Schrage, Y.M.
Citation
Schrage, Y. M. (2009, November 5). Towards new therapeutic strategies in chondrosarcoma. Retrieved from https://hdl.handle.net/1887/14327
Version: Corrected Publisher’s Version
License: Licence agreement concerning inclusion of doctoral thesis in the Institutional Repository of the University of Leiden
Downloaded from: https://hdl.handle.net/1887/14327
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Contents
7.1 Histological distinction between benign and low-grade malignant cartilaginous tumours
7.2 Prognostic markers superior to histological grading
7.3 New therapeutic strategies for metastatic and irresectable chondrosarcoma
7.4 Concluding remarks
7.1 Histological distinction between benign and low-grade malignant cartilaginous tumours
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outcome of cartilaginous tumours.
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depending on histological grade.
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7.3 New therapeutic strategies in chondrosarcoma treatment
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the development of enchondromas and central chondrosarcomas. Central cartilaginous tumours were shown to have normal EXT1 and EXT2 H[SUHVVLRQZKLFKLVLQFRQWUDVWWRSHULSKHUDOWXPRXUVZLWKORZEXT1 and EXT2H[SUHVVLRQGXHWRJHQHWLFORVVLQVSRUDGLFWXPRXUV or inactivating PXWDWLRQVLQKHUHGLWDU\WXPRXUV. In central cartilaginous tumours, active Indian hedgehog signalling was found. Indian hedgehog is important for the UHJXODWLRQ RI QRUPDO ORQJLWXGLQDO ERQH JURZWK &\FORSDPLQH D KHGJHKRJ
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the importance of prevention of malignant progression is evident to improve prognosis.
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Reference List
/HHUDSXQ7+XJDWH55,QZDUGV&<6FXOO\636LP)+6XUJLFDOPDQDJHPHQW
RIFRQYHQWLRQDOJUDGH,FKRQGURVDUFRPDRIORQJERQHVClinical Orthopaedics and Related Research
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LQDJJUHVVLYHEHQLJQDQGORZJUDGHPDOLJQDQWERQHWXPRXUVLancet Oncol
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RISKHQRODQGHWKDQRORQWKHFKRQGURVDUFRPDGHULYHGFHOOOLQH2806DQ
LQYLWURH[SHULPHQWJ Bone Joint Surg Br
5HOLDELOLW\ RI +LVWRSDWKRORJLF DQG 5DGLRORJLF *UDGLQJ RI &DUWLODJLQRXV
Neoplasms in Long Bones. J Bone Joint Surg Am$
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RIWKH-DPKLGLWURFDUELRSV\LQWKHGLDJQRVLVRIERQHWXPRXUVClin Orthop
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GHFUHDVHG,QGLDQ+HGJHKRJ,++VLJQDOOLQJJ Pathol
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DO7UDQVIRUPLQJJURZWKIDFWRUEHWDLQFUHDVHVVXUYLYDORIKXPDQPHODQRPD
through stroma remodeling. Cancer Res
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and Peripheral Tumours. Clin Cancer Res 2009.
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cancer. Clin Cancer Res
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carcinoma. Clin Cancer Res
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-RKQVRQ6$+XQWHU7.LQRPLFVPHWKRGVIRUGHFLSKHULQJWKHNLQRPHNat Methods
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human chondrosarcoma cell. Cancer Lett
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chondrosarcoma and is associated with adverse outcome. Am J Surg Pathol
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chondrosarcoma. J Pathol
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