1
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Tzelnick S, Soroka HP, Tasnim N, Gilbert RW, Irish JC, Goldstein DP, Brown D, Gullane P, Chepeha DB, Yao CMKL, Sahovaler A, Witterick IJ, Monteiro E, Davies J, Huang SH, O'Sullivan B, Hahn E, Hosni A, Razak AA, Gupta AA, de Almeida JR. The impact of surgical resection margins on outcomes for adults with head and neck osteosarcomas: A Canadian sarcoma research and Clinical Collaboration (CanSaRCC) study. Oral Oncol 2023; 145:106495. [PMID: 37478572 DOI: 10.1016/j.oraloncology.2023.106495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Accepted: 07/04/2023] [Indexed: 07/23/2023]
Abstract
OBJECTIVE The aim of the study is to describe the factors that influence outcome in adults with head and neck osteosarcoma (HNO) with a specific focus on the margin status. METHODS Patients with a diagnosis of HNO between the years 1996-2021 were reviewed from the Canadian Sarcoma Research and Clinical Collaboration (CanSaRCC) Database. Baseline characteristics, pathology, treatment, and outcomes were analyzed. Univariable (UVA) and multivariable (MVA) Cox regression models were performed. 5-year locoregional control rate and overall survival (OS) were estimated using Kaplan-Meier method and Log-Rank test. RESULTS Of 50 patients with a median age of 40 years (range 16-80), 27 (54%) were male. HNO commonly involved the mandible (n = 21, 42%) followed by maxilla (n = 15, 30%). Thirteen (33.3%) had low-intermediate grade and 26 (66.6%) had high grade tumors. Three patients (6%) had negative resection margins (>5 mm), 24 (48%) had close margins (1-5 mm), 15 (30%) had positive margins (<1mm) and 7 (16%) had unknown margin status. In total, 39 (78%) received chemotherapy - 22 (44%) received neoadjuvant chemotherapy while 17 (34%) received adjuvant chemotherapy. A total of 12 (24%) patients received radiotherapy, of whom 8 (16%) had adjuvant and 3 (6%) had neo-adjuvant. Median follow-up time was 6.3 years (range 0.26-24.9). Disease recurred in 21 patients (42%), of whom 15 (30%) had local recurrence only, 4 (8%) had distant metastasis, and 2 (4%) had both local and distant recurrence. 5-year locoregional control rate and OS was 62% and 79.2% respectively. Resection margins <3 mm was associated with lower 5 years OS and locoregional control rate (Log-Rank p = 0.02, p = 0.01 respectively). CONCLUSION Osteosarcomas of the head and neck are rare and local recurrence remains a concern. Surgical resection with negative resection margins may improve survival, and a 3 mm resection margin threshold may optimize survival. Radiotherapy and/or chemotherapy should be considered in a multidisciplinary setting based on risk-features.
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Affiliation(s)
- Sharon Tzelnick
- Department of Otolaryngology-Head and Neck Surgery/Surgical Oncology, Princess Margaret Hospital, University of Toronto, Ontario, Canada
| | - Hagit Peretz Soroka
- Department of Medical Oncology, Princess Margaret Cancer Centre, University of Toronto, Ontario, Canada; CanSaRCC, Princess Margaret Cancer Center, Ontario, Canada
| | - Najifah Tasnim
- CanSaRCC, Princess Margaret Cancer Center, Ontario, Canada
| | - Ralph W Gilbert
- Department of Otolaryngology-Head and Neck Surgery/Surgical Oncology, Princess Margaret Hospital, University of Toronto, Ontario, Canada
| | - Jonathan C Irish
- Department of Otolaryngology-Head and Neck Surgery/Surgical Oncology, Princess Margaret Hospital, University of Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | - David P Goldstein
- Department of Otolaryngology-Head and Neck Surgery/Surgical Oncology, Princess Margaret Hospital, University of Toronto, Ontario, Canada
| | - Dale Brown
- Department of Otolaryngology-Head and Neck Surgery/Surgical Oncology, Princess Margaret Hospital, University of Toronto, Ontario, Canada
| | - Patrick Gullane
- Department of Otolaryngology-Head and Neck Surgery/Surgical Oncology, Princess Margaret Hospital, University of Toronto, Ontario, Canada
| | - Douglas B Chepeha
- Department of Otolaryngology-Head and Neck Surgery/Surgical Oncology, Princess Margaret Hospital, University of Toronto, Ontario, Canada
| | - Christopher M K L Yao
- Department of Otolaryngology-Head and Neck Surgery/Surgical Oncology, Princess Margaret Hospital, University of Toronto, Ontario, Canada
| | - Axel Sahovaler
- Department of Otolaryngology-Head and Neck Surgery/Surgical Oncology, Princess Margaret Hospital, University of Toronto, Ontario, Canada
| | - Ian J Witterick
- Department of Otolaryngology-Head and Neck Surgery, Mt Sinai Hospital, Toronto, Ontario, Canada
| | - Eric Monteiro
- Department of Otolaryngology-Head and Neck Surgery, Mt Sinai Hospital, Toronto, Ontario, Canada
| | - Joel Davies
- Department of Otolaryngology-Head and Neck Surgery, Mt Sinai Hospital, Toronto, Ontario, Canada
| | - Shao Hui Huang
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Ontario, Canada
| | - Brian O'Sullivan
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Ontario, Canada
| | - Ezra Hahn
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Ontario, Canada
| | - Ali Hosni
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Ontario, Canada
| | - Albiruni Abdul Razak
- Department of Medical Oncology, Princess Margaret Cancer Centre, University of Toronto, Ontario, Canada; Department of Medical Oncology, Mount Sinai Hospital, University of Toronto, Ontario, Canada
| | - Abha A Gupta
- Division of Hematology/Oncology, Hospital for Sick Children, University of Toronto, Ontario, Canada; Department of Medical Oncology, Princess Margaret Cancer Centre, University of Toronto, Ontario, Canada; CanSaRCC, Princess Margaret Cancer Center, Ontario, Canada
| | - John R de Almeida
- Department of Otolaryngology-Head and Neck Surgery/Surgical Oncology, Princess Margaret Hospital, University of Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada.
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2
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Sharin F, Pai A, Mair M. Management of osteosarcoma of the head and neck. Curr Opin Otolaryngol Head Neck Surg 2023:00020840-990000000-00066. [PMID: 37144500 DOI: 10.1097/moo.0000000000000900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
PURPOSE OF REVIEW There is no clear consensus guideline that specifies the optimum course of treatment for adult head and neck osteosarcoma (HNO) because of its rarity. The review's goal is to examine the most recent research on the presentation, diagnosis, prognosis, and therapy of head and neck osteosarcoma. RECENT FINDINGS Due to overlapping symptoms with various benign disorders of the lower jaw and midface bone, these patients present with a noticeable delay. The greatest results for these malignancies can be achieved with surgery with sufficient margins. However, it may not be able to achieve sufficient margins in tumours of the midface and skull base, and the significance of adjuvant radiation/chemotherapy needs to be investigated. The use of adjuvant radiation in instances with an advanced stage, poor prognostic indicators, and inadequate resection is supported by evidence. Nonetheless, there are divergent opinions regarding the advantages of chemotherapy in adjuvant and neoadjuvant conditions, and further multicentric randomized control trials are required to provide robust evidence. SUMMARY Multimodality treatments seem to yield better results for advanced HNO with adverse features and incomplete resections.
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Affiliation(s)
| | | | - Manish Mair
- University hospital of Leicester, Leicester, UK
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3
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Khadembaschi D, Jafri M, Praveen P, Parmar S, Breik O. Does neoadjuvant chemotherapy provide a survival benefit in maxillofacial osteosarcoma: A systematic review and pooled analysis. Oral Oncol 2022; 135:106133. [DOI: 10.1016/j.oraloncology.2022.106133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 09/14/2022] [Accepted: 09/17/2022] [Indexed: 11/06/2022]
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4
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Shim T, Chillakuru Y, Darwish C, Chalif E, Strum D, Benito DA, Mulcahy CF, Monfared A. Head and neck osteosarcomas: An analysis of treatment trends and survival outcomes in the United States (2004-2016). Head Neck 2021; 43:3294-3305. [PMID: 34272901 DOI: 10.1002/hed.26817] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 06/08/2021] [Accepted: 07/09/2021] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Head and neck osteosarcoma (HNOS) is a rare primary bone tumor with limited data to guide treatment approaches. METHODS The NCDB was used to identify patients diagnosed with HNOS. Kaplan-Meier and Cox multivariate regression were used to examine the impact of each treatment on overall survival (OS). RESULTS We identified 821 patients diagnosed with HNOS. Utilization of neoadjuvant chemotherapy + surgery increased from zero cases in 2004 to 24% of cases in 2016. Among surgically treated patients, 5-year OS was 55.8% (CI: 51.7-60.1%). No difference was seen in OS between each treatment cohort on multivariate analysis. However, neoadjuvant chemotherapy + surgery + adjuvant chemotherapy had improved 18-month survival compared to surgery alone (95.8% vs. 78.5%, p = 0.031). CONCLUSIONS Our study demonstrated no survival benefit in perioperative chemotherapy or radiation therapy; however, short-term survival improvement in patients receiving both neoadjuvant and adjuvant chemotherapy displays promise and requires further investigation.
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Affiliation(s)
- Timothy Shim
- Division of Otolaryngology - Head and Neck Surgery, George Washington University School of Medicine & Health Sciences, Washington, DC, USA
| | - Yeshwant Chillakuru
- Division of Otolaryngology - Head and Neck Surgery, George Washington University School of Medicine & Health Sciences, Washington, DC, USA
| | - Christina Darwish
- Division of Otolaryngology - Head and Neck Surgery, George Washington University School of Medicine & Health Sciences, Washington, DC, USA
| | - Eric Chalif
- Division of Otolaryngology - Head and Neck Surgery, George Washington University School of Medicine & Health Sciences, Washington, DC, USA
| | - David Strum
- Division of Otolaryngology - Head and Neck Surgery, George Washington University School of Medicine & Health Sciences, Washington, DC, USA
| | - Daniel A Benito
- Division of Otolaryngology - Head and Neck Surgery, George Washington University School of Medicine & Health Sciences, Washington, DC, USA
| | - Collin F Mulcahy
- Division of Otolaryngology - Head and Neck Surgery, George Washington University School of Medicine & Health Sciences, Washington, DC, USA
| | - Ashkan Monfared
- Division of Otolaryngology - Head and Neck Surgery, George Washington University School of Medicine & Health Sciences, Washington, DC, USA
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5
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Low CM, Gruszczynski NR, Moore EJ, Price DL, Janus JR, Kasperbauer JL, Van Abel KM, Stokken JK, Van Gompel JJ, Link MJ, Choby G. Sinonasal Osteosarcoma: Report of 14 New Cases and Systematic Review of the Literature. J Neurol Surg B Skull Base 2021; 82:e138-e147. [PMID: 34306929 PMCID: PMC8289535 DOI: 10.1055/s-0040-1701221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Accepted: 11/12/2019] [Indexed: 10/25/2022] Open
Abstract
Objective The objective of this study is to describe the clinical presentation, tumor characteristics, natural history, and treatment patterns of sinonasal osteosarcoma. Methods Fourteen patients who had been treated for osteosarcoma of the nasal cavity and paranasal sinuses at a tertiary care center were reviewed. In addition, a systematic review of the literature for osteosarcoma of the sinonasal cavity was performed. Results In a systematic review, including 14 patients from the authors' institution, 53 total studies including 88 patients were assessed. Median follow-up was 18 months (interquartile range: 8-39 months). The most common presenting symptoms were facial mass or swelling (34%), and nasal obstruction (30%). The most common paranasal sinus involved by tumor was the maxillary sinus (64%), followed by the ethmoid sinuses (52%). The orbit (33%), dura (13%) and infratemporal fossa (10%) were the most common sites of local invasion. The majority of patients underwent surgery followed by adjuvant therapy (52.4%). Increasing age was associated with decreased overall survival rate (unit risk ratio [95% confidence interval (CI)] = 1.02 [1.003-1.043]; p = 0.0216) and T4 disease was associated with decreased disease-specific survival rate (hazard ratio [HR] = 2.87; p = 0.0495). The 2- and 5-year overall survival rates were 68 and 40%, respectively, while 2- and 5-year disease-specific survival rates were 71% and 44%, respectively. Conclusion Sinonasal osteosarcomas are uncommon tumors and can pose a significant therapeutic challenge. Increasing age and T4 disease are associated with worse prognosis. This disease usually warrants consultation by a multidisciplinary team and consideration of multimodality therapy.
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Affiliation(s)
- Christopher M. Low
- Department of Otolaryngology–Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, United States
| | | | - Eric J. Moore
- Department of Otolaryngology–Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, United States
| | - Daniel L. Price
- Department of Otolaryngology–Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, United States
| | - Jeffrey R. Janus
- Department of Otolaryngology–Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, United States
| | - Jan L. Kasperbauer
- Department of Otolaryngology–Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, United States
| | - Kathryn M. Van Abel
- Department of Otolaryngology–Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, United States
| | - Janalee K. Stokken
- Department of Otolaryngology–Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, United States
| | - Jamie J. Van Gompel
- Department of Otolaryngology–Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, United States
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, United States
| | - Michael J. Link
- Department of Otolaryngology–Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, United States
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, United States
| | - Garret Choby
- Department of Otolaryngology–Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, United States
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6
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Surgical Advances in Osteosarcoma. Cancers (Basel) 2021; 13:cancers13030388. [PMID: 33494243 PMCID: PMC7864509 DOI: 10.3390/cancers13030388] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 01/17/2021] [Accepted: 01/18/2021] [Indexed: 02/07/2023] Open
Abstract
Simple Summary Osteosarcoma (OS) is the most common bone cancer in children. OS most commonly arises in the legs, but can arise in any bone, including the spine, head or neck. Along with chemotherapy, surgery is a mainstay of OS treatment and in the 1990s, surgeons began to shift from amputation to limb-preserving surgery. Since then, improvements in imaging, surgical techniques and implant design have led to improvements in functional outcomes without compromising on the cancer outcomes for these patients. This paper summarises these advances, along with a brief discussion of future technologies currently in development. Abstract Osteosarcoma (OS) is the most common primary bone cancer in children and, unfortunately, is associated with poor survival rates. OS most commonly arises around the knee joint, and was traditionally treated with amputation until surgeons began to favour limb-preserving surgery in the 1990s. Whilst improving functional outcomes, this was not without problems, such as implant failure and limb length discrepancies. OS can also arise in areas such as the pelvis, spine, head, and neck, which creates additional technical difficulty given the anatomical complexity of the areas. We reviewed the literature and summarised the recent advances in OS surgery. Improvements have been made in many areas; developments in pre-operative imaging technology have allowed improved planning, whilst the ongoing development of intraoperative imaging techniques, such as fluorescent dyes, offer the possibility of improved surgical margins. Technological developments, such as computer navigation, patient specific instruments, and improved implant design similarly provide the opportunity to improve patient outcomes. Going forward, there are a number of promising avenues currently being pursued, such as targeted fluorescent dyes, robotics, and augmented reality, which bring the prospect of improving these outcomes further.
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7
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Singh R, Jha K, Pant I, Satti D. Primary osteogenic sarcoma of the skull: Report of two cases with review of literature. J Postgrad Med 2019; 64:232-236. [PMID: 30264740 PMCID: PMC6198693 DOI: 10.4103/jpgm.jpgm_706_17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Primary calvarial (excluding jaw) osteosarcoma is rare. We report two cases highlighting their unusual presentation and histopathologic variability – a 30-year-old female who presented with progressively increasing headache and a rapidly growing frontal swelling and a 16-year-old girl who had a rapidly growing mass in the left frontoparietal region which had recurred thrice but was otherwise asymptomatic. The lesions were osteolytic on neuroimaging and histopathological examination confirmed osteosarcoma. These two unusual cases are discussed along with a brief review of literature.
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Affiliation(s)
- R Singh
- Department of Pathology, Institute of Human Behaviour and Allied Sciences, New Delhi, India
| | - K Jha
- Department of Pathology, Institute of Human Behaviour and Allied Sciences, New Delhi, India
| | - I Pant
- Department of Pathology, Institute of Human Behaviour and Allied Sciences, New Delhi, India
| | - D Satti
- Department of Neurosurgery, Guru Teg Bahadur Hospital, New Delhi, India
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8
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KURTUL N, YURTTUTAN N, BAHAR AY, AKTAŞ G. Kalvaryumda multifokal osteosarkom: Nadir bir vaka sunumu ve literatür derlemesi. KAHRAMANMARAŞ SÜTÇÜ İMAM ÜNIVERSITESI TIP FAKÜLTESI DERGISI 2019. [DOI: 10.17517/ksutfd.540305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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9
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Liang L, Zhang T, You Y, He Q, Fan Y, Liao G. An individual patient data meta‐analysis on the effect of chemotherapy on survival in patients with craniofacial osteosarcoma. Head Neck 2019; 41:2016-2023. [PMID: 30706580 DOI: 10.1002/hed.25668] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Revised: 10/15/2018] [Accepted: 01/07/2019] [Indexed: 11/11/2022] Open
Affiliation(s)
- Lizhong Liang
- Department of ENT, Head and Neck, Oral and Maxillofacial SurgeryFifth Affiliated Hospital of Sun Yat‐sen University Zhuhai Guangdong China
| | - Tonghan Zhang
- Department of StomatologyAffiliated Zhongshan Hospital of Sun Yat‐sen University Zhongshan Guangdong China
| | - Yingying You
- Department of StomatologyFifth Affiliated Hospital of Sun Yat‐sen University Zhuhai Guangdong China
| | - Qifen He
- Department of StomatologyFifth Affiliated Hospital of Sun Yat‐sen University Zhuhai Guangdong China
| | - Yunping Fan
- Department of ENT, Head and Neck, Oral and Maxillofacial SurgeryFifth Affiliated Hospital of Sun Yat‐sen University Zhuhai Guangdong China
| | - Guiqing Liao
- Department of Oral and Maxillofacial SurgeryGuanghua School of Stomatology, Sun Yat‐Sen University Guangzhou Guangdong China
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10
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Martin E, Senders JT, ter Wengel PV, Smith TR, Broekman MLD. Treatment and survival of osteosarcoma and Ewing sarcoma of the skull: a SEER database analysis. Acta Neurochir (Wien) 2019; 161:317-325. [PMID: 30578430 PMCID: PMC6373276 DOI: 10.1007/s00701-018-3754-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Accepted: 11/26/2018] [Indexed: 11/27/2022]
Abstract
Background Common primary bone tumors include osteosarcomas (OSC) and Ewing sarcomas (EWS). The skull is a rare site, and literature about their treatment and survival is scarce. Using the Surveillance, Epidemiology, and End Results (SEER) database, this study aims to assess the treatment and survival of skull OSC and skull EWS, as well as predictors for survival. Methods Skull OSC and EWS cases were obtained from the SEER database. Patient and tumor characteristics, treatment modalities, and survival were extracted. Overall survival (OS) was assessed using multivariable Cox proportional hazard regression stratified by tumor histology. Kaplan-Meier curves were constructed for OS comparing OSC and EWS, as well as histological subtypes in OSC. Results A total of 321 skull OSC and 80 skull EWS patients were registered from 1973 to 2013. EWS was more common in younger patients (p < 0.001). Resection was the predominant treatment strategy (80.1%), frequently in combination with adjuvant radiotherapy (30.4%). The 5-year survival rate varied significantly between OSC and EWS (51.0% versus 68.5%, p = 0.02). Kaplan-Meier curves show that EWS had a significantly better survival compared to OSC. Comparing histological subtypes of skull OSC, chondroblastic OSC had the best OS, Paget OSC the worst. Older age, tumor advancement, no surgical treatment, and the use of radiotherapy were identified as independent predictors of decreased OS in skull OSC. Conclusion Overall prognosis is better for EWS compared to OSC. Chondroblastic OSC have the best overall survival, while OSC associated with Paget’s disease of the bone has the poorest overall survival.
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11
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Young Adult With Osteosarcoma of the Mandible and the Challenge in Management: Review of the Pediatric and Adult Literatures. J Pediatr Hematol Oncol 2019; 41:21-27. [PMID: 30334903 DOI: 10.1097/mph.0000000000001332] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Neoadjuvant chemotherapy for osteosarcoma of the jaw (OSJ) remains controversial despite being a standardized treatment in osteosarcoma of the long bones. We present a case of a 22-year-old male with OSJ and performed a retrospective systemic review of previously published literatures of OSJ. We identified 27 articles: 7% recommended neoadjuvant chemotherapy, 22% recommended adjuvant chemotherapy, 19% recommended both neoadjuvant and adjuvant chemotherapy, 33% recommended against chemotherapy and 19% stated the role of chemotherapy is unknown. The lack of consensus regarding the use of chemotherapy in OSJ, despite its benefits, demonstrates the need to establish a standardized algorithm for OSJ.
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12
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Abstract
Our goal was to evaluate the prognosis of osteosarcomas (OS) in the mandible for finding out the best treatment.Patients diagnosed with OS in the mandible from January 2000 to December 2015 were retrospectively enrolled. Demographic, tumor-specific, treatment, and survival data were collected and analyzed.A total of 55 patients (35 male and 20 female) were included, all patients had first manifestation of swelling. Cachexia occurred in 15 (27.3%) patients. Chondroblastic type was the most common histology subtype followed by osteoblastic type. High grade tumors were found in 30 (63.6%) patients. 33 (60%) patients received an operation of hemimandibulectomy, and free fibula reconstruction was performed in 20 (36.4%) patients. The 5-year recurrence-free survival (RFS) and disease-specific survival (DSS) rates were 73.6% and 66.9%, respectively. Univariate prognostic analysis reported risk factors of tumor grade, reconstruction type (free fibula flap vs non-free flap), and operation extent were significant for the recurrence, and reconstruction type and operation extent were significant for the disease-specific death, but in multivariate analysis, only the factor of operation extent was significantly associated with both the recurrence and death.A wide excision extent such as hemimandibulectomy is suggested for OS in the mandible for achieving good prognosis.
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Affiliation(s)
- Dongjie Seng
- Department of Otohinolaryngology, Children's Hospital to Zhengzhou University, Zhengzhou University, Zhengzhou
| | - Junfu Wu
- Department of Head and Neck, Affiliated Cancer Hospital of Zhengzhou University
| | - Qigen Fang
- Department of Head and Neck, Affiliated Cancer Hospital of Zhengzhou University
| | - Fei Liu
- Department of Oral Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
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13
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Abstract
RATIONALE Primary osteosarcomas of the skull and skull base are rare, comprising <2% of all skull tumors. Primary osteosarcomas of the skull are aggressive neoplasms composed of spindle cells producing osteoid which have poor outcome. PATIENT CONCERNS A 33-year-old woman was admitted to our hospital with a major complaint of a growing mass on her left frontal region of the skull for 10 months. Prior to the accurate diagnosis, the mass on her skull was considered to be eosinophilic granuloma. DIAGNOSES Computerized tomogram (CT) scan of skull revealed a lytic lesion causing destruction of left frontal bone with surrounding soft tissue mass. The histological examination of the lesion showed typical features of osteosarcoma. INTERVENTIONS The patient received 3 surgeries and adjuvant chemotherapy and radiotherapy for the frontal bone lesion. OUTCOMES At the last follow-up, after 4 years, the patient was free of disease both clinically and on imaging by magnetic resonance imaging (MRI) scan after 4 years. LESSONS Because osteosarcoma of skull is a rare disease, the early recognition and correct diagnosis are very important for a better prognosis. It is therefore imperative that clinicians recognize osteosarcoma early to make an accurate diagnosis and complete surgical resection followed by combined chemo-radiation is proved to be one of the most optimal treatment regimens.
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Affiliation(s)
| | - Qi Liang
- Department of Radiology, The Third Xiangya Hospital, Central South University, Changsha, Hunan, P.R. China
| | - Yu Liu
- Department of Neurosurgery
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14
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Jeong HI, Lee MJ, Nam W, Cha IH, Kim HJ. Osteosarcoma of the jaws in Koreans: analysis of 26 cases. J Korean Assoc Oral Maxillofac Surg 2017; 43:312-317. [PMID: 29142865 PMCID: PMC5685860 DOI: 10.5125/jkaoms.2017.43.5.312] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Revised: 09/29/2017] [Accepted: 10/04/2017] [Indexed: 11/11/2022] Open
Abstract
Objectives In order to assess clinical behavior, response to treatment, and factors influencing prognosis of Korean patients with osteosarcoma of the jaws (OSJ). Materials and Methods A retrospective study of clinical, and pathological records of 26 patients with OSJ treated at the Department of Oral and Maxillofacial Surgery in Yonsei University Dental Hospital from 1990 to March 2017. Results Of 26 patients, there were 9 men (34.6%) and 17 women (65.4%). Twenty-one of 26 patients had osteosarcoma of the mandible, and 5 of 26 patients had osteosarcoma of the maxilla. The histopathology of OSJ is highly variable, ranging from chondroblastic type (6 out of 26), osteoblastic type (10 out of 26), fibroblastic type (2 out of 26), to the rare variants like mixed type, small cell osteosarcoma types and more. All patients underwent gross total excision and only a few patients underwent neoadjuvant chemotherapy. Postoperative chemotherapy was given to most of the patients as adjuvant treatment or in combination with radiotherapy. The overall survival rate was 73.1% with an overall 2-year survival rate of 83.3%. The overall 5-,10-,15-year survival rates in this study were 73.5%, 73.5%, 49%, respectively. Using Kaplan-Meier analysis with log rank tests, the size of tumor (T-stage), and resection margins were found to affect the survival rate significantly. The chemotherapy was not significantly associated with improved survival rate. Conclusion Surgical resection with a clear margin is the most important factor in disease survival. The role of chemotherapy and radiotherapy in OSJ remains controversial, and deserves further studies.
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Affiliation(s)
- Hye-In Jeong
- Department of Oral and Maxillofacial Surgery, Yonsei University College of Dentistry, Seoul, Korea
| | - Mi Jee Lee
- Oral Cancer Research Institute, Yonsei University College of Dentistry, Seoul, Korea.,Colonical War Memorial Hospital, Ministry of Health, Suva, Fiji
| | - Woong Nam
- Department of Oral and Maxillofacial Surgery, Yonsei University College of Dentistry, Seoul, Korea.,Oral Cancer Research Institute, Yonsei University College of Dentistry, Seoul, Korea
| | - In-Ho Cha
- Department of Oral and Maxillofacial Surgery, Yonsei University College of Dentistry, Seoul, Korea.,Oral Cancer Research Institute, Yonsei University College of Dentistry, Seoul, Korea
| | - Hyung Jun Kim
- Department of Oral and Maxillofacial Surgery, Yonsei University College of Dentistry, Seoul, Korea.,Oral Cancer Research Institute, Yonsei University College of Dentistry, Seoul, Korea
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15
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Osteosarcoma of the skull base: An analysis of 19 cases and literature review. J Clin Neurosci 2017; 44:133-142. [DOI: 10.1016/j.jocn.2017.06.014] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2017] [Revised: 05/19/2017] [Accepted: 06/08/2017] [Indexed: 12/14/2022]
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Krishnamurthy A, Palaniappan R. Osteosarcomas of the Head and Neck Region: A Case Series with a Review of Literature. J Maxillofac Oral Surg 2017; 17:38-43. [PMID: 29382992 DOI: 10.1007/s12663-017-1017-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Accepted: 04/19/2017] [Indexed: 10/19/2022] Open
Abstract
Background Osteosarcomas of head and neck region have unique biology and exhibit a clinical behavior and natural history that is distinct from osteosarcomas of the trunk and extremities. Our understanding of this malignant bone tumor is largely based on data from single institutions or compiled from registries, and hence the clinical practice guidelines seem confusing and conflicting. Aims and Objectives To analyze the demographic profile, disease characteristics and survival outcomes of osteosarcoma of head and neck region. Materials and Methods Retrospective analysis of the patients treated for osteosarcoma of head and neck region with curative intent in the period between the years 2001-2013 at a tertiary cancer center from South India. Results A total of 14 patients were treated in the said period with a mean age of 37 years. The most common site was mandible (n = 9 patients) followed by maxilla (n = 4) and paranasal sinuses (n = 1). Conventional osteoblastic variant of OS was the most common histological variant (n = 8) followed by the chondroblastic variant (n = 5). The median disease-free survival was 41.7 months, whereas the median overall survival of our patient cohort was 47.6 months. A formal analysis of various prognostic factors showed only postoperative margin positivity to be the single important factor affecting the survival outcomes. Conclusion Head and neck osteosarcoma that most commonly afflicts the jaw bones occurs in the fourth decade of life. Despite being a small series, our study does highlight the importance of achieving a margin-negative resection as a part of the multimodality treatment of head and neck osteosarcomas. Considering the relative paucity of data, there is a need for multi-institutional collaborative studies to refine the therapeutic strategies for the management of patients with head and neck osteosarcomas.
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Affiliation(s)
- Arvind Krishnamurthy
- Surgical Oncology, Cancer Institute (WIA), 38, Sardar Patel Rd, Adyar, Chennai, 600036 India
| | - Ravishankar Palaniappan
- Surgical Oncology, Cancer Institute (WIA), 38, Sardar Patel Rd, Adyar, Chennai, 600036 India
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Vassiliou LV, Lalabekyan B, Jay A, Liew C, Whelan J, Newman L, Kalavrezos N. Head and neck sarcomas: A single institute series. Oral Oncol 2016; 65:16-22. [PMID: 28109463 DOI: 10.1016/j.oraloncology.2016.12.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2016] [Revised: 12/01/2016] [Accepted: 12/04/2016] [Indexed: 01/26/2023]
Abstract
BACKGROUND Sarcomas are tumours of mesenchymal origin, accounting for 1% of all malignancies. METHODS This is a retrospective analysis of 107 head and neck sarcoma cases, treated over a period of thirteen years. RESULTS Fifty-four patients had with craniofacial bone sarcomas (BSs) (male: 33; female: 21) with high grade osteosarcoma being the most predominant type. The soft tissue sarcomas (STS) (53 patients; male: 28, female: 25) were histologically diverse with rhabdomyosarcomas and myxofibrosarcomas being the predominant types. The majority of BSs were managed with neoadjuvant chemotherapy followed by surgery, whereas in STSs treatment included predominantly surgery followed by radiotherapy. Overall survival estimates were 79% at 2years and 64% at 5years (mean follow-up period was 48months). CONCLUSIONS The mesenchymal origin of sarcomas, the pattern of disease spread and the different extent of cancellous bone infiltration in contrast to epithelial tumours, dictate distinct principles for surgical clearance.
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Affiliation(s)
| | | | - Amrita Jay
- University College London Hospital (UCLH), London, UK
| | - Colin Liew
- University College London Hospital (UCLH), London, UK
| | - Jeremy Whelan
- University College London Hospital (UCLH), London, UK
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18
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König M, Osnes TA, Lobmaier I, Bjerkehagen B, Bruland ØS, Sundby Hall K, Meling TR. Multimodal treatment of craniofacial osteosarcoma with high-grade histology. A single-center experience over 35 years. Neurosurg Rev 2016; 40:449-460. [PMID: 27858303 DOI: 10.1007/s10143-016-0802-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Revised: 10/06/2016] [Accepted: 11/09/2016] [Indexed: 11/28/2022]
Abstract
High-grade craniofacial osteosarcoma (CFOS) is an aggressive malignancy with a poor prognosis. Our goals were to evaluate treatment outcomes in those treated at a single referral institution over 35 years and to compare our results to the available literature. A retrospective analysis of all 42 patients treated between 1980 and 2015 at Oslo University Hospital, Norway, identified in a prospectively collected database, was conducted. Mean follow-up was 79.6 months. Overall survival at 2 and 5 years was 70.5 and 44.7%, respectively. The corresponding disease-specific survival rates were 73.0 and 49.8%. Treatment was surgery only in eight cases. Additional therapy was administered in 34 patients: chemotherapy in nine, radiotherapy in seven, and a combination of these in 18 cases. Stratified analysis by resection margins demonstrated significantly better survival at 2 and 5 years after radical surgical treatment. Neoadjuvant chemotherapy and subsequent adequate surgery resulted in better survival than surgery alone. Half of the patients either had a primary or familial cancer predisposition. This is the largest single-center study conducted on high-grade CFOS to date. Our experience indicates that neoadjuvant chemotherapy with complete surgical resection significantly improved survival, compared to surgery alone.
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Affiliation(s)
- Marton König
- Department of Neurosurgery, Oslo University Hospital - Rikshospitalet, 4950 Nydalen, Oslo, 0424, Norway. .,Department of Neurology, Ostfold Hospital Trust, 300, Gralum, 1714, Norway. .,Institute of Clinical Medicine, University of Oslo, 1711 Blindern, Oslo, 0318, Norway.
| | - Terje A Osnes
- Institute of Clinical Medicine, University of Oslo, 1711 Blindern, Oslo, 0318, Norway.,Department of Otorhinolaryngology, Oslo University Hospital - Rikshospitalet, 4950 Nydalen, 0424, Oslo, Norway
| | - Ingvild Lobmaier
- Department of Pathology, Oslo University Hospital - Radiumhospitalet, 4950 Nydalen, Oslo, 0424, Norway
| | - Bodil Bjerkehagen
- Department of Pathology, Oslo University Hospital - Radiumhospitalet, 4950 Nydalen, Oslo, 0424, Norway
| | - Øyvind S Bruland
- Institute of Clinical Medicine, University of Oslo, 1711 Blindern, Oslo, 0318, Norway.,Department of Oncology, Oslo University Hospital - Radiumhospitalet, 4950 Nydalen, Oslo, 0424, Norway
| | - Kirsten Sundby Hall
- Department of Oncology, Oslo University Hospital - Radiumhospitalet, 4950 Nydalen, Oslo, 0424, Norway
| | - Torstein R Meling
- Department of Neurosurgery, Oslo University Hospital - Rikshospitalet, 4950 Nydalen, Oslo, 0424, Norway.,Institute of Clinical Medicine, University of Oslo, 1711 Blindern, Oslo, 0318, Norway
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Mathkour M, Garces J, Beard B, Bartholomew A, Sulaiman OAR, Ware ML. Primary High-Grade Osteosarcoma of the Clivus: A Case Report and Literature Review. World Neurosurg 2016; 89:730.e9-730.e13. [PMID: 26836700 DOI: 10.1016/j.wneu.2016.01.054] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2015] [Revised: 01/17/2016] [Accepted: 01/19/2016] [Indexed: 12/26/2022]
Abstract
BACKGROUND Osteosarcoma is the second most common primary tumor of the skeletal system and the most common primary bone tumor. Usually occurring at the metaphysis of long bones, osteosarcomas are highly aggressive lesions that comprise osteoid-producing spindle cells. Craniofacial osteosarcomas comprise <8% and are believed to be less aggressive and lower grade. Primary osteosarcomas of the skull and skull base comprise <2% of all skull tumors. Osteosarcomas originating from the clivus are rare. We present a case of a primar, high-grade clival osteosarcoma. CASE DESCRIPTION A 29-year-old man presented to our institution with a progressively worsening right frontal headache for 3 weeks. There were no sensory or cranial nerve deficits. Computed tomography revealed a destructive mass involving the clivus with extension into the left sphenoid sinus. Magnetic resonance imaging revealed a homogenously enhancing lesion measuring 2.7 × 2.5 × 3.2 cm. The patient underwent endonasal transphenoidal surgery for gross total resection. The histopathologic analysis revealed proliferation of malignant-appearing spindled and epithelioid cells with associated osteoclast-like giant cells and a small area of osteoid production. The analysis was consistent with high-grade osteosarcoma. The patient did well and was discharged on postoperative day 2. He was referred for adjuvant radiation therapy and chemotherapy. Two-year follow-up showed postoperative changes and clival expansion caused by packing material. CONCLUSIONS Osteosarcoma is a highly malignant neoplasm. These lesions are usually found in the extremities; however, they may rarely present in the craniofacial region. Clival osteosarcomas are relatively infrequent. We present a case of a primary clival osteosarcoma with high-grade pathology.
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Affiliation(s)
- Mansour Mathkour
- Department of Neurosurgery, Ochsner Health System, New Orleans, Louisiana, USA; Department of Neurosurgery, Tulane Medical Center, New Orleans, Louisiana, USA.
| | - Juanita Garces
- Department of Neurosurgery, Ochsner Health System, New Orleans, Louisiana, USA; Department of Neurosurgery, Tulane Medical Center, New Orleans, Louisiana, USA
| | - Bryce Beard
- Department of Neurosurgery, Tulane Medical Center, New Orleans, Louisiana, USA
| | - Angela Bartholomew
- Department of Neurosurgery, Ochsner Health System, New Orleans, Louisiana, USA
| | | | - Marcus L Ware
- Department of Neurosurgery, Ochsner Health System, New Orleans, Louisiana, USA
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Ahrari A, Labib M, Gravel D, Macdonald KI. Primary Osteosarcoma of the Skull Base Treated with Endoscopic Endonasal Approach: A Case Report and Literature Review. J Neurol Surg Rep 2015; 76:e270-4. [PMID: 26623240 PMCID: PMC4648719 DOI: 10.1055/s-0035-1564606] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2015] [Accepted: 08/10/2015] [Indexed: 11/29/2022] Open
Abstract
Introduction Giant cell-rich osteosarcoma (GCRO) is a rare pathologic diagnosis, and most cases have involved the appendicular skeleton. We present a challenging diagnosis of GCRO of the skull base treated with an endoscopic endonasal approach. Case Presentation An 18-year-old female patient presented with acute monocular visual loss. Imaging revealed a large clival mass encasing the internal carotid arteries bilaterally with pituitary and optic nerve compression. The lesion was resected via a staged endoscopic endonasal approach and the patient's vision normalized postoperatively. The final pathological diagnosis was challenging and, after consultation with multiple North American centers, was concluded as GCRO. The tumor recurred and further surgery was performed, followed by adjuvant chemoradiation. Conclusion We highlight diagnostic challenges of GCRO of the skull base, and describe, with intraoperative pictures, successful surgical resection via an endoscopic endonasal approach. Based on our literature review, this is the first published case report of GCRO of the skull base.
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Affiliation(s)
- Azin Ahrari
- Department of Otolaryngology-Head and Neck Surgery, University of Ottawa, Ottawa, Ontario, Canada
| | - Mohamed Labib
- Department of Neurosurgery, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Denis Gravel
- Department of Pathology and Laboratory Medicine, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Kristian I Macdonald
- Department of Otolaryngology-Head and Neck Surgery, University of Ottawa, Ottawa, Ontario, Canada
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Ferbeyre Binelfa L. Abordaje submaseterino ampliado para la resección de lipoma del espacio masticatorio: nota anatomoquirúrgica y reporte de un caso. GACETA MEXICANA DE ONCOLOGÍA 2015. [DOI: 10.1016/j.gamo.2015.06.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Kuba K, Inoue H, Hayashi T, Matsumura S, Minami K, Takajo H, Morita K, Nakahira M, Sugasawa M. Laryngeal osteosarcoma: case report and literature review. Head Neck 2014; 37:E26-9. [PMID: 24824784 DOI: 10.1002/hed.23767] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/10/2014] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Sarcomas of the larynx are uncommon tumors, and osteosarcoma is the rarest. Only 24 cases of osteosarcoma of the larynx have been reported. The only case reported in Asia was from Thailand in 1981. METHODS A 55-year-old male patient was referred to our hospital because of an 8-month history of odynophagia and a gradually enlarging left neck mass. A neck CT scan was performed. A literature review was also performed for this report. RESULTS The CT scan revealed extensive calcification with enlargement of the thyroid cartilage. The patient was diagnosed with osteosarcoma and was successfully treated by surgery alone. CONCLUSION Adequate surgical resection is required for successful treatment of laryngeal sarcomas. Adjuvant therapy is not contraindicated, but chemotherapy may improve the prognosis in patients with high-grade tumors or metastatic disease.
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Affiliation(s)
- Kiyomi Kuba
- Department of Head and Neck Surgery and Otolaryngology, Saitama Medical University International Medical Center, Hidaka, Saitama, Japan
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23
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Hadley C, Gressot LV, Patel AJ, Wang LL, Flores RJ, Whitehead WE, Luerssen TG, Jea A, Bollo RJ. Osteosarcoma of the cranial vault and skull base in pediatric patients. J Neurosurg Pediatr 2014; 13:380-7. [PMID: 24483254 DOI: 10.3171/2013.12.peds13359] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Cranial osteosarcoma is very rare in children, rendering the development of optimal treatment algorithms challenging. The authors present 3 cases of pediatric cranial osteosarcoma: a primary calvarial tumor, a cranial metastasis, and a primary osteosarcoma of the cranial base. A review of the literature demonstrates significant variation in the management of cranial osteosarcomas and the outcome for patients with these tumors. This series and literature review is presented to improve the understanding of pediatric cranial osteosarcoma and to reinforce the importance of maximal resection in optimizing outcome.
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Affiliation(s)
- Caroline Hadley
- Department of Neurosurgery, Baylor College of Medicine and Division of Pediatric Neurosurgery, Texas Children's Hospital
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24
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Frezza AM, Beale T, Bomanji J, Jay A, Kalavrezos N, Dileo P, Whelan J, Strauss SJ. Is [F-18]-fluorodeoxy-D-glucose positron emission tomography of value in the management of patients with craniofacial bone sarcomas undergoing neo-adjuvant treatment? BMC Cancer 2014; 14:23. [PMID: 24422949 PMCID: PMC3904418 DOI: 10.1186/1471-2407-14-23] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2012] [Accepted: 01/06/2014] [Indexed: 11/25/2022] Open
Abstract
Background We evaluated the role of 18FDG PET/CT used to assess response to preoperative chemotherapy in patients with primary craniofacial bone sarcomas. Methods Fourteen patients with craniofacial bone sarcomas (13 osteosarcoma, 1 spindle cell sarcoma) were retrospectively evaluated. All patients received up to 6 cycles of preoperative chemotherapy followed by resection of the primary tumour. Response to treatment was assessed using MRI (RECIST criteria) and 18FDG PET/CT (EORTC guidelines), performed at least at baseline, after 2-4 cycles and pre-operatively. Results The median baseline 18FDG PET/CT SUV was 10.2 (range 0-41); in 2 patients no uptake was detected. The preoperative 18FDG PET/CT, compared with the baseline, demonstrated a partial metabolic response in 7 patients (59%), complete metabolic response in 2 (16%) and stable metabolic disease in 3 (25%). In contrast, only two patients achieved a RECIST response on MRI: 10 (83%) had stable disease. One patient underwent early resection due to clinical progression after an initial response to treatment. This was confirmed by PET (SUV from 21 to 42) but not on MRI. Twelve of 14 patients (86%) had <90% histological necrosis in the resected tumour. At a median follow-up 23 months, 11 patients (79%) remain disease free, two had metastatic progression (14%) and 1 a local relapse (7%). The median DFS was 17 months. For those patients who achieved a response to preoperative 18FDG PET/CT the median DFS was 19 months (range: 1-66) compared with 3 months (range: 3-13) in those who did not (p = 0.01). In contrast, the median disease free survival (DFS) did not differ according to histological response (19 versus 17 months, >90% versus <90% necrosis, p = 0.45) or resection margins (19 months for R0 versus 18 months for R1, p = 0.2). Conclusion 18FDG PET/CT is more reliable than standard imaging in evaluating response to neo-adjuvant chemotherapy in craniofacial bone sarcomas, changed management in one patient, and in this small series, correlated better with patient outcome than histological response and resection margins. These results warrant prospective validation in a larger cohort of patients.
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Affiliation(s)
| | | | | | | | | | | | | | - Sandra J Strauss
- The London Sarcoma Service, University College London Hospital, London, England.
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25
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Rapidis AD. Sarcomas of the head and neck in adult patients: current concepts and future perspectives. Expert Rev Anticancer Ther 2014; 8:1271-97. [DOI: 10.1586/14737140.8.8.1271] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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26
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van den Berg H, Merks JHM. Incidence and grading of cranio-facial osteosarcomas. Int J Oral Maxillofac Surg 2013; 43:7-12. [PMID: 24035127 DOI: 10.1016/j.ijom.2013.06.017] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2013] [Revised: 05/30/2013] [Accepted: 06/03/2013] [Indexed: 11/27/2022]
Abstract
Osteosarcoma of the cranio-facial structures and skull is rare. In children, only 5.6% of cases are localized in these areas. It is claimed that the mean age at presentation is at least 10-15 years higher than for osteosarcomas in other parts of the body. However these reports are based on data from single institutions or compiled from several registries. It is further claimed that tumours in the mandible and maxilla are less malignant, as based on observations of a better prognosis and lower incidence of metastatic spread as compared with osteosarcomas arising elsewhere. We report all histologically proven cranio-facial osteosarcomas in The Netherlands occurring over a 20-year period, based on the national registration covering all Dutch pathology laboratories (PALGA). The age-corrected incidence of primary osteosarcoma ranged from 0.33 to 0.41 per million across the age ranges. The mandible was the most frequent site of involvement. Only 61% had a high malignant histological grading. Our data indicate that the age-corrected incidence of primary osteosarcomas is similar across all age ranges. In respect to histology, a lower grade of malignancy is more frequent. Maxillary lesions significantly more often have a lower histological grade of malignancy.
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Affiliation(s)
- H van den Berg
- Department of Paediatric Oncology, Emma Children's Hospital, Academic Medical Centre, University of Amsterdam, The Netherlands.
| | - J H M Merks
- Department of Paediatric Oncology, Emma Children's Hospital, Academic Medical Centre, University of Amsterdam, The Netherlands
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Amini Shakib P, Foroughi R, Seyedmajidi M. Osteosarcoma of the maxilla: a rare case with unusual clinical presentation. J Dent Res Dent Clin Dent Prospects 2013; 7:177-81. [PMID: 24082991 PMCID: PMC3779379 DOI: 10.5681/joddd.2013.029] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2012] [Accepted: 06/22/2013] [Indexed: 12/03/2022] Open
Abstract
Osteosarcoma (OS) is a malignant mesenchymal tumor, which rarely occurs in the maxilla. Although variable histologic and radiographic features of OS have been reported previously, in the majority of the cases painful swelling of the jaw is mentioned as the first clinical presentation. Furthermore, early diagnosis and wide surgical resection of the tumor are the most important determinant factors of prognosis. Therefore, the unusual clinical presentations of OS should be considered meticulously to expedite the diagnosis process. We describe a case of OS of the maxilla with extremely unusual presenta-tion in a 42-year-old female, that was initially designated as “epulis fissuratum”. Here, we highlight the importance of com-bining the clinical, radiographic and histopathologic examination to obtain a definitive diagnosis and also the significance ofearly effective surgical intervention in evaluation of pathologic lesions.
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Affiliation(s)
- Pouyan Amini Shakib
- Assistant Professor, Department of Oral and Maxillofacial Pathology, Faculty of Dentistry, Babol University of Medical Sciences, Babol, Iran
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Osteosarcoma: A Comparison of Jaw versus Nonjaw Localizations and Review of the Literature. Sarcoma 2013; 2013:316123. [PMID: 23956680 PMCID: PMC3727198 DOI: 10.1155/2013/316123] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2013] [Accepted: 06/18/2013] [Indexed: 11/17/2022] Open
Abstract
Purpose. It is assumed that osteosarcomas of the jaws mainly occur at older ages, whereas the most prominent sites, that is, the long bones, are more affected at ages <20. Jaw-localized tumors are less malignant and have lower metastatic spread rates. Patients and Methods. This study analyses the nationwide data of the Dutch Cancer Registry on osteosarcoma during the period from 1991 to 2010. Age-corrected incidence rates were calculated. Results. In 949, 38 patients had tumors in the maxilla and in 58 in the mandible. Median age for maxilla, mandible, and other localizations was 45.5, 49, and 23 years, respectively. Age-corrected incidence for osteosarcomas increased after a steep decline for the age cohorts from 20 to 60 years to nearly the same level as the younger patients. The incidence for maxillary lesions showed a steady increase from 0.46 to 1.60 per million over all age ranges; the highest incidence for mandibular lesions was found in the age cohort from 60 to 79 years. In respect to histology, no shifts for age were found, except for Paget's disease-related osteosarcoma. In older patients, chemotherapy was omitted more often. Overall survival was similar for all age groups, except for extragnatic tumor patients in the age range of 60-79 years. Conclusions. Osteosarcomas have comparable incidences below the age of 20 as compared with ages >60 years. Poorer outcome in older people is likely due to refraining from chemotherapy.
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Thariat J, Schouman T, Brouchet A, Sarini J, Miller R, Reychler H, Ray-Coquard I, Italiano A, Verite C, Sohawon S, Bompas E, Dassonville O, Salas S, Aldabbagh K, Maingon P, de La MotteRouge T, Kurtz J, Usseglio J, Kerbrat P, Raoul G, Lotz J, Bar-Sela G, Brugières L, Chaigneau L, Saada E, Odin G, Marcy P, Thyss A, Julieron M. Osteosarcomas of the mandible: multidisciplinary management of a rare tumor of the young adult a cooperative study of the GSF-GETO, Rare Cancer Network, GETTEC/REFCOR and SFCE. Ann Oncol 2013; 24:824-31. [DOI: 10.1093/annonc/mds507] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Kämmerer PW, Shabazfar N, Vorkhshori Makoie N, Moergel M, Al-Nawas B. Clinical, therapeutic and prognostic features of osteosarcoma of the jaws – Experience of 36 cases. J Craniomaxillofac Surg 2012; 40:541-8. [DOI: 10.1016/j.jcms.2011.10.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2011] [Revised: 09/27/2011] [Accepted: 10/06/2011] [Indexed: 10/15/2022] Open
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Harvey RJ, Winder M, Parmar P, Lund V. Endoscopic skull base surgery for sinonasal malignancy. Otolaryngol Clin North Am 2012; 44:1081-140. [PMID: 21978897 DOI: 10.1016/j.otc.2011.06.020] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Management of malignant neoplasms of the sinonasal tract and skull base is hampered by the relative low incidence and pathologic diversity of patient presentations. Many studies have reported successful outcomes in the endoscopic management of malignancy since 1996, and these are summarized in this article. Nonsurgical adjuvant therapies are important for locoregional control because surgery occurs in a restricted anatomic space with close margins to critical structures, and distant disease is an ongoing concern in these disorders. There remains a need for collaborative consistent multicenter reporting, and international registries have been established to assist in such efforts.
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Affiliation(s)
- Richard J Harvey
- Department of Otolaryngology/Skull Base Surgery, St Vincent's Hospital, Victoria Street, Darlinghurst, Sydney, New South Wales 2010, Australia.
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32
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Woo SB. Nonodontogenic Intraosseous Lesions. ORAL PATHOLOGY 2012:382-431. [DOI: 10.1016/b978-1-4377-2226-0.00016-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
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Abstract
OBJECTIVE The objective of the study was to discuss the optimal management and treatment outcomes for patients with head and neck osteosarcomas. STUDY DESIGN Review article. METHODS Review of the pertinent literature. RESULTS Osteosarcomas account for approximately 1% or less of all head and neck cancers. The vast majority occur in the mandible and maxilla. The median age is in the fourth decade, with a wide range. They are more likely to recur locally after treatment and distant metastases are observed less often than with the more common osteosarcomas arising in the long bones. The optimal treatment is complete resection. The role of adjuvant chemotherapy is ill-defined. The vast majority of recurrences are observed within 5 years. The 5-year disease-specific and overall survival rates are approximately 60% to 70%. CONCLUSIONS Osteosarcoma of the head and neck is a rare entity that occurs primarily in the mandible and maxilla. The optimal treatment is surgery. Adjuvant radiotherapy should be considered for those with close or positive margins. The role of adjuvant chemotherapy is ill-defined. The likelihood of cure is approximately 60% to 70%.
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Steve M, Ernenwein D, Chaine A, Bertolus C, Goudot P, Ruhin-Poncet B. [Jaw osteosarcomas]. ACTA ACUST UNITED AC 2011; 112:286-92. [PMID: 21943494 DOI: 10.1016/j.stomax.2011.08.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2010] [Revised: 01/06/2011] [Accepted: 08/10/2011] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Osteosarcoma (OS) is the most frequent bone malignant tumor. It is usually found on long bones, 5 to 10% are located on jaws, accounting for 0.5 to 1% of all facial tumors. There is little published data which concerns only few patients. Our aim was to study retrospectively cases of facial bone OS in adults, and to compare our results with published data to suggest an optimal management scheme. PATIENTS AND METHOD Thirty-three patients were managed for an OS, from January 1997 to January 2007. Fourteen patients with a maxillary and mandibular OS, treated in first-intention in our unit, were included. The following data were analyzed: age; personal history; circumstance of discovery; clinical, functional, and physical signs; loco-regional extension and metastasis radiological investigation. The histological slides were systematically reviewed. The protocol, therapeutic outcome, and follow-up were studied. RESULTS The mean age at diagnosis was 43. Swelling was the most frequent functional sign. The mean delay before management was 3.4 months. The most frequent radiological presentation was a lytic and hyperdense image. The diagnosis was suggested after CT scan in 57.1% of cases. The biopsy was correlated to the anatomopathological analysis in 78.6% of cases. The most common treatment was surgical exeresis completed by chemotherapy. The 5-year survival rate was 50%. DISCUSSION Jaw OS are specific because of their localization and specific bone ultrastructure. Their management remains controversial: should they be managed like limb OS or treated more specifically? Neoadjuvant chemotherapy, even if it delays exeresis for 3 months, seems to stop the growth or reduce the tumor. An early anatomopathological analysis of the surgical piece determines adjuvant therapy. The negative prognostic factors are: maxillary localization because of limited exeresis margins, tumoral size, and osteoblastic sub-type.
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Affiliation(s)
- M Steve
- Service de stomatologie et chirurgie maxillo-faciale, hôpital de la Pitié-Salpêtrière, Assistance publique-Hôpitaux de Paris, université Pierre-et-Marie-Curie Paris-6, 47-83 boulevard de l'Hôpital, Paris cedex 13, France
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LeCornu MG, Chuang SK, Kaban LB, August M. Osteosarcoma of the Jaws: Factors Influencing Prognosis. J Oral Maxillofac Surg 2011; 69:2368-75. [DOI: 10.1016/j.joms.2010.10.023] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2010] [Revised: 08/09/2010] [Accepted: 10/07/2010] [Indexed: 11/26/2022]
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Thariat J, Julieron M, Brouchet A, Italiano A, Schouman T, Marcy PY, Odin G, Lacout A, Dassonville O, Peyrottes-Birstwisles I, Miller R, Thyss A, Isambert N. Osteosarcomas of the mandible: are they different from other tumor sites? Crit Rev Oncol Hematol 2011; 82:280-95. [PMID: 21868246 DOI: 10.1016/j.critrevonc.2011.07.001] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2011] [Revised: 07/03/2011] [Accepted: 07/29/2011] [Indexed: 10/17/2022] Open
Abstract
BACKGROUND Osteosarcomas of the mandible (MOS) affect 1/10 million persons/year, mostly the young adult. Due to lack of specific data, the treatment of MOS is extrapolated from that of extragnathic OS but varies widely between institutions. MATERIALS AND METHODS We aimed at providing a focused description of MOS histologies and grades through the English literature, at determining the evidence-based role of chemotherapy, of adjuvant radiation therapy and the potential of reconstructive surgery tailored through modern pre-operative multi-modal imaging. RESULTS The estimated proportion of high grade MOS was 58%. However, low-grade MOS may be underestimated as they are mostly reported as case reports. The intermediate grade was hardly found in the literature. Estimated weighted-mean proportions of chondroblastic and osteoblastic MOS were 37% and 46%, respectively. Multimodal imaging modalities including MRI has a great potential for accurate pre-operative assessment of tumor extensions into bone and soft tissues. Surgery is the mainstay of treatment and margins the most important factor. The role of neoadjuvant chemotherapy in treating occult systemic metastases and in increasing the probability of clear margins is controversial, as well as the histology-dependent response to chemotherapy. The role of adjuvant radiotherapy (mostly proposed for positive margins) and/or adjuvant chemotherapy is still controversial. Crude survival is around 77% and local control around 67%. Local failure is the main cause of death in MOS compared to extragnathic sites.
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Affiliation(s)
- Juliette Thariat
- Department of Radiation Oncology/IBDC CNRS UMR 6543, Cancer Center Antoine-Lacassagne - Institut Universitaire de la Face et du Cou, University Nice Sophia-Antipolis, 33 Av. Valombrose, 06189 NICE Cedex 2 France.
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König M, Mork J, Hall KS, Osnes T, Meling TR. Multimodal treatment of osteogenic sarcoma of the jaw. Skull Base 2011; 20:207-12. [PMID: 21318040 DOI: 10.1055/s-0029-1246221] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Osteosarcomas (OSs) account for 40 to 60% of primary malignant bone tumors. About 10% occur in the head and neck region, frequently in the mandibula or maxilla. We treated a 30-year-old patient with 26-month history of right-sided facial pain and paresthesia. Investigation showed high-grade OS of the right mandibular coronoid process, affecting the mandibular nerve, middle cranial fossa, internal jugular vein, and internal carotid artery (ICA). True en bloc resection was performed after upfront adjuvant chemotherapy. The ICA was trap-ligated intradurally, whereafter the floor of the middle fossa, including the mandibular nerve and the glenoid fossa, was detached from the skull base in one piece. Subsequently, a hemimandibulectomy, total parotidectomy, ICA sacrifice, and removal of the pterygoid plates and muscles were performed, and the abovementioned structures were removed as a solitary specimen, including the facial nerve branches overlying the tumor. A sural nerve graft was interposed between five major facial nerve branches to reanimate the face. The patient had an uneventful recovery, is able to eat, and has a partial facial nerve palsy. He has no tumor recurrence 26 months after surgery. OS of the jaw should be treated with radical surgery as the primary modality.
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Affiliation(s)
- Marton König
- Department of Neurosurgery, Rikshospitalet, Oslo University Hospital, Oslo, Norway
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Abstract
BACKGROUND AND OBJECTIVES This study analyzed maxillary osteosarcoma in a mestizo population, with particular emphasis on the type of treatment and disease-free and overall survival. METHODS This is a retrospective study including all mestizo patients with osteosarcoma of the maxilla seen in a single cancer institution in Mexico during a 20-year period. RESULTS There were 21 patients. Age ranged from 16 to 76 years (mean, 37.5 y). Mean evolution time to diagnosis was 13 months, with a mean tumor size of 7 × 6 cm2. Surgery was the initial treatment in 19 patients, 17 of whom received adjuvant treatment. Disease-free survival according to surgical margin and overall survival were not statistically significant. Disease-free survival was 29% at 5 years, and overall survival was 50% and 25% at 5 and 10 years, respectively. CONCLUSIONS Osteosarcomas of the maxilla are infrequent lesions that merit early diagnosis and proper treatment because of their rapid evolution. Treatment is currently based on a well-planned surgery with free surgical margins plus adjuvant radiotherapy and/or chemotherapy.
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Ketabchi A, Kalavrezos N, Newman L. Sarcomas of the head and neck: a 10-year retrospective of 25 patients to evaluate treatment modalities, function and survival. Br J Oral Maxillofac Surg 2011; 49:116-20. [DOI: 10.1016/j.bjoms.2010.02.012] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2009] [Accepted: 02/02/2010] [Indexed: 11/25/2022]
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Patel AJ, Rao VY, Fox BD, Suki D, Wildrick DM, Sawaya R, DeMonte F. Radiation-induced osteosarcomas of the calvarium and skull base. Cancer 2010; 117:2120-6. [DOI: 10.1002/cncr.25734] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2010] [Accepted: 09/27/2010] [Indexed: 11/06/2022]
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Chang CS, Bergeron L, Liao CC, Liao HT, Chang CN, Kuo-Ting Chen P, Chen YR. Craniofacial reconstruction of primary osteogenic sarcoma of the skull. J Plast Reconstr Aesthet Surg 2010; 63:1265-8. [DOI: 10.1016/j.bjps.2009.07.020] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2008] [Revised: 07/16/2009] [Accepted: 07/23/2009] [Indexed: 11/29/2022]
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Shao Z, He Y, Wang L, Hu H, Shi H. Computed tomography findings in radiation-induced osteosarcoma of the jaws. ACTA ACUST UNITED AC 2010; 109:e88-94. [DOI: 10.1016/j.tripleo.2009.10.049] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2009] [Revised: 10/09/2009] [Accepted: 10/31/2009] [Indexed: 10/19/2022]
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Guadagnolo BA, Zagars GK, Raymond AK, Benjamin RS, Sturgis EM. Osteosarcoma of the jaw/craniofacial region: outcomes after multimodality treatment. Cancer 2009; 115:3262-70. [PMID: 19382187 DOI: 10.1002/cncr.24297] [Citation(s) in RCA: 109] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND The current study was performed to evaluate outcomes in patients with osteosarcoma of the head and neck (OHN) who were treated with surgery with or without radiotherapy (RT). METHODS Between 1960 and 2007, 119 patients with OHN underwent macroscopic total resection with or without RT. The median age of the patients was 33 years (range, 7-77 years). Of these 119 patients 92 (77%) underwent surgery alone whereas 27 (23%) patients were treated with combined modality treatment (CMT) comprised of surgery and RT (median dose, 60 Gray [Gy]; range, 50-66 Gy). RESULTS The median follow-up was 5.8 years. Overall survival (OS) rates at 5 years and 10 years were 63% and 55%, respectively. Corresponding disease-specific survival (DSS) rates were 67% and 61%, respectively. Stratified analysis by resection margin status demonstrated that CMT compared with surgery alone improved OS (80% vs 31%; P = .02) and DSS (80% vs 35%; P = .02) for patients with positive/uncertain resection margins. Multivariate analysis indicated that CMT for patients with positive/uncertain resection margins improved OS (P < .0001). A total of 44 (37%) patients experienced local disease recurrence (LR) and 25 (21%) developed distant metastases (DM). There was no difference noted with regard to DSS if disease recurrence was isolated (LR vs DM: 26% vs 29%, respectively, at 5 years; P = .48) The use of CMT versus surgery alone improved local control (LC) (75% vs 24%; P = .006) for patients with positive/uncertain resection margins. The rate of surgical complications was 28% at 5 years. The rates of RT-associated complications were 40% and 47% at 5 years and 10 years, respectively. CONCLUSIONS The results of the current study indicated that RT in addition to surgery improves OS, DSS, and LC for patients with OHN who have positive/uncertain resection margins.
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Affiliation(s)
- B Ashleigh Guadagnolo
- Division of Radiation Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, TX, USA.
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Park HR, Cabrini RL, Araujo ES, Paparella ML, Brandizzi D, Park YK. Expression of ezrin and metastatic tumor antigen in osteosarcomas of the jaw. TUMORI JOURNAL 2009; 95:81-6. [PMID: 19366061 DOI: 10.1177/030089160909500113] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2023]
Abstract
AIMS AND BACKGROUND Ezrin is a membrane-cytoskeleton linker protein involved in regulation of the growth and metastatic behavior of cancer cells. Metastatic tumor antigen (MTA) is a potential metastasis-associated protein. The objective of this study was to evaluate the expression of ezrin and MTA and their correlation with clinicopathological features in osteosarcomas of the jaw. METHODS We analyzed ezrin and MTA protein levels by immunohistochemistry in 31 osteosarcomas of the jaw. RESULTS The mean age at diagnosis was 39 years and half of the patients were male. The mandible (n = 19) was more frequently involved than the maxilla (n = 12). The predominant histological type was chondroblastic (58.1%) and 24 patients (77.4%) were classified as having a high grade of malignancy. Immunoreactivity for ezrin was identified in 6 of 31 cases (19.4%), while 77.4% displayed expression of MTA. All ezrin-positive patients had high-grade tumors. The high-grade tumors (n = 24) had a higher rate of MTA expression (42.9% vs 87.5%). Expression of ezrin and MTA was not significantly different according to age, sex, tumor site, histological type, and tumor ploidy. Follow-up information was available for 13 patients, with a mean follow-up time of 26.7 months (range, 6-48 months). At the time of last follow-up, 5 (38.5%) patients had died of disease and 8 patients (61.5%) were alive with no evidence of disease. Expression of ezrin and MTA was not significantly different according to the follow-up data. CONCLUSIONS In our study, high-grade tumors had a higher rate of ezrin and MTA expression. This expression pattern indicates that ezrin and MTA positivity can be additional prognostic markers in osteosarcoma of the jaw.
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Affiliation(s)
- Hye-Rim Park
- Department of Pathology College of Medicine, Hallym University, Anyang, Korea
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Eversole R, Su L, ElMofty S. Benign fibro-osseous lesions of the craniofacial complex. A review. Head Neck Pathol 2008; 2:177-202. [PMID: 20614314 PMCID: PMC2807558 DOI: 10.1007/s12105-008-0057-2] [Citation(s) in RCA: 206] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2008] [Accepted: 04/22/2008] [Indexed: 10/22/2022]
Abstract
Benign fibro-osseous lesions of the craniofacial complex are represented by a variety of disease processes that are characterized by pathologic ossifications and calcifications in association with a hypercellular fibroblastic marrow element. The current classification includes neoplasms, developmental dysplastic lesions and inflammatory/reactive processes. The definitive diagnosis can rarely be rendered on the basis of histopathologic features alone; rather, procurement of a final diagnosis is usually dependent upon assessment of microscopic, clinical and imaging features together. Fibrous dysplasia and osteitis deformans constitute two dysplastic lesions in which mutations have been uncovered. Other dysplastic bone diseases of the craniofacial complex include florid osseous dysplasia, focal cemento-osseous dysplasia and periapical cemental dysplasia, all showing a predilection for African descent individuals; although no specific genetic alterations in DNA coding have yet to be uncovered and most studies have been derived from predominant high African descent populations. Ossifying fibromas are neoplastic lesions with four subtypes varying with regard to behavior and propensity for recurrence after surgical excision. The clinicopathologic and molecular features of this unique yet heterogeneous group of diseases are reviewed.
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Affiliation(s)
- Roy Eversole
- Department of Pathology and Medicine, Arthur Dugoni School of Dentistry, University of the Pacific, San Francisco, CA, USA.
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Laskar S, Basu A, Muckaden MA, D'Cruz A, Pai S, Jambhekar N, Tike P, Shrivastava SK. Osteosarcoma of the head and neck region: Lessons learned from a single-institution experience of 50 patients. Head Neck 2008; 30:1020-6. [DOI: 10.1002/hed.20820] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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Chennupati SK, Norris R, Dunham B, Kazahaya K. Osteosarcoma of the skull base: case report and review of literature. Int J Pediatr Otorhinolaryngol 2008; 72:115-9. [PMID: 17980919 DOI: 10.1016/j.ijporl.2007.08.015] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2007] [Revised: 08/12/2007] [Accepted: 08/12/2007] [Indexed: 10/22/2022]
Abstract
Osteosarcoma is the most common primary malignancy of bone in children and adolescents. Osteosarcomas are an aggressive neoplasm composed of spindle cells producing osteoid. They primarily affect the long bones, particularly after radiation or chemotherapy for other neoplasms; however, 6-7% present in the head and neck. Primary head and neck osteosarcomas in children are rare. There are few case reports and limited-sized case series in the literature. A case report presentation of a skull base osteosarcoma in a teenage female. A 14-year-old African American female presented with dysphagia, voice changes, and neck pain. On examination, she had right-sided palsies in cranial nerves X, XI, and XII. Imaging revealed partial enhancement of the clivus without bony erosion and expansion of the hypoglossal canal. There were also findings consistent with chronic denervation of her right tongue and pharynx. During the evaluation process, she developed diplopia from a right cranial nerve VI palsy. Repeat imaging revealed progression of the skull base lesion with extension into the right sphenoid sinus. An endoscopic sphenoidotomy was performed to obtain tissue. The diagnosis of high-grade osteosarcoma was made by histologic morphology and immunohistochemistry. The child was treated primarily with chemotherapy. Other adjunctive therapies are being considered. Osteosarcoma of the skull base is a rare entity. We describe a case of a high-grade clival osteosarcoma presenting primarily with lower cranial nerve palsies and pain. The rapid progression, treatment options, and prognosis are discussed.
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Affiliation(s)
- Sri Kiran Chennupati
- Division of Otolaryngology, Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA
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Fernandes R, Nikitakis NG, Pazoki A, Ord RA. Osteogenic sarcoma of the jaw: a 10-year experience. J Oral Maxillofac Surg 2007; 65:1286-91. [PMID: 17577490 DOI: 10.1016/j.joms.2006.10.030] [Citation(s) in RCA: 75] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2006] [Revised: 09/28/2006] [Accepted: 10/19/2006] [Indexed: 11/18/2022]
Abstract
BACKGROUND Osteosarcomas (OS) of all sites account for approximately 40% to 60% of primary malignant bone tumors. About 10% of OS occur in the head and neck; most are located in the mandible or maxilla. Jaw lesions are diagnosed on average 2 decades later than their long bone counterparts, which have a peak incidence between the ages of 10 and 14 years. Head and neck OS are associated with a lower metastatic rate than long bone OS, and they have a better 5-year survival rate, ranging between 27% and 84%. PATIENTS AND METHODS We present our experience at the Department of Oral and Maxillofacial Surgery, University of Maryland, Baltimore, MD, with 16 patients with OS of the jaw during a period from 1993 to 2003. RESULTS In a retrospective chart review, 16 cases of OS of the jaw were identified. Patients ranged in age from 14 to 51 years (mean age, 41 years). The gender distribution consisted of 10 females and 6 males, at a ratio of 1.6:1. Evaluation of site distribution revealed a more frequent occurrence in the mandible than in the maxilla (9 and 7 cases, respectively). The main histologic subtype was chondroblastic (8 cases), followed by osteoblastic (4 cases). According to histologic grading, 8 tumors were high grade, 1 intermediate, 5 low grade, and 2 unknown. Overall, the primary treatment modality consisted of surgery in all 14 patients treated at the University of Maryland; 2 patients opted for treatment at other institutions. Chemotherapy, consisting primarily of cisplatin and Adriamycin (doxorubicin hydrochloride; Pharmacia, Kalamazoo, MI), was used as adjuvant treatment in 4 cases of high-grade OS. Follow-up ranges from 14 months to 108 months (mean, 46 months). To date, of the 14 patients treated at our institution, 12 (86%) had no evidence of disease at last appointment, and 2 patients died of the disease. CONCLUSION In light of the rarity of this disease, this series represents a large single-center experience with OS of the jaw. Our data show an older patient population, different gender distribution, and higher survival rate compared with overall published reports.
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Affiliation(s)
- Rui Fernandes
- Division of Maxillofacial Surgery, Department of Surgery, University of Florida College of Medicine, Jacksonville, FL 32209, USA
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Jasnau S, Meyer U, Potratz J, Jundt G, Kevric M, Joos UK, Jürgens H, Bielack SS. Craniofacial osteosarcoma Experience of the cooperative German-Austrian-Swiss osteosarcoma study group. Oral Oncol 2007; 44:286-94. [PMID: 17467326 DOI: 10.1016/j.oraloncology.2007.03.001] [Citation(s) in RCA: 86] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2006] [Revised: 03/05/2007] [Accepted: 03/06/2007] [Indexed: 10/23/2022]
Abstract
The aim of this retrospective analysis was to evaluate patient and tumor characteristics and treatment results and prognostic factors for patients with craniofacial osteosarcoma (CFOS). The COSS database was searched for patients with previously untreated, histologically confirmed craniofacial osteosarcoma with at least one follow-up examination. In a 28-year period extending from 1977 to 2004, 49 eligible patients were identified and their charts retrospectively analysed. The median age at diagnosis was 19.7 years (range: 4.6-57.2) with no gender predilection. Thirteen CFOS were second or even third primary malignancies. The jaws were the primary site in 27 patients (55% - mandible 15 (31%), maxilla 12 (24%)), while extragnathic bones were involved in 22 (45%). All 49 patients underwent surgery; in 37 (76%) combined with chemotherapy, in seven (14%) with chemotherapy and radiotherapy. Twenty-one patients (43%) received preoperative chemotherapy and the other 28 (57%) had primary surgery. A complete surgical remission was achieved in 32 patients, of whom 24 remained in local control. Actuarial five-year overall and event-free survival rates were 74% and 44%, respectively. Extragnathic site (p<.001) and documented postsurgical rest of the primary tumor (p<.001) were associated with inferior overall survival probabilities. All 24 patients who achieved and maintained local surgical control survived disease-free. Multidisciplinary treatment of CFOS within a multicenter setting resulted in long-term survival in well over two thirds of affected patients. Extragnathic sites and failure to achieve and maintain local surgical control emerged as strong negative prognostic factors.
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Affiliation(s)
- Sven Jasnau
- Universitätsklinikum Münster, Klinik und Poliklinik für Kinder- und Jugendmedizin, Pädiatrische Hämatologie und Onkologie, Münster, Germany
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