intraoperative microwave inactivation in-situ of malignant tumors in the scapula

Abstract

To explore the feasibility and effect of microwave in situ inactivation of malignant primary or metastatic tumors in the scapula. Seventeen patients (12 men, 5 women, mean age 48 years [range, 13-59 years]) with malignant primary or metastatic tumors involving the scapula were treated by microwave inactivation between June 1998 and February 2008. There were 12 malignant primary bone and 5 metastatic tumors. In 14 cases Area Sl was involved and in 3 cases both Areas S1 and S2. All 17 cases were by making a dorsal arc- or "∩-" shaped incision to expose the tumor, protecting the surrounding soft tissues with a copper grid, and then heated the tumors locally with 2450 MHz microwave to 50°C for 20 min, after which all or some of the necrotic tumor tissue was removed, preserving the support role of the scapula. The operation time was 60-180 min (mean 120 min) and blood loss was 300-1000 mL (mean 460 mL). No serious intraoperative or postoperative complications occurred in any patient. The patients were followed up for 3 months to 10 years (mean 4.2 years). Three patients with Ewing's sarcoma in the scapula had pulmonary, cerebral and systemic multiple metastases and died 8~24 months after surgery. Three patients with malignant fibrous histiocytoma died of pulmonary and systemic multiple metastases 10~22 months after surgery; one patient had recurrence 6 months after surgery and survived with tumor. Five patients with metastatic tumor in the scapula died of non-scapular metastatic tumor 6~14 months after surgery. The other five patients with primary malignant bone tumors had no recurrence or metastasis during follow-up. Three cases had restricted extension of the shoulder joint with unrestricted protraction and retroflexion after surgery. In situ microwave inactivation features simple surgery, reliable effects and patient acceptability, making it an ideal surgical method for malignant tumors in the scapula.