1
|
Hoffman BA, Sanford C, Didier AJ, Lassiter E, Lozano-Calderon SA. Pediatric Axial Ewing Sarcoma: A Retrospective Population-Based Survival Analysis. J Am Acad Orthop Surg Glob Res Rev 2024; 8:01979360-202407000-00015. [PMID: 39024656 PMCID: PMC11257667 DOI: 10.5435/jaaosglobal-d-24-00130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2024] [Accepted: 04/10/2024] [Indexed: 07/20/2024]
Abstract
INTRODUCTION Ewing sarcomas of the axial skeleton represent a notable challenge for clinicians because of their aggressive presentation and tendency to obstruct neurovascular structures; however, little data exist regarding axial tumors in children. This study is the first population-based analysis assessing treatment regimens for axial Ewing sarcomas and their effects on cancer-specific survival and overall survival (OS). METHODS Data from 2004 to 2019 were collected for all patients aged 1 to 24 years from the Surveillance, Epidemiology, and End Results (SEER) database. Primary groups included pelvic tumors, thoracic tumors, and vertebral tumors. Chi-squared and Kaplan-Meier tests were used to assess associations between demographic variables, clinical and treatment characteristics, and patient survival. RESULTS Pelvic tumors were most common, and 49.7% received chemotherapy/radiation. Vertebral tumors were least common, and 56.7% received chemotherapy/surgery/radiation. 53.5% of thoracic tumors received chemotherapy/surgery. Surgery was most common for thoracic tumors (80.2%) and rare for pelvic tumors (38.9%). Radiation therapy was most common for vertebral tumors (83.6%) and least common for thoracic tumors (36.0%). Pelvic tumors exhibited the lowest OS (1-year, 5-year, and 10-year OS: 96%, 70%, and 59%), followed by thoracic tumors (1-year, 5-year, and 10-year OS: 97%, 79%, and 66%) and vertebral tumors (1-year, 5-year, and 10-year OS: 92%, 77%, and 68%). CONCLUSION This study underpins the importance of both early detection and chemotherapy-based multimodal therapy in the treatment of axial Ewing sarcoma in a pediatric population. A comparatively large decline in OS was observed between 5 and 10 years for patients with thoracic tumors, and this cohort's 10-year OS has not improved when compared with a similar SEER cohort from 1973 to 2011. Despite a growing body of research supporting definitive radiation therapy, a notable portion of patients with pelvic Ewing sarcoma did not receive radiation, representing an unmet need for this population.
Collapse
Affiliation(s)
- Brett A. Hoffman
- University of Toledo College of Medicine and Life Sciences, Toledo, OH (Mr. Hoffman, Dr. Sanford, Mr. Didier, and Mr. Lassiter); Department of Orthopedic Surgery, Massachusetts General Hospital Boston, Boston, MA (Dr. Lozano-Calderon)
| | - Christopher Sanford
- University of Toledo College of Medicine and Life Sciences, Toledo, OH (Mr. Hoffman, Dr. Sanford, Mr. Didier, and Mr. Lassiter); Department of Orthopedic Surgery, Massachusetts General Hospital Boston, Boston, MA (Dr. Lozano-Calderon)
| | - Alexander J. Didier
- University of Toledo College of Medicine and Life Sciences, Toledo, OH (Mr. Hoffman, Dr. Sanford, Mr. Didier, and Mr. Lassiter); Department of Orthopedic Surgery, Massachusetts General Hospital Boston, Boston, MA (Dr. Lozano-Calderon)
| | - Eric Lassiter
- University of Toledo College of Medicine and Life Sciences, Toledo, OH (Mr. Hoffman, Dr. Sanford, Mr. Didier, and Mr. Lassiter); Department of Orthopedic Surgery, Massachusetts General Hospital Boston, Boston, MA (Dr. Lozano-Calderon)
| | - Santiago A Lozano-Calderon
- University of Toledo College of Medicine and Life Sciences, Toledo, OH (Mr. Hoffman, Dr. Sanford, Mr. Didier, and Mr. Lassiter); Department of Orthopedic Surgery, Massachusetts General Hospital Boston, Boston, MA (Dr. Lozano-Calderon)
| |
Collapse
|
2
|
Rechl V, Ranft A, Bhadri V, Brichard B, Collaud S, Cyprova S, Eich H, Ek T, Gelderblom H, Hardes J, Haveman LM, Hartmann W, Hauser P, Heesen P, Jürgens H, Kanerva J, Kühne T, Raciborska A, Rascon J, Streitbürger A, Uhlenbruch Y, Timmermann B, Kersting J, Pham MT, Dirksen U. Factors Influencing the Outcome of Patients with Primary Ewing Sarcoma of the Sacrum. Sarcoma 2024; 2024:4751914. [PMID: 38524902 PMCID: PMC10960648 DOI: 10.1155/2024/4751914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 02/29/2024] [Accepted: 03/04/2024] [Indexed: 03/26/2024] Open
Abstract
Background Ewing sarcoma (EwS) is a rare and highly malignant bone tumor primarily affecting children, adolescents, and young adults. The pelvis, trunk, and lower extremities are the most common sites, while EwS of the sacrum as a primary site is very rare, and only few studies focusing on this location are published. Due to the anatomical condition, local treatment is challenging in sacral malignancies. We analyzed factors that might influence the outcome of patients suffering from sacral EwS. Methods We retrospectively analyzed data of the GPOH EURO-E.W.I.N.G 99 trial and the EWING 2008 trial, with a cohort of 124 patients with localized or metastatic sacral EwS. The study endpoints were overall survival (OS) and event-free survival (EFS). OS and EFS were calculated using the Kaplan-Meier method, and univariate comparisons were estimated using the log-rank test. Hazard ratios (HRs) with respective 95% confidence intervals (CIs) were estimated in a multivariable Cox regression model. Results The presence of metastases (3y-EFS: 0.33 vs. 0.68; P < 0.001; HR = 3.4, 95% CI 1.7 to 6.6; 3y-OS: 0.48 vs. 0.85; P < 0.001; HR = 4.23, 95% CI 1.8 to 9.7), large tumor volume (≥200 ml) (3y-EFS: 0.36 vs. 0.69; P=0.02; HR = 2.1, 95% CI 1.1 to 4.0; 3y-OS: 0.42 vs. 0.73; P=0.04; HR = 2.1, 95% CI 1.03 to 4.5), and age ≥18 years (3y-EFS: 0.41 vs. 0.60; P=0.02; HR = 2.6, 95% CI 1.3 to 5.2; 3y-OS: 0.294 vs. 0.59; P=0.01; HR = 2.92, 95% CI 1.29 to 6.6) were revealed as adverse prognostic factors. Conclusion Young age seems to positively influence patients` survival, especially in patients with primary metastatic disease. In this context, our results support other studies, stating that older age has a negative impact on survival. Tumor volume, metastases, and the type of local therapy modality have an impact on the outcome of sacral EwS. Level of evidence: Level 2. This trial is registered with NCT00020566 and NCT00987636.
Collapse
Affiliation(s)
- Victor Rechl
- Pediatrics III, West German Cancer Center, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Andreas Ranft
- Pediatrics III, West German Cancer Center, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
- German Cancer Consortium, Partnersite, Essen, Germany
| | - Vivek Bhadri
- Chris O'Brien Lifehouse, Camperdown, Australia
- Faculty of Medicine and Health, University of Sydney, Camperdown, Australia
| | - Benedicte Brichard
- Cliniques Universitaires Saint Luc, Department of Pediatric Hematology and Oncology, Université Catholique de Louvain, Brussels, Belgium
| | - Stephane Collaud
- Lung Clinic, Department of Thoracic Surgery, Cologne Merheim Hospital, University of Witten/Herdecke, Witten, Germany
| | - Sona Cyprova
- Charles University, Motol Child Ren's Hospital, Prague, Czech Republic
| | - Hans Eich
- Radiotherapy and Radiooncology, University Hospital Muenster, West German Cancer Center Network, Muenster, Germany
| | - Torben Ek
- Childhood Cancer Center Queen Silvia Children's Hospital, Gothenburg, Sweden
| | - Hans Gelderblom
- Leiden University Medical Center, Department of Medical Oncology, Leiden, NL, USA
| | - Jendrik Hardes
- German Cancer Consortium, Partnersite, Essen, Germany
- Clinic of Tumororthopedics, University Hospital Essen, West German Cancer Centre, Essen, Germany
| | - Lianne M. Haveman
- Princess Máxima Center for Pediatric Oncology, Department of Solid Tumors, Utrecht, Netherlands
| | - Wolfgang Hartmann
- Gerhard Domagk Institute for Pathology, University Hospital Muenster, West German Cancer Center Network, Muenster, Germany
| | - Peter Hauser
- Velkey László Child's, Health Center, Borsod-Abaúj-Zemplén County University Teaching Hospital, Miskolc, Hungary
| | - Philip Heesen
- Pediatrics III, West German Cancer Center, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Heribert Jürgens
- Department of Pediatric Hematology and Oncology, University Children's Hospital Münster, West German Cancer Center Network, Münster, Germany
| | - Jukka Kanerva
- HUS Helsinki University Hospital, New Children's Hospital, Div. Hematology and Stem Cell Transplantation, Helsinki, Finland
| | - Thomas Kühne
- Department of Oncology/Hematology, University Children's Hospital Basel, Basel, Switzerland
| | - Anna Raciborska
- Mother and Child Institute, Department of Oncology and Surgical Oncology for Children and Youth, Warsaw, Poland
| | - Jelena Rascon
- Center for Pediatric Oncology and Hematology, Vilnius University Hospital Santaros Klinikos, Vilnius University, Vilnius, Lithuania
- Clinics of Children's Diseases, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Arne Streitbürger
- German Cancer Consortium, Partnersite, Essen, Germany
- Clinic of Tumororthopedics, University Hospital Essen, West German Cancer Centre, Essen, Germany
| | - Yasmin Uhlenbruch
- Patient Representative, St. Josef's Hospital Bochum, University Hospital, Bochum, Germany
| | - Beate Timmermann
- German Cancer Consortium, Partnersite, Essen, Germany
- Clinic for Particle Therapy, West German Proton Beam Centre, University Hospital Essen, West German Cancer Centre, German Cancer Research Centre (DKTK), Essen, Germany
| | - Josephine Kersting
- Pediatrics III, West German Cancer Center, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
- German Cancer Consortium, Partnersite, Essen, Germany
| | - Minh Thanh Pham
- Pediatrics III, West German Cancer Center, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Uta Dirksen
- Pediatrics III, West German Cancer Center, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
- German Cancer Consortium, Partnersite, Essen, Germany
| |
Collapse
|
3
|
Brown JM, Rakoczy K, Tokson JH, Jones KB, Groundland JS. Ewing sarcoma of the pelvis: Clinical features and overall survival . Cancer Treat Res Commun 2022; 33:100634. [PMID: 36126512 DOI: 10.1016/j.ctarc.2022.100634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 09/08/2022] [Accepted: 09/09/2022] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Primary Ewing Sarcoma of Bone is a malignancy whose treatment requires both systemic chemotherapy and local control through surgical resection and/or radiation. Ewing Sarcoma of the pelvis has been noted to confer a worse prognosis relative to other anatomic sites of Ewing Sarcoma. This study explores the presenting features, treatment modalities for local control, and overall survival of primary Ewing sarcoma of the pelvis in comparison to other commonly affected anatomic sites. METHODS The National Cancer Institute Surveillance, Epidemiology, and End-Results (SEER) database was used to identify cases of pelvic Ewing sarcoma diagnosed between years 2004 and 2015. Demographic variables including sex, race, and age at diagnosis were described for each case, as well as therapeutic modalities including surgery and radiation. Bone-specific Collaborative Staging variables, including tumor size, tumor extension, and metastasis at diagnosis, were described for the same cohort. Univariate and multivariate assessments were performed for statistical comparison between presenting factors, treatment modalities, and between anatomic locations of presentation. RESULTS Within the database, 296 patients with Ewing sarcoma of the pelvic bones were available for review, which represented 25.7% of the 1152 cases surveyed across all anatomic sites. In the subset of patients with Ewing Sarcoma of the pelvis, 63.5% were male; the median age of diagnosis was 17 years; extra-compartmental tumor extension was noted in 82.1%; average tumor size was 9.7 cm; and metastasis at diagnosis was noted in 46.1% of the cohort. Only 28.6% of the pelvis sarcoma patients received surgical resection as part or all of their local control treatment, while 67.6% received some form of radiation therapy. When compared to the presenting features of Ewing Sarcoma from other anatomic sites, patients with pelvic tumors had larger tumors at time of diagnosis, higher rates of metastatic disease, and were less likely to undergo surgical intervention. The 2-, 5-, and 10-year overall survival rates for the patients presenting with Ewing Sarcoma of the pelvis was 70.3%, 49.7%, and 41.9%, respectively, which were significantly lower across all time-points than any other anatomic site. DISCUSSION AND CONCLUSION Ewing Sarcoma of the pelvis is an aggressive malignancy that presents with relatively large tumors and a high rate of metastatic dissemination. Surgical intervention is less frequent when Ewing Sarcoma presents in the pelvis than when it presents in other anatomic locations. These factors may contribute to the worse overall survival of Ewing Sarcoma when compared to the same diagnosis originating in other anatomic sites. Prospective, randomized study is required to determine the true causal effects of these factors on survival.
Collapse
Affiliation(s)
- Jeffrey Mark Brown
- University of Miami Miller School of Medicine, Orthopaedics, Miami, FL, United States of America; Department of Orthopaedics, Musculoskeletal Surgical Oncology, University of Utah, Huntsman Cancer Institute, Salt Lake City, UT, United States of America.
| | - Kyla Rakoczy
- University of Miami Miller School of Medicine, Orthopaedics, Miami, FL, United States of America
| | - Jacqueline Hart Tokson
- Department of Orthopaedics, Musculoskeletal Surgical Oncology, University of Utah, Huntsman Cancer Institute, Salt Lake City, UT, United States of America
| | - Kevin B Jones
- Department of Orthopaedics, Musculoskeletal Surgical Oncology, University of Utah, Huntsman Cancer Institute, Salt Lake City, UT, United States of America
| | - John S Groundland
- Department of Orthopaedics, Musculoskeletal Surgical Oncology, University of Utah, Huntsman Cancer Institute, Salt Lake City, UT, United States of America
| |
Collapse
|
4
|
Bioinformatics Analysis of ZBTB16 as a Prognostic Marker for Ewing's Sarcoma. BIOMED RESEARCH INTERNATIONAL 2021; 2021:1989917. [PMID: 34660783 PMCID: PMC8514890 DOI: 10.1155/2021/1989917] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 09/03/2021] [Accepted: 09/04/2021] [Indexed: 11/19/2022]
Abstract
Objective The purpose of this study is to identify novel biomarkers for the prognosis of Ewing's sarcoma based on bioinformatics analysis. Methods The GSE63157 and GSE17679 datasets contain patient and healthy control microarray data that were downloaded from the Gene Expression Omnibus (GEO) database and analyzed through R language software to obtain differentially expressed genes (DEGs). Firstly, Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) functional enrichment, protein-protein interaction (PPI) networks, and Cytoscape Molecular Complex Detection (MCODE) plug-in were then used to compute the highest scores of the module. After survival analysis, the hub genes were lastly obtained from the two module genes. Results A total of 1181 DEGs were identified from the two GSEs. Through MCODE and survival analysis, we obtain 53 DEGs from the module and 29 overall survival- (OS-) related genes. ZBTB16 was the only downregulated gene after Venn diagrams. Survival analysis indicates that there was a significant correlation between the high expression of ZBTB16 and the OS of Ewing's sarcoma (ES), and the low expression group had an unfavorable OS when compared to the high expression group. Conclusions High expression of ZBTB16 may serve as a predictor biomarker of poor prognosis in ES patients.
Collapse
|
5
|
Blight TJ, Choong PFM. The need for improved patient reported outcome measures in patients with extremity sarcoma: A narrative review. ANZ J Surg 2021; 91:2021-2025. [PMID: 34227237 DOI: 10.1111/ans.17028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Revised: 06/05/2021] [Accepted: 06/06/2021] [Indexed: 01/13/2023]
Abstract
BACKGROUND Extremity sarcoma causes impairments to functionality and quality of life. Patient-reported outcome measures (PROMS) assess patient perspectives relating to domains of health and quality of life. METHODS To describe PROMs utilised in extremity sarcoma, the available literature was screened for studies that utilised PROMs to evaluate outcomes in extremity sarcoma following surgery. RESULTS Seventy articles met eligibility criteria; six PROMs were identified. The Toronto Extremity Salvage Score, The Short-Form 36, The EORTC QLQ-C30, The Disabilities of the Arm, Shoulder and Hand questionnaire, the Reintegration to Normal Living index and the Patient-Reported Outcomes Measurement Information System. Most sarcoma patients score well in these tools, with bone sarcoma, and extent of resection being predictors of poor outcomes. CONCLUSION TESS is the only sarcoma-specific PROM, and though a valid assessment of functionality, it has difficulty differentiating patients with minor functional impairments. The absence of a disease-specific measure of health is concerning, as generic tools do not account for the unique experiences sarcoma patients face and may impair their accuracy in analysing intervention effectiveness.
Collapse
Affiliation(s)
- Thomas J Blight
- Melbourne Medical School, University of Melbourne, Melbourne, Australia.,Clinical School, St. Vincent's Hospital Melbourne, Melbourne, Australia
| | - Peter F M Choong
- Department of Surgery, University of Melbourne, Melbourne, Australia.,Bone and Soft Tissue Sarcoma Unit, Peter MacCallum Cancer Centre, Melbourne, Australia.,Department of Orthopaedics, St. Vincent's Hospital Melbourne, Melbourne, Australia
| |
Collapse
|
6
|
Zöllner SK, Amatruda JF, Bauer S, Collaud S, de Álava E, DuBois SG, Hardes J, Hartmann W, Kovar H, Metzler M, Shulman DS, Streitbürger A, Timmermann B, Toretsky JA, Uhlenbruch Y, Vieth V, Grünewald TGP, Dirksen U. Ewing Sarcoma-Diagnosis, Treatment, Clinical Challenges and Future Perspectives. J Clin Med 2021; 10:1685. [PMID: 33919988 PMCID: PMC8071040 DOI: 10.3390/jcm10081685] [Citation(s) in RCA: 89] [Impact Index Per Article: 29.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 03/30/2021] [Accepted: 03/31/2021] [Indexed: 02/08/2023] Open
Abstract
Ewing sarcoma, a highly aggressive bone and soft-tissue cancer, is considered a prime example of the paradigms of a translocation-positive sarcoma: a genetically rather simple disease with a specific and neomorphic-potential therapeutic target, whose oncogenic role was irrefutably defined decades ago. This is a disease that by definition has micrometastatic disease at diagnosis and a dismal prognosis for patients with macrometastatic or recurrent disease. International collaborations have defined the current standard of care in prospective studies, delivering multiple cycles of systemic therapy combined with local treatment; both are associated with significant morbidity that may result in strong psychological and physical burden for survivors. Nevertheless, the combination of non-directed chemotherapeutics and ever-evolving local modalities nowadays achieve a realistic chance of cure for the majority of patients with Ewing sarcoma. In this review, we focus on the current standard of diagnosis and treatment while attempting to answer some of the most pressing questions in clinical practice. In addition, this review provides scientific answers to clinical phenomena and occasionally defines the resulting translational studies needed to overcome the hurdle of treatment-associated morbidities and, most importantly, non-survival.
Collapse
Affiliation(s)
- Stefan K. Zöllner
- Pediatrics III, University Hospital Essen, 45147 Essen, Germany;
- West German Cancer Center (WTZ), University Hospital Essen, 45147 Essen, Germany; (S.B.); (S.C.); (J.H.); (A.S.); (B.T.)
- German Cancer Consortium (DKTK), Essen/Düsseldorf, University Hospital Essen, 45147 Essen, Germany
| | - James F. Amatruda
- Cancer and Blood Disease Institute, Children’s Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, CA 90027, USA;
| | - Sebastian Bauer
- West German Cancer Center (WTZ), University Hospital Essen, 45147 Essen, Germany; (S.B.); (S.C.); (J.H.); (A.S.); (B.T.)
- German Cancer Consortium (DKTK), Essen/Düsseldorf, University Hospital Essen, 45147 Essen, Germany
- Department of Medical Oncology, Sarcoma Center, University Hospital Essen, 45147 Essen, Germany
| | - Stéphane Collaud
- West German Cancer Center (WTZ), University Hospital Essen, 45147 Essen, Germany; (S.B.); (S.C.); (J.H.); (A.S.); (B.T.)
- German Cancer Consortium (DKTK), Essen/Düsseldorf, University Hospital Essen, 45147 Essen, Germany
- Department of Thoracic Surgery, Ruhrlandklinik, University of Essen-Duisburg, 45239 Essen, Germany
| | - Enrique de Álava
- Institute of Biomedicine of Sevilla (IbiS), Virgen del Rocio University Hospital, CSIC, University of Sevilla, CIBERONC, 41013 Seville, Spain;
- Department of Normal and Pathological Cytology and Histology, School of Medicine, University of Seville, 41009 Seville, Spain
| | - Steven G. DuBois
- Dana-Farber/Boston Children’s Cancer and Blood Disorders Center, Harvard Medical School, Boston, MA 02215, USA; (S.G.D.); (D.S.S.)
| | - Jendrik Hardes
- West German Cancer Center (WTZ), University Hospital Essen, 45147 Essen, Germany; (S.B.); (S.C.); (J.H.); (A.S.); (B.T.)
- German Cancer Consortium (DKTK), Essen/Düsseldorf, University Hospital Essen, 45147 Essen, Germany
- Department of Musculoskeletal Oncology, Sarcoma Center, 45147 Essen, Germany
| | - Wolfgang Hartmann
- Division of Translational Pathology, Gerhard-Domagk Institute of Pathology, University Hospital Münster, 48149 Münster, Germany;
- West German Cancer Center (WTZ), Network Partner Site, University Hospital Münster, 48149 Münster, Germany
| | - Heinrich Kovar
- St. Anna Children’s Cancer Research Institute and Medical University Vienna, 1090 Vienna, Austria;
| | - Markus Metzler
- Department of Pediatrics and Adolescent Medicine, University Hospital Erlangen, 91054 Erlangen, Germany;
| | - David S. Shulman
- Dana-Farber/Boston Children’s Cancer and Blood Disorders Center, Harvard Medical School, Boston, MA 02215, USA; (S.G.D.); (D.S.S.)
| | - Arne Streitbürger
- West German Cancer Center (WTZ), University Hospital Essen, 45147 Essen, Germany; (S.B.); (S.C.); (J.H.); (A.S.); (B.T.)
- German Cancer Consortium (DKTK), Essen/Düsseldorf, University Hospital Essen, 45147 Essen, Germany
- Department of Musculoskeletal Oncology, Sarcoma Center, 45147 Essen, Germany
| | - Beate Timmermann
- West German Cancer Center (WTZ), University Hospital Essen, 45147 Essen, Germany; (S.B.); (S.C.); (J.H.); (A.S.); (B.T.)
- German Cancer Consortium (DKTK), Essen/Düsseldorf, University Hospital Essen, 45147 Essen, Germany
- Department of Particle Therapy, University Hospital Essen, West German Proton Therapy Centre, 45147 Essen, Germany
| | - Jeffrey A. Toretsky
- Departments of Oncology and Pediatrics, Georgetown University, Washington, DC 20057, USA;
| | - Yasmin Uhlenbruch
- St. Josefs Hospital Bochum, University Hospital, 44791 Bochum, Germany;
| | - Volker Vieth
- Department of Radiology, Klinikum Ibbenbüren, 49477 Ibbenbühren, Germany;
| | - Thomas G. P. Grünewald
- Division of Translational Pediatric Sarcoma Research, Hopp-Children’s Cancer Center Heidelberg (KiTZ), 69120 Heidelberg, Germany;
- Division of Translational Pediatric Sarcoma Research, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
- Institute of Pathology, University Hospital Heidelberg, 69120 Heidelberg, Germany
- German Cancer Consortium (DKTK), Core Center, 69120 Heidelberg, Germany
| | - Uta Dirksen
- Pediatrics III, University Hospital Essen, 45147 Essen, Germany;
- West German Cancer Center (WTZ), University Hospital Essen, 45147 Essen, Germany; (S.B.); (S.C.); (J.H.); (A.S.); (B.T.)
- German Cancer Consortium (DKTK), Essen/Düsseldorf, University Hospital Essen, 45147 Essen, Germany
| |
Collapse
|
7
|
Takenaka S, Araki N, Outani H, Hamada KI, Yoshikawa H, Kamada T, Imai R. Complication rate, functional outcomes, and risk factors associated with carbon ion radiotherapy for patients with unresectable pelvic bone sarcoma. Cancer 2020; 126:4188-4196. [PMID: 32658315 DOI: 10.1002/cncr.33082] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 06/11/2020] [Accepted: 06/12/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND To the authors' knowledge, carbon ion radiotherapy (CIRT) is one of the few curative treatments for unresectable pelvic bone sarcoma. The current study investigated the complications, functional outcomes, and risk factors of CIRT. METHODS Of 112 patients who were treated with CIRT for unresectable pelvic bone sarcoma, the authors enrolled 29 patients who were without local disease recurrence or distant metastasis. The mean follow-up was 93 months. Complications, functional outcomes, and quality of life scores were assessed. Risk factors were analyzed, including the dose-volume histogram of the femoral head. RESULTS Femoral head necrosis occurred in approximately 37% of patients, pelvic fractures were reported in 48% of patients, and neurological deficits were noted in 52% of patients. Femoral head necrosis was found to be significantly more prevalent among patients with periacetabular tumors (P = .018). The dose-volume histogram of the femoral head indicated tolerable volume percentages of the femoral head to be <33% for 40 grays (relative biological effectiveness) and 16% for 60 grays ( relative biological effectiveness). The mean Musculoskeletal Tumor Society score and Toronto Extremity Salvage Score were 53% and 64%, respectively, and the mean EuroQol 5 dimensions questionnaire index was 0.587. Patients aged >50 years and those with periacetabular tumors were found to have significantly lower Toronto Extremity Salvage Scores. CONCLUSIONS Femoral head necrosis, pelvic fracture, and nerve damage are common complications with the use of CIRT for pelvic bone sarcoma. To prevent femoral head necrosis, the radiation dose to the femoral head should be kept below the estimated tolerance curve presented in the current study. The functional outcome is nearly equivalent to that of surgery. CIRT may be a promising alternative to surgery for patients with unresectable pelvic bone sarcoma.
Collapse
Affiliation(s)
- Satoshi Takenaka
- Department of Orthopaedics, Osaka University Graduate School of Medicine, Suita, Japan.,Department of Orthopaedics, Osaka International Cancer Institute, Osaka, Japan.,Research Center for Charged Particle Therapy, National Institute of Radiological Sciences, Chiba, Japan
| | - Nobuhito Araki
- Department of Orthopaedic Surgery, Ashiya Municipal Hospital, Ashiya, Japan
| | - Hidetatsu Outani
- Department of Orthopaedics, Osaka University Graduate School of Medicine, Suita, Japan
| | - Ken-Ichiro Hamada
- Department of Orthopaedics, Osaka University Graduate School of Medicine, Suita, Japan
| | - Hideki Yoshikawa
- Department of Orthopaedics, Osaka University Graduate School of Medicine, Suita, Japan.,Department of Orthopaedic Surgery, Toyonaka Municipal Hospital, Toyonaka, Japan
| | - Tadashi Kamada
- Research Center for Charged Particle Therapy, National Institute of Radiological Sciences, Chiba, Japan
| | - Reiko Imai
- Research Center for Charged Particle Therapy, National Institute of Radiological Sciences, Chiba, Japan
| |
Collapse
|
8
|
Uezono H, Indelicato DJ, Rotondo RL, Mailhot Vega RB, Bradfield SM, Morris CG, Bradley JA. Treatment Outcomes After Proton Therapy for Ewing Sarcoma of the Pelvis. Int J Radiat Oncol Biol Phys 2020; 107:974-981. [PMID: 32437922 DOI: 10.1016/j.ijrobp.2020.04.043] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Revised: 03/18/2020] [Accepted: 04/30/2020] [Indexed: 01/10/2023]
Abstract
PURPOSE Ewing sarcoma of the pelvis is associated with inferior local control compared with those arising from other primary sites. Despite its increased use, outcome data for treatment with proton therapy remain limited. We report 3-year disease control and toxicity in pediatric patients treated with proton therapy. METHODS AND MATERIALS Thirty-five patients aged ≤21 years (median, 14 years) with nonmetastatic pelvic Ewing sarcoma received proton therapy and chemotherapy between 2010 and 2018. Overall survival and tumor control rates were calculated using the Kaplan-Meier method. A log-rank test assessed significance between strata of prognostic factors. Significant toxicity was reported per the Common Terminology Criteria for Adverse Events, version 4.0. RESULTS Most patients received definitive radiation (n = 26; median dose 55.8 Gy relative biological effectiveness [RBE]; range, 54.0-64.8), 7 received preoperative radiation (50.4 Gy RBE), and 2 received postoperative radiation (45 Gy RBE and 54 Gy RBE). The median primary tumor size was 10.5 cm. With a median follow-up of 3 years (range, 0.3-9.0 years), the 3-year overall survival, progression-free survival, and local control rates were 83% (95% confidence interval [CI], 65%-93%), 64% (95% CI, 45%-79%), and 92% (95% CI, 74%-98%), respectively. There was no association between local control, progression-free survival, or overall survival and tumor size, patient age, radiation dose, or definitive versus pre-/postoperative radiation therapy. Median time to progression was 1 year (range, 0.1-1.9 years). All patients with large tumors (≥8 cm) who underwent definitive proton therapy with a higher dose (≥59.4 Gy RBE) remained free from tumor recurrence (n = 5). Five patients experienced grade ≥2 subacute/late toxicity, all of whom were treated with combined surgery and radiation. CONCLUSIONS Definitive proton therapy offers local control comparable to photon therapy in pediatric patients with pelvic Ewing sarcoma. These data lend preliminary support to radiation dose escalation without significant toxicity, which may contribute to the favorable outcomes. Combined surgery and radiation therapy, particularly preoperative radiation, is associated with postoperative complications, but not survival, compared with radiation alone.
Collapse
Affiliation(s)
- Haruka Uezono
- Department of Radiation Oncology, University of Florida College of Medicine, Jacksonville, Florida
| | - Daniel J Indelicato
- Department of Radiation Oncology, University of Florida College of Medicine, Jacksonville, Florida
| | - Ronny L Rotondo
- Department of Radiation Oncology, University of Florida College of Medicine, Jacksonville, Florida
| | - Raymond B Mailhot Vega
- Department of Radiation Oncology, University of Florida College of Medicine, Jacksonville, Florida
| | - Scott M Bradfield
- Department of Pediatric Hematology/Oncology, Nemours Children's Specialty Care, Jacksonville, Florida
| | - Christopher G Morris
- Department of Radiation Oncology, University of Florida College of Medicine, Jacksonville, Florida
| | - Julie A Bradley
- Department of Radiation Oncology, University of Florida College of Medicine, Jacksonville, Florida.
| |
Collapse
|
9
|
Wilson RJ, Freeman TH, Halpern JL, Schwartz HS, Holt GE. Surgical Outcomes After Limb-Sparing Resection and Reconstruction for Pelvic Sarcoma: A Systematic Review. JBJS Rev 2019; 6:e10. [PMID: 29688908 DOI: 10.2106/jbjs.rvw.17.00072] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND Limb-sparing resection and reconstruction for pelvic sarcomas in multiple small studies have been fraught with complications, reoperations, and impaired patient function. However, the non-oncologic complication and reoperation rates and functional outcomes for patients have never been rigorously compiled, to our knowledge. A systematic review was undertaken to more accurately determine the non-oncologic complication and reoperation rates and functional outcomes for patients after pelvic sarcoma resection and reconstruction. METHODS The review was performed in accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. PubMed and Cochrane database searches of English-only studies using the terms "pelvis AND sarcoma" and "pelvis AND sarcoma AND surgery" were performed. Study inclusion criteria were ≥10 patients enrolled, at least 12 months of follow-up, utilization of comparable functional outcome measure(s), and the majority of the resections treating primary bone sarcoma. RESULTS In this study, 2,350 studies were reviewed, of which 22 Level-IV studies with a total of 801 patients met inclusion criteria. Reconstructive techniques varied widely and included allografts, allograft-prosthesis composites, saddle prostheses, custom endoprostheses, and irradiated autografts. Pooled means showed a mean 5-year patient survival of 55%. The mean non-oncologic complication rate was 49%. The mean non-oncologic reoperation rate was 37%. The mean Musculoskeletal Tumor Society score was 65%. CONCLUSIONS The non-oncologic complication and reoperation rates for pelvic reconstructions are remarkably high and 5-year survival is poor. Functional outcomes are acceptable but may not be better than a resection of the same Enneking and Dunham type without reconstruction. Consideration should be given to forgoing pelvic reconstruction, especially in patients with poor overall prognosis. Further studies comparing non-oncologic complication rates, reoperation rates, and functional outcomes in patients with equivalent resections treated with or without reconstruction are needed to further elucidate the utility of pelvic reconstruction. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Collapse
Affiliation(s)
- Robert J Wilson
- Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Thomas H Freeman
- Department of Orthopaedic Surgery and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Jennifer L Halpern
- Department of Orthopaedic Surgery and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Herbert S Schwartz
- Department of Orthopaedic Surgery and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Ginger E Holt
- Department of Orthopaedic Surgery and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee
| |
Collapse
|
10
|
Fujiwara T, Lex JR, Stevenson JD, Tsuda Y, Clark R, Parry MC, Grimer RJ, Jeys LM. Surgical treatment for pelvic Ewing sarcoma: What is a safe and functional acetabular reconstruction when combined with modern multidisciplinary treatments? J Surg Oncol 2019; 120:985-993. [PMID: 31381161 DOI: 10.1002/jso.25660] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Accepted: 07/23/2019] [Indexed: 12/19/2022]
Abstract
PURPOSE The purpose of this study was to clarify which local treatment is oncologically and functionally effective in pelvic Ewing sarcoma (ES). METHODS A consecutive series of patients who underwent pelvic resections and acetabular reconstructions after chemotherapy between 1986 and 2016 at a supra-regional center were evaluated. RESULTS The cohort consisted of 35 patients. The 5-year overall survival (OS) and local recurrence-free survival (LRFS) was 61% and 72%, respectively. Preoperative radiotherapy (RT) and surgery provided an excellent/good histological response in 92% and achieved significantly better OS (5 years, 64%) and LRFS (5 years, 100%) than surgery alone or surgery with postoperative RT. The Musculoskeletal Tumor Society functional scores were significantly better in patients with hip transposition than those with structural reconstructions (74% vs 57%; P = .031) using custom-made prostheses, irradiated autografts, and ice-cream cone prostheses. These scores were significantly lower if patients had deep infection (P = .035), which was the most common complication (28%) in structural reconstructions but did not occur in hip transposition even when performed after preoperative RT. CONCLUSION Acetabular reconstruction with hip transposition resulted in no deep infection and superior function in patients with pelvic ES even when combined with preoperative RT, which improved tumor necrosis and rate of local control and survival.
Collapse
Affiliation(s)
- Tomohiro Fujiwara
- Oncology Service, The Royal Orthopaedic Hospital, Birmingham, UK.,Department of Orthopaedic Surgery, Okayama University Hospital, Okayama, Japan
| | - Johnathan R Lex
- Oncology Service, The Royal Orthopaedic Hospital, Birmingham, UK
| | | | - Yusuke Tsuda
- Oncology Service, The Royal Orthopaedic Hospital, Birmingham, UK
| | - Rhys Clark
- Oncology Service, The Royal Orthopaedic Hospital, Birmingham, UK
| | - Michael C Parry
- Oncology Service, The Royal Orthopaedic Hospital, Birmingham, UK
| | - Robert J Grimer
- Oncology Service, The Royal Orthopaedic Hospital, Birmingham, UK
| | - Lee M Jeys
- Oncology Service, The Royal Orthopaedic Hospital, Birmingham, UK
| |
Collapse
|
11
|
El Demellawy D, Menzies‐Toman D, Murphy M, Kabir N, Shaw A, Chernetsova E, Serlo JA, Nanassy J. Viable versus nonviable positive margins in Ewing sarcoma and associated recurrence rates: A systematic review. Asia Pac J Clin Oncol 2019; 15:e79-e90. [DOI: 10.1111/ajco.13181] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Accepted: 05/27/2019] [Indexed: 12/14/2022]
Affiliation(s)
- Dina El Demellawy
- Department of PathologyChildren's Hospital of Eastern Ontario (CHEO) Ottawa Ontario Canada
- Faculty of MedicineDepartment of Pathology and Laboratory MedicineUniversity of Ottawa Ottawa Ontario Canada
| | - Danielle Menzies‐Toman
- Department of PathologyChildren's Hospital of Eastern Ontario (CHEO) Ottawa Ontario Canada
| | - Michelle Murphy
- Faculty of MedicineDepartment of Pathology and Laboratory MedicineUniversity of Ottawa Ottawa Ontario Canada
| | - Nooh Kabir
- Faculty of MedicineDepartment of Pathology and Laboratory MedicineUniversity of Ottawa Ottawa Ontario Canada
| | - Ashley Shaw
- Department of PathologyChildren's Hospital of Eastern Ontario (CHEO) Ottawa Ontario Canada
| | - Elizavita Chernetsova
- Faculty of MedicineDepartment of Pathology and Laboratory MedicineUniversity of Ottawa Ottawa Ontario Canada
| | - Joni A. Serlo
- Department of Orthopedics and TraumatologyHelsinki University Central Hospital Helsinki Finland
| | - Joseph Nanassy
- Department of PathologyChildren's Hospital of Eastern Ontario (CHEO) Ottawa Ontario Canada
- Faculty of MedicineDepartment of Pathology and Laboratory MedicineUniversity of Ottawa Ottawa Ontario Canada
| |
Collapse
|
12
|
Fan H, Guo Z, Fu J, Li X, Li J, Wang Z. Surgical management of pelvic Ewing's sarcoma in children and adolescents. Oncol Lett 2017; 14:3917-3926. [PMID: 28943899 PMCID: PMC5605962 DOI: 10.3892/ol.2017.6677] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Accepted: 03/09/2017] [Indexed: 12/03/2022] Open
Abstract
The present study describes a novel surgical strategy used to treat immature pelvic Ewing's sarcoma (ES), one made possible owing to the intrinsic structure of the skeletally immature pelvis. A total of 12 children and adolescents with open triradiate cartilage received limb-salvage surgeries following a diagnosis of pelvic ES. In total, 3 patients with iliac lesions (2 lesions with extension into the sacrum) received surgical tumor excisions and allograft reconstructions. Another 8 patients with periacetabular lesions received trans-acetabular osteotomies and allograft reconstructions. No reconstruction was performed on 1 patient following excision of a pubic lesion. The median follow-up time was 39 months. At the time of the final follow-up appointment, 9 patients exhibited no evidence of disease, 2 patients had slow progressive pulmonary metastasis, 1 patient exhibited local recurrence of the disease and 1 patient had succumbed to the disease 24 months after surgery. Complications included issues with wound healing in 1 patient, a discrepancy in leg length in another and a screw loosening in a further patient. The patients had a mean Musculoskeletal Tumor Society score of 26 points and a mean International Society of Limb Salvage radiographic score of 90.1%. The proposed surgical strategy for children and adolescents with pelvic ES in the present study could provide a feasible solution for acetabulum salvage and local tumor control.
Collapse
Affiliation(s)
- Hongbin Fan
- Department of Orthopedic Surgery, Xi-Jing Hospital, The Fourth Military Medical University, Xi'an, Shaanxi 710032, P.R. China
| | - Zheng Guo
- Department of Orthopedic Surgery, Xi-Jing Hospital, The Fourth Military Medical University, Xi'an, Shaanxi 710032, P.R. China
| | - Jun Fu
- Department of Orthopedic Surgery, Xi-Jing Hospital, The Fourth Military Medical University, Xi'an, Shaanxi 710032, P.R. China
| | - Xiangdong Li
- Department of Orthopedic Surgery, Xi-Jing Hospital, The Fourth Military Medical University, Xi'an, Shaanxi 710032, P.R. China
| | - Jing Li
- Department of Orthopedic Surgery, Xi-Jing Hospital, The Fourth Military Medical University, Xi'an, Shaanxi 710032, P.R. China
| | - Zhen Wang
- Department of Orthopedic Surgery, Xi-Jing Hospital, The Fourth Military Medical University, Xi'an, Shaanxi 710032, P.R. China
| |
Collapse
|
13
|
Riff AJ, Gross CE, Foucher KC, Kuo KN, Gitelis S. Acetabular Osteoarticular Allograft After Ewing Sarcoma Resection: A 15-Year Follow-up: A Case Report. JBJS Case Connect 2016; 6:e89. [PMID: 29252743 DOI: 10.2106/jbjs.cc.16.00071] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CASE A 4-year-old girl with Ewing sarcoma of the periacetabular region had been treated with neoadjuvant chemotherapy followed by resection and osteoarticular allograft reconstruction with an adult hemipelvis. At 15 years postoperatively, she remained disease-free with remarkable functionality. She had minimal groin pain and could walk an unlimited distance. Radiographs demonstrated union at the anastomotic junctions. The allograft, which had been considerably oversized 15 years ago, was now identical in size to the contralateral ilium. CONCLUSION Osteoarticular allograft remains one of the best reconstructive options following hemipelvectomy in the pediatric population because of its potential durability and its capacity to restore pelvic stability and preserve functionality.
Collapse
Affiliation(s)
- Andrew J Riff
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois
| | - Christopher E Gross
- Department of Orthopaedic Surgery, Medical University of South Carolina, Charleston, South Carolina
| | - Kharma C Foucher
- Department of Bioengineering, University of Illinois at Chicago, Chicago, Illinois
| | - Ken N Kuo
- National Taiwan University Children's Hospital and Taipei Medical University, Taipei City, Taiwan
| | - Steven Gitelis
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois
| |
Collapse
|
14
|
The role of radiotherapy in local control of nonextremity Ewing sarcomas. TUMORI JOURNAL 2016; 102:162-7. [PMID: 26917407 DOI: 10.5301/tj.5000478] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/28/2016] [Indexed: 11/20/2022]
Abstract
PURPOSE To evaluate the results of radiotherapy and the prognostic factors affecting local control in nonextremity Ewing sarcomas. METHODS Between 1995 and 2011, 44 patients with nonextremity Ewing sarcomas were treated with radiotherapy. Tumor localizations were pelvis in 23, spine in 13, thoracic region in 5, and cranium in 3 patients. Tumor size was ≥8 cm in 56.8% of patients. Distant metastases were present in 19 of the patients at the time of diagnosis (43.1%). All patients were treated with 12 weeks of neoadjuvant chemotherapy followed by surgery and radiotherapy (45-54 Gy) or radiotherapy alone (54-64.8 Gy). Radiotherapy was applied due to microscopic residue (R1) in 5 patients after the operation and macroscopic tumor in 39 patients (macroscopic residue [R2] and nonresectable tumor). RESULTS Median follow-up was 49 months (range 9-195). Local failures developed in 7 patients (15.9%) and local control at 5 years was 81.4%. Local recurrence was detected in 6 patients (6/38) who did not have residual tumor after RT. Progression was detected in 1 patient (1/6) who had residual tumor. All those patients with local failure experienced further distant metastases. Possible prognostic factors such as age (≤17 vs >17), tumor localization, tumor volume (≤8 cm vs >8 cm), and M status at diagnosis (0 vs 1) were not related to local control. CONCLUSIONS Radiotherapy, either alone or adjuvant to surgery, provides local control in 80% of nonextremity Ewing sarcomas and plays an important role in treatment.
Collapse
|
15
|
Hesla AC, Tsagozis P, Jebsen N, Zaikova O, Bauer H, Brosjö O. Improved Prognosis for Patients with Ewing Sarcoma in the Sacrum Compared with the Innominate Bones: The Scandinavian Sarcoma Group Experience. J Bone Joint Surg Am 2016; 98:199-210. [PMID: 26842410 DOI: 10.2106/jbjs.o.00362] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Treatment of Ewing sarcoma of the pelvic bones remains one of the most difficult tasks in the treatment of bone sarcomas. Whether surgery or radiation therapy is the best local treatment is still a matter of debate. The aim of the present study was to compare sacral and nonsacral sites with regard to the treatment and outcome of pelvic Ewing sarcomas. METHODS Patients with Ewing sarcoma of the osseous pelvis diagnosed between 1986 and 2011 were identified through the Scandinavian Sarcoma Group registry. Data regarding tumor size, local treatment (surgery or radiation therapy), metastatic disease, surgical margins, local recurrence, and overall survival were analyzed. RESULTS Of the 117 patients examined, eighty-eight had tumors in the innominate bones and twenty-nine, in the sacrum. Radiation therapy was the sole local treatment for 40% of the innominate bone tumors in contrast to 79% of the sacral tumors. The five-year disease-free survival rate in the latter group (66%) was greater than that in the group with tumors in the innominate bones (40%) (p = 0.02 adjusted for size). CONCLUSIONS Disease-free survival among patients with Ewing sarcoma was improved when the tumor was localized in the sacrum compared with the innominate bones, where these tumors are generally larger. Local radiation therapy alone appears to result in good local tumor control and may be the treatment of choice for sacral tumors.
Collapse
Affiliation(s)
- Asle Charles Hesla
- Department of Orthopaedic Surgery, Karolinska University Hospital, Solna, Sweden
| | - Panagiotis Tsagozis
- Department of Orthopaedic Surgery, Karolinska University Hospital, Solna, Sweden
| | - Nina Jebsen
- Department of Oncology, Haukeland University Hospital, Bergen, Norway
| | - Olga Zaikova
- Department of Orthopaedic Surgery, Norwegian Radium Hospital, Oslo, Norway
| | - Henrik Bauer
- Department of Orthopaedic Surgery, Karolinska University Hospital, Solna, Sweden
| | - Otte Brosjö
- Department of Orthopaedic Surgery, Karolinska University Hospital, Solna, Sweden
| |
Collapse
|
16
|
Ng VY, Jones R, Bompadre V, Louie P, Punt S, Conrad EU. The effect of surgery with radiation on pelvic Ewing sarcoma survival. J Surg Oncol 2015; 112:861-5. [PMID: 26525492 DOI: 10.1002/jso.24081] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2015] [Accepted: 10/17/2015] [Indexed: 12/24/2022]
Abstract
BACKGROUND Pelvic Ewing sarcoma (ES) has poorer outcomes than extremity-based lesions and the method of local control is controversial. METHODS A retrospective review was performed of 40 primary pelvic or sacral ES treated by a single surgeon. All received modern chemotherapy and those that received radiation were treated with modern dosages. RESULTS Fifty-five percent were disease-free at latest follow-up (median, 83.1 mos). Sixty-one percent had ≥ 99% necrosis, which was associated with 65% disease-free survival. Larger size (P = 0.016) and the absence of metastatic disease (P = 0.005) was predictive of survival. Eighty-three percent of relapsed patients were DOD. Half of patients who received surgery alone or RT alone have NED while 57% of those who received S/RT have NED. Complication rates were 69% (S/RT), 75% (surgery alone), 10% (RT alone). Functional outcomes were similar. CONCLUSION Primary pelvic ES is localized at presentation in 50% and the absence of metastases is the strongest predictor for survival. Chemotherapy is key, but excellent histologic response is neither a guarantee nor a necessity for survival. More than one-third die despite an excellent histologic response and at least one-third with lung metastases survive. With chemotherapy, radiation, and surgery, reasonable control of disease can be achieved. LEVEL OF EVIDENCE III Case-control or retrospective cohort study.
Collapse
Affiliation(s)
- Vincent Y Ng
- Department of Orthopaedics, University of Maryland, Baltimore, Maryland
| | - Robin Jones
- Sarcoma Unit Royal Marsden Hospital, London, United Kingdom
| | - Viviana Bompadre
- Department of Orthopaedics and Sports Medicine, Seattle Children's Hospital, Seattle, Washington
| | - Philip Louie
- Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, Washington
| | - Stephanie Punt
- Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, Washington
| | - Ernest U Conrad
- Department of Orthopaedics and Sports Medicine, Seattle Children's Hospital, Seattle, Washington
| |
Collapse
|
17
|
Ning MS, Perkins SM, Borinstein SC, Holt GE, Stavas MJ, Shinohara ET. Role of radiation in the treatment of non-metastatic osseous Ewing sarcoma. J Med Imaging Radiat Oncol 2015; 60:119-28. [DOI: 10.1111/1754-9485.12389] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2015] [Accepted: 08/16/2015] [Indexed: 12/21/2022]
Affiliation(s)
- Matthew S Ning
- Department of Radiation Oncology; Vanderbilt University School of Medicine; Nashville Tennessee USA
| | - Stephanie M Perkins
- Department of Radiation Oncology; Washington University School of Medicine; Saint Louis Missouri USA
| | - Scott C Borinstein
- Department of Pediatrics; Division of Pediatric Hematology/Oncology; Vanderbilt University School of Medicine; Nashville Tennessee USA
| | - Ginger E Holt
- Department of Orthopedics; Vanderbilt University School of Medicine; Nashville Tennessee USA
| | - Mark J Stavas
- Department of Radiation Oncology; Vanderbilt University School of Medicine; Nashville Tennessee USA
| | - Eric T Shinohara
- Department of Radiation Oncology; Vanderbilt University School of Medicine; Nashville Tennessee USA
| |
Collapse
|
18
|
Abstract
Ewing sarcoma (ES) is rare in Japanese people, and only 30-40 patients develop the disease annually. To diagnose ES, molecular techniques that aim to detect characteristic fusion genes are commonly used in combination with conventional histological and immunohistochemical examinations. The treatment strategy for ES is characterized by multi-disciplinary collaboration between pediatric oncologists, medical oncologists, radiation oncologists, and orthopedic surgeons. In recent years, numerous large-scale national or international multi-institutional studies of ES have been performed. Pre- and postoperative intensive systemic chemotherapy with multiple anticancer drugs is the standard treatment method for ES. Depending on the obtained surgical margin, postoperative radiation might also be performed. If preoperative radiological examinations indicate that surgical excision would be difficult, preoperative radiation can be administered. As the treatment outcomes of ES have improved, late complications and secondary malignancies have become a problem. After treatment, patients with ES require very long-term follow-up in order to detect secondary malignancies and growth-related musculoskeletal complications.
Collapse
Affiliation(s)
- Toshifumi Ozaki
- Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry, Pharmaceutical Sciences, Shikata-cho 2-5-1, Kita-ku, Okayama, 700-8558, Japan,
| |
Collapse
|
19
|
Do patients with ewing's sarcoma continue with sports activities after limb salvage surgery of the lower extremity? Clin Orthop Relat Res 2015; 473:839-46. [PMID: 24748070 PMCID: PMC4317429 DOI: 10.1007/s11999-014-3622-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Limb salvage surgery has evolved to become the standard method of treating sarcomas of the extremities with acceptable oncologic results. However, little information exists relative to the activity level or ability to participate in sports after tumor reconstructions. QUESTIONS/PURPOSES The aims of the study were to answer the following questions: (1) Which sports activity levels and what types of sports can be expected in the long term after tumor reconstruction? (2) Which frequency durations are patients with Ewing's sarcoma able to perform in long-term followup after local control? (3) Do surgical complications affect sports activity level? METHODS Thirty patients (13 females, 17 males; mean age, 18 ± 8 years; range, 2-36 years at diagnosis; mean followup 16 ± 6 years [minimum, 5 years]) were included. Tumors were located in the pelvis, femur, tibia, and fibula. Surgical procedures included surgical resections alone (n = 8), surgical resection with biological reconstruction (n = 9), or endoprosthetic reconstruction (n = 13). We assessed UCLA sports activity levels, kinds of sports as well as the frequency per week and the duration of each training unit at long term (minimum followup, 5 years). RESULTS In long-term followup 83% patients (25 of 30) were performing athletic activity regularly. The hours/week of sports depended on type of surgery and were highest after resections in the pelvis and femur (5.8) and were lowest after megaprosthetic reconstruction of the pelvis (1.0). Patients undergoing biologic reconstructions were able to perform high-impact sports. UCLA sports activity levels were high after joint-preserving vascularized fibula for tibia reconstruction (7.4) and after megaprosthetic reconstruction of the lower extremity (6.3-6.4) and were low after tumors located in the fibula (4.2). Complications during followup did not significantly influence sports activity in long-term survivors. CONCLUSIONS Long-term survivors can achieve high levels of sports activity in many instances. Tumor sites are associated with the postoperative sports activity levels. This information can help surgeons counsel patients in terms of athletic expectations after limb salvage reconstruction for patients with Ewing's sarcoma. LEVEL OF EVIDENCE Level III, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
Collapse
|
20
|
Analysis of surgical and oncological outcome in internal and external hemipelvectomy in 34 patients above the age of 65 years at a mean follow-up of 56 months. BMC Musculoskelet Disord 2015; 16:33. [PMID: 25888345 PMCID: PMC4342034 DOI: 10.1186/s12891-015-0494-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2014] [Accepted: 02/05/2015] [Indexed: 11/12/2022] Open
Abstract
Background With an increasing life expectancy and improved treatment regimens for primary or secondary malignant diseases of soft tissue or bone, hemipelvectomy will have to be considered more often in elderly patients in the future. Scientific reviews concerned with the surgical and oncological outcome of elderly patients undergoing hemipelvectomy are scarce. Therefore, it is the purpose of this study to review the outcome of patients treated with that procedure at our hospital and investigate the feasibility of such extensive procedures at an increased age. Methods A retrospective analysis of thirty-four patients who underwent hemipelvectomy at an age of 65 years or older was performed to determine their surgical and oncological outcome. The Kaplan-Meier method was used to calculate the cumulative probability of survival using the day of tumor resection as a starting point. Univariate analysis was carried out to investigate the influence of a particular single parameter. Results The mean age at operation was 70.2 years. Thirty patients were treated for intermediate- to high-grade sarcoma and 81.8% of tumors were larger than or equal to 10 cm in the longest diameter. Thirteen patients underwent internal hemipelvectomy and nine patients external hemipelvectomy as a primary procedure. Twelve patients were treated with external hemipelvectomy after failed local tumor control at primary operation. Wound infection occurred in 61.7% of cases. Three patients underwent amputation for non-manageable infection after internal hemipelvectomy. Hospital mortality was 8.8%. Clear resection margins were obtained in 88% of patients; in another 6% of patients planned intralesional resections were performed. Local recurrence occurred in 8.8% of patients at a mean time of 26 months after operation. Eleven patients are alive with no evidence of disease and 23 patients died of disease or other causes. Patients with pulmonary metastases had a mean survival period after operation to DOD of 22 months compared to 37 months in the curative group. Conclusion Despite an elevated rate in hospital mortality and wound infection, this study suggests that hemipelvectomy is feasible in elderly patients, although requiring long hospitalization periods and causing a limited functional outcome.
Collapse
|
21
|
Angelini A, Calabrò T, Pala E, Trovarelli G, Maraldi M, Ruggieri P. Resection and reconstruction of pelvic bone tumors. Orthopedics 2015; 38:87-93. [PMID: 25665107 DOI: 10.3928/01477447-20150204-51] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2014] [Accepted: 05/15/2014] [Indexed: 02/03/2023]
Abstract
The objective of this study was to assess outcome and recurrence rate after limb-salvage surgery with reconstruction for pelvic bone tumors and analyze complications and their relationship with surgery. The authors analyzed 129 patients followed for a mean of 6 years (range, 2-19 years). Chondrosarcoma was the most frequent histotype. Thirty-one cases with no acetabular involvement were reconstructed with allograft only. Acetabular resections were reconstructed with allograft prosthetic composite (n=60), allograft only (n=11), trabecular metal components (n=2), prosthesis only (n=10), saddle prosthesis (n=11), and iliofemoral arthrodesis (n=1). Margins were wide (n=94), wide contaminated (n=22), marginal (n=7), and intralesional (n=6). Oncologic outcomes were as follows: 75 patients were continuously disease free, 6 were disease free after treatment of relapse, 13 were alive with disease, 28 were dead of disease, and 5 were dead of other causes. Survival was 66% at 10 years. Local recurrence rate of malignant tumors was 22.1% and was not statistically influenced by margins (P=.140) or site (P=.933). Metastasis rate was 32.8%. Deep infection was observed in 30 (23.6%) cases, with no statistical difference between reconstructions with and without allograft (P=.09). Final external hemipelvectomy was performed in 16 cases. Newer techniques of reconstruction using stemmed acetabular cups or porous metal components combined with allograft are now available. Local control and satisfactory survival is achievable long term in patients with pelvic tumors, but this surgery implies a high rate of complications. Infection is a major complication, not influenced by the use of allografts. Amputation is rarely needed.
Collapse
|
22
|
Raciborska A, Bilska K, Rychlowska-Pruszynska M, Drabko K, Chaber R, Pogorzała M, Połczyńska K, Godziński J, Rodriguez-Galindo C, Wożniak W. Internal hemipelvectomy in the management of pelvic Ewing sarcoma - are outcomes better than with radiation therapy? J Pediatr Surg 2014; 49:1500-4. [PMID: 25280655 DOI: 10.1016/j.jpedsurg.2014.04.013] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2013] [Revised: 03/10/2014] [Accepted: 04/25/2014] [Indexed: 12/18/2022]
Abstract
BACKGROUND Pelvic Ewing sarcoma (ES) is commonly associated with a worse prognosis. Large size and location limit local control options to radiation therapy, and local recurrences are common. We evaluated the impact of hemipelvectomy and radiation on outcomes, including function. MATERIALS AND METHODS Thirty-nine patients (median age 13.5years) with ES of the pelvis and sacral bones were treated during the period 2000-2012. Fifteen were treated with definitive radiotherapy (RT), 9 patients underwent hemipelvectomy alone, and 15 were treated with combined hemipelvectomy and RT. RESULTS Twenty patients (51.2%) are alive with a median follow-up 3.2years from diagnosis. Median time from diagnosis to relapse was 1.3years. Three-year estimates of EFS and OS were 47% and 61%, respectively. Patients treated with surgery or surgery with RT had better outcome than patients treated with RT only (3-year OS 78% or 81% vs. 36%, respectively, p=0.00083). The outcome of patients with pelvic ES treated with hemipelvectomy was not significantly different from the outcome of all patients with Ewing sarcoma treated on the national Polish protocol. CONCLUSIONS Internal hemipelvectomy offers good chances of cure for patients with pelvic ES, with a reasonable rate of complications and good function.
Collapse
Affiliation(s)
- Anna Raciborska
- Department of Surgical Oncology for Children and Youth, Institute of Mother and Child, Warsaw, Poland.
| | - Katarzyna Bilska
- Department of Surgical Oncology for Children and Youth, Institute of Mother and Child, Warsaw, Poland
| | | | - Katarzyna Drabko
- Department of Pediatric Hematology, Oncology and Transplantology, Medical University of Lublin, Lublin, Poland
| | - Radosław Chaber
- Department and Clinic of Pediatric Oncology, Hematology and Bone Marrow Transplantation, Wroclaw Medical University, Wroclaw, Poland
| | - Monika Pogorzała
- Department of Pediatric Hematology and Oncology Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland
| | - Katarzyna Połczyńska
- Department of Pediatric Hematology and Oncology, Medical University of Gdansk, Gdansk, Poland
| | - Jan Godziński
- Department of Paediatric Surgery Marciniak Hospital, Chair of Emergency Medicine, Medical University, Wroclaw, Poland
| | - Carlos Rodriguez-Galindo
- Pediatric Oncology, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Harvard Medical School, Boston, TX
| | - Wojciech Wożniak
- Department of Surgical Oncology for Children and Youth, Institute of Mother and Child, Warsaw, Poland
| |
Collapse
|
23
|
Abstract
BACKGROUND The aim of the following study is to evaluate the morbidity, oncologic results and functional outcome in nonmetastatic patients with primary osteosarcoma of the pelvis treated with surgical resection. MATERIALS AND METHODS Twelve cases of nonmetastatic osteosarcoma of pelvis were operated as part of their multimodality treatment regime between November 2003 and May 2011. There were 5 males and 7 females with a median age of 22 years (range 8-39 years). Ten patients underwent limb sparing resections while 2 had a hindquarter amputation. All 10 cases of limb sparing surgery included resection of the acetabulum. A pseudarthrosis was carried out in 7 cases. Extracorporeal radiation therapy and reimplantation of the bone followed by fixation with plates was used in 1 case and an ischiofemoral arthrodesis was carried out in 2 cases. RESULTS Surgical margins were free in 11 patients. Seven patients had a poor histological response to chemotherapy while 4 patients had a good response to chemotherapy. In the patient reconstructed with radiated auto bone graft, the histological response to chemotherapy could not be assessed. Surgery related complications were seen in 8 out of 12 patients (67%). Three of these patients (25%) required additional surgical intervention for their complications. All patients were available for followup. The median followup of survivors was 56 months (range 24-102 months). Four patients (33%) developed a local recurrence. At 5 years, overall survival was 67%. Patients with a good response to chemotherapy had a better overall survival when compared with patients with a poor response to chemotherapy. The mean Musculoskeletal Tumor Society functional score was 22 (range12-27). CONCLUSIONS Though complex and challenging, surgery provides good local control and oncologic outcomes with acceptable function in patients with osteosarcoma of the pelvis treated with appropriate surgical resection as part of their multimodality treatment.
Collapse
Affiliation(s)
- Ajay Puri
- Department of Orthopaedic Oncology, Tata Memorial Hospital, Parel, Mumbai, Maharashtra, India,Address for correspondence: Prof. Ajay Puri, Room No: 45, Tata Memorial Hospital, E. Borges Road, Parel, Mumbai - 400 012, Maharashtra, India. E-mail:
| | - Ashish Gulia
- Department of Orthopaedic Oncology, Tata Memorial Hospital, Parel, Mumbai, Maharashtra, India
| | - Manish Pruthi
- Department of Orthopaedic Oncology, Tata Memorial Hospital, Parel, Mumbai, Maharashtra, India
| |
Collapse
|
24
|
Angelini A, Drago G, Trovarelli G, Calabrò T, Ruggieri P. Infection after surgical resection for pelvic bone tumors: an analysis of 270 patients from one institution. Clin Orthop Relat Res 2014; 472:349-59. [PMID: 23975252 PMCID: PMC3889428 DOI: 10.1007/s11999-013-3250-x] [Citation(s) in RCA: 91] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2013] [Accepted: 08/15/2013] [Indexed: 01/31/2023]
Abstract
BACKGROUND Surgical treatment of pelvic tumors with or without acetabular involvement is challenging. Primary goals of surgery include local control and maintenance of good quality of life, but the procedures are marked by significant perioperative morbidity and complications. QUESTIONS/PURPOSES We wished to (1) evaluate the frequency of infection after limb salvage surgical resection for bone tumors in the pelvis; (2) determine whether infection after these resections is associated with particular risk factors, including pelvic reconstruction, radiotherapy or chemotherapy, type of resection, and age; and (3) analyze treatment of these infections, particularly with respect to the need of additional surgery or hemipelvectomy. METHODS From 1975 to 2010, 270 patients with pelvic bone tumors (149 with chondrosarcoma, 40 with Ewing's sarcoma, 27 with osteosarcoma, 18 with other primary malignant tumors, 11 with metastatic tumors, and 25 with primary benign tumors) were treated by surgical resection. Minimum followup was 1.1 years (mean, 8 years; range, 1-33 years). The resection involved the periacetabular area in 166 patients. In 137 patients reconstruction was performed; in 133 there was no reconstruction. Chart review ascertained the frequency of deep infections, how they were treated, and the frequency of resection arthroplasty or hemipelvectomies that occurred thereafter. RESULTS A total of 55 patients (20%) had a deep infection develop at a mean followup of 8 months. There were 20 infections in 133 patients without reconstruction (15%) and 35 infections in 137 patients with reconstruction (26 %). Survivorship rates of the index procedures using infection as the end point were 87%, 83%, and 80% at 1 month, 1 year, and 5 years, respectively. Infection was more common in patients who underwent pelvic reconstruction after resection (univariate analysis, p = 0.0326; multivariate analysis, p = 0.0418; odds ratio, 1.7718; 95% CI, 1.0243-3.0650); no other risk factors we evaluated were associated with an increased likelihood of infection. Despite surgical débridements and antibiotics, 16 patients (46%) had the implant removed and five (9%) underwent external hemipelvectomy (four owing to infection and one as a result of persistent infection and local recurrence). CONCLUSIONS Infection is a common complication of pelvic resection for bone tumors. Reconstruction after resection is associated with an increased risk of infection compared with resection alone, without significant difference in percentage between allograft and metallic prosthesis. When infection occurs, it requires removal of the implant in nearly half of the patients who have this complication develop, and external hemipelvectomy sometimes is needed to eradicate the infection.
Collapse
Affiliation(s)
- Andrea Angelini
- III Department of Orthopedics, University of Bologna, Istituto Ortopedico Rizzoli, Via Pupilli, 1, 40136 Bologna, (BO) Italy
| | - Gabriele Drago
- III Department of Orthopedics, University of Bologna, Istituto Ortopedico Rizzoli, Via Pupilli, 1, 40136 Bologna, (BO) Italy
| | - Giulia Trovarelli
- III Department of Orthopedics, University of Bologna, Istituto Ortopedico Rizzoli, Via Pupilli, 1, 40136 Bologna, (BO) Italy
| | - Teresa Calabrò
- III Department of Orthopedics, University of Bologna, Istituto Ortopedico Rizzoli, Via Pupilli, 1, 40136 Bologna, (BO) Italy
| | - Pietro Ruggieri
- III Department of Orthopedics, University of Bologna, Istituto Ortopedico Rizzoli, Via Pupilli, 1, 40136 Bologna, (BO) Italy
| |
Collapse
|
25
|
Puri A, Pruthi M, Gulia A. Outcomes after limb sparing resection in primary malignant pelvic tumors. Eur J Surg Oncol 2013; 40:27-33. [PMID: 24239184 DOI: 10.1016/j.ejso.2013.10.017] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2013] [Revised: 10/07/2013] [Accepted: 10/21/2013] [Indexed: 01/08/2023] Open
Abstract
AIM To evaluate morbidity, oncologic results and functional outcome in patients with malignant tumors of pelvis treated with limb sparing resection. METHODS Between March 2002 and November 2010, 106 cases of non metastatic malignant pelvic tumors were treated with limb sparing resections of pelvis. Diagnosis included chondrosarcoma (65), Ewing's sarcoma (25), osteogenic sarcoma (10), synovial sarcoma (3) and malignant fibrous histiocytoma, high grade sarcoma, epitheloid hemangiothelioma (1 each). Three patients had intralesional surgery because of erroneous pre-operative diagnosis of benign tumor and were excluded from final analysis. Remaining 103 patients underwent limb sparing resections with intent to achieve tumor free margins. In 1 case, an intraoperative cardiac event lead to the surgery being abandoned. Reconstruction was done in 2 of 38 cases that did not include resection of acetabulum. For 64 resections involving acetabulum various reconstruction modalities were used. RESULTS Surgical margins were involved in 20 patients. Forty five patients had complications. 91 patients were available for follow up. Follow up of survivors ranged from 24 to 122 months (mean 55 months).Twenty one patients (23%) had local recurrence. Sixty patients are currently alive, 46 being continuously disease free. Overall survival was 67% at 5 years. Patients in whom acetabulum was retained had better function (mean MSTS score 27) compared to patients in whom acetabulum was resected (mean MSTS score 22). CONCLUSIONS Though complex and challenging, limb sparing surgery in non metastatic malignant tumors is oncologically safe and has better functional outcomes than after an amputation surgery.
Collapse
Affiliation(s)
- A Puri
- Orthopaedic Oncology, Tata Memorial Hospital, Mumbai, India.
| | - M Pruthi
- Orthopaedic Oncology, Tata Memorial Hospital, Mumbai, India
| | - A Gulia
- Orthopaedic Oncology, Tata Memorial Hospital, Mumbai, India
| |
Collapse
|
26
|
Use of tissue expander in pelvic Ewing's sarcoma treated with radiotherapy. Eur J Surg Oncol 2013; 40:197-201. [PMID: 24084085 DOI: 10.1016/j.ejso.2013.09.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2013] [Revised: 08/05/2013] [Accepted: 09/01/2013] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION The local treatment option for pelvic Ewing sarcoma (ES) remains uncertain and challenging as surgery is often disabling while radiotherapy alone has a higher risk of local recurrence but not necessarily a worse survival. The aim is to analyse the outcome of patients with pelvic ES after radiotherapy as the primary local treatment in combination with a temporary intrapelvic surgically placed tissue expander (TE) to reduce bowel complications. MATERIALS AND METHODS 20 patients were retrospectively analysed. All patients had neoadjuvant and adjuvant chemotherapy. We identified survival, time to develop local recurrence and metastasis, dose of radiotherapy administered, local complications related to the use of the tissue expander and bowel effects of radiotherapy. RESULTS The median follow-up was 41 months. 14 patients were stage IIb and six stage III. There were no problems after insertion of the TE and only one patient who developed mild diarrhoea. Local recurrence occurred in six patients. At the last follow-up 12 patients have died from sarcoma, five are disease free and three have had recurrent disease. CONCLUSIONS In this paper we reviewed pelvic Ewing sarcoma with all the special considerations that this entails. We think that tissue expander can be safely used when radiotherapy is chosen to treat pelvic ES. It does appear to prevent bowel problems and is a low morbidity procedure. New treatment approaches should be considered to give a chance of cure to those patients with "bad prognostic" pelvic ES.
Collapse
|
27
|
Biswas B, Agarwala S, Rastogi S, Khan SA, Mohanti BK, Sharma DN, Pathy S, Bakhshi S. High burden of metastases and poor outcome in pelvic PNET. Pediatr Blood Cancer 2013; 60:E97-9. [PMID: 23625700 DOI: 10.1002/pbc.24552] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2013] [Accepted: 03/08/2013] [Indexed: 12/19/2022]
Abstract
Data on prognostic factors in pelvic PNET are minimal. We analyzed patients with pelvic PNET treated between June 2003 and November 2011 for prognostic factors. Forty-eight (13%) of 374 patients with PNET were pelvic PNET with median age 14.5 years (range: 5-33); 31 (65%) had metastases. After median follow-up of 20.4 months (range: 1.3-64.9), 3-year EFS, OS, and local-control-rate were 13.5 ± 5.5%, 15.4 ± 9%, and 41.3 ± 14.9%, respectively. Hypoalbuminemia (≤3.4 g/dl) predicted inferior EFS and OS for both entire cohort and metastatic group. All patients with hypoalbuminemia (n = 10) had low BMI as compared to 23/38 without hypoalbuminemia (P = 0.02).
Collapse
Affiliation(s)
- Bivas Biswas
- Department of Medical Oncology, Dr. B R A Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | | | | | | | | | | | | | | |
Collapse
|
28
|
Mounessi FS, Lehrich P, Haverkamp U, Willich N, Bölling T, Eich HT. Pelvic Ewing sarcomas. Three-dimensional conformal vs. intensity-modulated radiotherapy. Strahlenther Onkol 2013; 189:308-14. [PMID: 23443613 DOI: 10.1007/s00066-012-0304-z] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2012] [Accepted: 12/20/2012] [Indexed: 12/21/2022]
Abstract
PURPOSE The goal of the present work was to assess the potential advantage of intensity-modulated radiotherapy (IMRT) over three-dimensional conformal radiotherapy (3D-CRT) planning in pelvic Ewing's sarcoma. PATIENTS AND METHODS A total of 8 patients with Ewing sarcoma of the pelvis undergoing radiotherapy were analyzed. Plans for 3D-CRT and IMRT were calculated for each patient. Dose coverage of the planning target volume (PTV), conformity and homogeneity indices, as well as further parameters were evaluated. RESULTS The average dose coverage values for PTV were comparable in 3D-CRT and IMRT plans. Both techniques had a PTV coverage of V95 > 98 % in all patients. Whereas the IMRT plans achieved a higher conformity index compared to the 3D-CRT plans (conformity index 0.79 ± 0.12 vs. 0.54 ± 0.19, p = 0.012), the dose distribution across the target volumes was less homogeneous with IMRT planning than with 3D-CRT planning. This difference was statistically significant (homogeneity index 0.11 ± 0.03 vs. 0.07 ± 0.0, p = 0.035). For the bowel, Dmean and D1%, as well as V2 to V60 were reduced in IMRT plans. For the bladder and the rectum, there was no significant difference in Dmean. However, the percentages of volumes receiving at least doses of 30, 40, 45, and 50 Gy (V30 to V50) were lower for the rectum in IMRT plans. The volume of normal tissue receiving at least 2 Gy (V2) was significantly higher in IMRT plans compared with 3D-CRT, whereas at high dose levels (V30) it was significantly lower. CONCLUSION Compared to 3D-CRT, IMRT showed significantly better results regarding dose conformity (p = 0.012) and bowel sparing at dose levels above 30 Gy (p = 0.012). Thus, dose escalation in the radiotherapy of pelvic Ewing's sarcoma can be more easily achieved using IMRT.
Collapse
Affiliation(s)
- F S Mounessi
- Department of Radiation Oncology, University of Münster, Albert-Schweitzer-Campus 1, Münster, Germany.
| | | | | | | | | | | |
Collapse
|
29
|
Abstract
Thirty nonmetastatic patients with malignant tumors of the pelvis underwent surgical resection between November 2000 and December 2009. The diagnosis included Ewing's sarcoma (22), osteogenic sarcoma (four), chondrosarcoma (two), and synovial sarcoma (two). Eighteen resections included the acetabulum and 12 did not. Twenty-seven patients were available for follow-up. Follow-up ranged from 4 to 138 months (mean 43 months). Nineteen patients are currently alive. There were two local recurrences. The overall survival was 68% at 5 years. The Musculoskeletal Tumor Society Score ranged from 22 to 29. Surgery provides good local control and oncologic outcomes with acceptable function in these patients.
Collapse
|
30
|
Wang J, Tang Q, Xie X, Yin J, Zhao Z, Li Z, Zou C, Huang G, Shen J. Iliosacral resections of pelvic malignant tumors and reconstruction with nonvascular bilateral fibular autografts. Ann Surg Oncol 2012; 19:4043-51. [PMID: 22948770 DOI: 10.1245/s10434-012-2339-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2011] [Indexed: 11/18/2022]
Abstract
BACKGROUND Iliosacral resection of pelvic malignant tumors and subsequent reconstruction have tested the ingenuity of orthopedic oncologists because of the difficulty of oncological wide resection and the complex biomechanics of the sacroiliac joint render reconstruction challenging. This study compared the functional and surgical outcomes of a biological reconstruction technique with the lack of reconstruction following iliosacral resection. METHODS Twenty-six consecutive cases with malignant iliac tumors involving the sacrum were retrospectively reviewed. These cases underwent iliosacral resection (type I/IV) followed by no reconstruction or a biological reconstruction blinded to authors between 1997 and 2007. After iliosacral resection, 12 cases underwent reconstruction with nonvascular fibular grafts and plate and/or pedicle screw-rod; the other 14 cases did not undergo reconstruction. RESULTS The median follow-up was 84.42 (range, 32-165) months. The local recurrence rate in the reconstruction group was 8.33 % (1/12) with 14.29 % (2/14) in the group without reconstruction. The functional score of the biological reconstruction group was significantly higher than that of the no-reconstruction group as determined by Student's t test. In the biological reconstruction group, bone fusion occurred in 91 % of cases and fibula hypertrophy was observed in 41.7 %. Complications included sciatic nerve palsy, broken screws, intractable pain, nonunion, pelvic oblique, and leg-length discrepancy. CONCLUSIONS After iliosacral resections of pelvic malignant tumors, the biologic reconstruction of these defects could restore spinopelvic stability and continuity. The double-barrel fibular autograft combined with the plate or pedicle screw-rod system is an effective reconstruction method for both optimal short- and long-term stability.
Collapse
Affiliation(s)
- Jin Wang
- Muskulaskeletal Oncology Department, First Affiliated Hospital of Zhongshan University, Guangzhou, Guangdong, China
| | | | | | | | | | | | | | | | | |
Collapse
|
31
|
Puri A, Gulia A, Jambhekar N, Laskar S. Results of surgical resection in pelvic Ewing's sarcoma. J Surg Oncol 2012; 106:417-22. [DOI: 10.1002/jso.23107] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2011] [Accepted: 03/01/2012] [Indexed: 11/10/2022]
|
32
|
Gebert C, Wessling M, Hoffmann C, Roedl R, Winkelmann W, Gosheger G, Hardes J. Hip transposition as a limb salvage procedure following the resection of periacetabular tumors. J Surg Oncol 2010; 103:269-75. [DOI: 10.1002/jso.21820] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2010] [Accepted: 11/02/2010] [Indexed: 11/07/2022]
|
33
|
Jawad MU, Haleem AA, Scully SP. Malignant sarcoma of the pelvic bones: treatment outcomes and prognostic factors vary by histopathology. Cancer 2010; 117:1529-41. [PMID: 21425154 DOI: 10.1002/cncr.25684] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2010] [Revised: 08/19/2010] [Accepted: 09/07/2010] [Indexed: 11/05/2022]
Abstract
BACKGROUND Treatment of malignant sarcomas of the pelvis poses a challenge for local disease control and oncologic outcome. Many reports have described the dismal outcomes. Most studies are retrospective series coming out of single centers, thus biased toward patient selection and are of limited statistical power. METHODS The authors used the Surveillance, Epidemiology, and End Results database to analyze 1185 pelvic sarcoma cases from 1987 to 2006. Kaplan-Meier and Cox regression were used to analyze the significance of prognostic factors. The analysis was repeated for different histopathological subtypes to determine specific prognostic factors in each case. RESULTS Incidence of pelvic sarcoma in 2006 was 89 per 100,000 persons; it has significantly increased since 1973 (P < .05). The overall 5-year survival for all the patients with pelvic sarcoma was 47%, with osteosarcoma having the worst 5-year survival at 19% and patients with chordoma having the best 5-year survival at 60%. Independent prognostic factors included age, stage, grade, size of primary lesion, histopathology, and treatment-related factors. Comparing the patients only with high-grade lesions, patients with Ewing sarcoma have the best prognosis. CONCLUSIONS This is an analysis of patients with pelvic sarcomas derived from a population-based registry. Survival and prognostics vary with histopathological diagnoses. Although surgical resection was associated with superior outcomes for osteosarcoma and chondrosarcoma, there was no significant difference in outcomes of patients with Ewing sarcoma treated with surgery and/or radiotherapy.
Collapse
Affiliation(s)
- Muhammad Umar Jawad
- Department of Orthopedics, Stanford University Hospital and Clinics, Stanford, California 94301, USA.
| | | | | |
Collapse
|
34
|
Fibula Free Flap Reconstruction of the Pelvisin Children after Limb-Sparing Internal Hemipelvectomy for Bone Sarcoma. Plast Reconstr Surg 2010; 125:195-200. [DOI: 10.1097/prs.0b013e3181c2a607] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
35
|
Hip transposition as a universal surgical procedure for periacetabular tumors of the pelvis. J Surg Oncol 2008; 99:169-72. [DOI: 10.1002/jso.21212] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
|
36
|
Gordley K, Marco R, Klebuc M. Supercharged internal hemipelvectomy that enhances flap perfusion and decreases wound-healing complications. Orthopedics 2008; 31:orthopedics.32940. [PMID: 19226052 DOI: 10.3928/01477447-20081201-09] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
|
37
|
Indelicato DJ, Keole SR, Shahlaee AH, Shi W, Morris CG, Marcus RB. Definitive radiotherapy for ewing tumors of extremities and pelvis: long-term disease control, limb function, and treatment toxicity. Int J Radiat Oncol Biol Phys 2008; 72:871-7. [PMID: 18455323 DOI: 10.1016/j.ijrobp.2008.02.023] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2007] [Revised: 01/11/2008] [Accepted: 02/12/2008] [Indexed: 10/22/2022]
Abstract
PURPOSE More than 70% of Ewing tumors occur in the extremities and pelvis. This study identified factors influencing local control and functional outcomes after management with definitive radiotherapy (RT). PATIENTS AND METHODS A total of 75 patients with a localized Ewing tumor of the extremity or pelvis were treated with definitive RT at the University of Florida between 1970 and 2006 (lower extremity tumors in 30, pelvic tumors in 26, and upper extremity tumors in 19). RT was performed on a once-daily (40%) or twice-daily (60%) basis. The median dose was 55.2 Gy in 1.8-Gy daily fractions or 55.0 Gy in 1.2-Gy twice-daily fractions. The median observed follow-up was 4.7 years. Functional outcome was assessed using the Toronto Extremity Salvage Score. RESULTS The 10-year actuarial overall survival, cause-specific survival, freedom from relapse, and local control rate was 48%, 48%, 42%, and 71%, respectively. Of the 72 patients, 3 required salvage amputation. Inferior cause-specific survival was associated with larger tumors (81% for tumors <8 cm vs. 39% for tumors >/=8 cm, p <0.05). No patient characteristics or treatment variables were predictive of local failure. No fractures occurred in patients treated with hyperfractionation or with tumors of the distal extremities. Severe late complications were more frequently associated with use of <8-MV photons and fields encompassing the entire bone or hemipelvis. A significantly better Toronto Extremity Salvage Score was associated with a late-effect biologically effective dose of <91.7 Gy(3). CONCLUSIONS Limb preservation was effectively achieved through definitive RT. Treating limited field sizes with hyperfractionated high-energy RT could minimize long-term complications and provides superior functional outcomes.
Collapse
Affiliation(s)
- Daniel J Indelicato
- Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, FL, USA
| | | | | | | | | | | |
Collapse
|
38
|
Indelicato DJ, Keole SR, Shahlaee AH, Shi W, Morris CG, Gibbs CP, Scarborough MT, Marcus RB. Impact of local management on long-term outcomes in Ewing tumors of the pelvis and sacral bones: the University of Florida experience. Int J Radiat Oncol Biol Phys 2008; 72:41-8. [PMID: 18234436 DOI: 10.1016/j.ijrobp.2007.12.014] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2007] [Revised: 12/05/2007] [Accepted: 12/06/2007] [Indexed: 11/18/2022]
Abstract
PURPOSE This retrospective analysis describes our 35-year experience with respect to disease control and functional status. PATIENTS AND METHODS Thirty-five patients with localized Ewing tumors of the pelvis and sacral bones were treated from 1970 to 2005. Twenty-six patients were treated with definitive radiotherapy (RT), and 9 patients were treated with combined local therapy in the form of surgery + RT. The median RT dose was 55.2 Gy. The patients who received RT alone were more likely to be older men with larger tumors exhibiting soft-tissue extension. Patients in the definitive RT group were more likely to receive etoposide and ifosfamide or undergo bone marrow transplant. Median potential follow-up was 19.4 years. RESULTS The 15-year actuarial cause-specific survival, freedom from relapse rate, and local control rates were 26% vs. 76% (p = 0.016), 28% vs. 78% (p = 0.015), and 64% vs. 100% (p = 0.087), respectively, for patients treated with definitive RT and combined therapy. Overall, tumors <8 cm had significantly better cause-specific survival, but this was unrelated to local control. The median Toronto Extremity Salvage Score for the definitive RT and combined therapy groups were 99 and 94, respectively (p = 0.19). Seven definitive RT patients (27%) had serious complications. CONCLUSION Combined modality local therapy should be considered if pelvic Ewing tumors are resectable. However, because of the extent of local disease, most patients have unresectable or partially resectable tumors and therefore require RT in some capacity. For this reason, innovative RT strategies are needed to improve long-term disease outcomes and minimize side effects while maintaining an acceptable functional result.
Collapse
Affiliation(s)
- Daniel J Indelicato
- Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, FL 32610-0385, USA.
| | | | | | | | | | | | | | | |
Collapse
|
39
|
Abstract
Survival rates of children with pelvic sarcoma have demonstrated unprecedented improvement during the past few decades, with a corresponding increase in the number of limb-sparing surgical procedures being performed. This increase may be attributed to earlier detection with advanced imaging techniques, the availability of a wider armamentarium of surgical techniques of reconstruction and limb salvage, and advances achieved in neoadjuvant chemotherapy and radiation therapy. Undertaking reconstruction after resection of pelvic sarcoma while preserving function of the hip and limb can be extremely challenging; this is especially true in children, who invite concern regarding growth potential and limb-length discrepancy. Decisions for surgery and reconstruction are individualized based on tumor type, size, and location as well as the probability of achieving a wide resection with negative margins and acceptable morbidity.
Collapse
Affiliation(s)
- Harish S Hosalkar
- Division of Orthopaedic Surgery, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | | |
Collapse
|
40
|
Abstract
Presacral tumours represent a heterogeneous group of predominantly benign and occasionally malignant neoplasms. Due to the rarity of these tumours, their management is often performed in an ad hoc fashion and an algorithm for optimal treatment remains undefined. This review aims to present an overview of presacral tumours, focusing on their presentation, pathology, investigation and management.
Collapse
Affiliation(s)
- J Ghosh
- Department of General Surgery, Manchester Royal Infirmary, Oxford Road, Manchester, M13 9WL, England, UK
| | | | | | | |
Collapse
|
41
|
Delloye C, Banse X, Brichard B, Docquier PL, Cornu O. Pelvic reconstruction with a structural pelvic allograft after resection of a malignant bone tumor. J Bone Joint Surg Am 2007; 89:579-87. [PMID: 17332107 DOI: 10.2106/jbjs.e.00943] [Citation(s) in RCA: 120] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Reconstruction of the pelvic arch after resection of a malignant pelvic tumor remains a major surgical challenge because of the high rate of associated complications. The purpose of this investigation was to assess the functional outcome and complication rate following treatment with a bone allograft to reconstruct the pelvis. METHODS Twenty-four consecutive patients underwent excision of a malignant pelvic bone tumor and reconstruction with a pelvic bone allograft. The living patients were followed for a minimum of twenty-four months. There were nineteen primary malignant bone tumors, sixteen of which were high-grade sarcomas, and there were five isolated metastases. Patients were examined clinically and radiographically and were assessed functionally with the Musculoskeletal Tumor Society score. RESULTS The mean age of the patients at the time of the index surgery was thirty-four years, and the mean duration of follow-up was forty-one months. Eighteen of the twenty-four resections involved the periacetabular area and were followed by reconstruction either with a hip prosthesis (thirteen) or with an osteochondral allograft alone (five). The six other resections involved the iliac bone. All patients received a massive bone allograft that had been sterilely procured without secondary irradiation. At the time of our last evaluation, eight patients were alive and free of disease. Seven patients had a local recurrence. Neurological deficits were present in six patients, and three had a deep infection. Nonunion of three of the sixteen allografts that could be evaluated was observed. Neither graft fracture nor lysis was observed. Eleven patients underwent surgical revision, with nine of these revisions related to the reconstruction. The average Musculoskeletal Tumor Society score at the time of the latest follow-up was 73% of the maximal possible score. The average score was 82% for the eleven patients with an age of less than twenty years at the time of the index procedure and 65% for the thirteen older patients. Ten patients walked without any assistive device, and five of them had normal function with no or only a slight limp. CONCLUSIONS Pelvic reconstruction after a limb-sparing resection is associated with a high risk of surgical complications and usually should be reserved for patients with a primary bone sarcoma. A pelvic allograft can restore the anatomy and provide good functional results, especially in young patients. Nonunion was the most common allograft-related complication.
Collapse
Affiliation(s)
- Christian Delloye
- Division of Orthopaedic Surgery, Department of Surgery, Cliniques Universitaires St.-Luc, 10, avenue Hippocrate, B1200 Brussels, Belgium.
| | | | | | | | | |
Collapse
|
42
|
Abstract
Ewing's sarcoma is the second most common primary bone tumor seen in children and adolescents, and was described by James Ewing in 1921 as a diffuse endothelioma of bone. It is one of the differential diagnoses of pediatric small round blue cell tumors. This is not a single condition, but a group of morphologically and clinically closely related disorders with similar molecular biology -- expression of tumor-specific chimeric oncoproteins through balanced chromosomal translocations involving the EWS gene -- often referred to as the Ewing family of tumors. This includes Ewing's sarcoma of bone, extra-osseous Ewing's sarcoma, Askin tumor and peripheral neuroectodermal tumor. These are aggressive neoplasms with almost 25% of patients having clinically evident metastases at presentation. Ewing's sarcoma has therefore been considered as a systemic disease necessitating local as well as systemic treatment. An aggressive multidisciplinary approach has resulted in significant improvement in prognosis for patients with these tumors. Despite aggressive treatment, 20-40% of patients with localized disease and almost 80% of patients with metastatic disease at presentation succumb to the illness. Advances in understanding the molecular biology of these tumors will hopefully result in the development of novel treatment approaches. The aim of this article is to review the existing treatment methods and to highlight the more recent approaches to the treatment of this condition.
Collapse
Affiliation(s)
- Mihir M Thacker
- Department of Orthopaedics and Rehabilitation, University of Miami School of Medicine (D-27), PO Box 016960, Miami, FL 33101, USA.
| | | | | |
Collapse
|
43
|
Sonmezer M, Shamonki MI, Oktay K. Ovarian tissue cryopreservation: benefits and risks. Cell Tissue Res 2005; 322:125-32. [PMID: 15912406 DOI: 10.1007/s00441-005-1098-4] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2004] [Accepted: 02/09/2005] [Indexed: 12/29/2022]
Abstract
An increasing number of women have been subjected to cytotoxic chemoradiotherapy for various malignant and nonmalignant diseases. Women who face the possibility of premature or imminent ovarian failure caused by cytotoxic therapy may retain their fertility potential with ovarian tissue cryopreservation. Until recently, this technique could only be performed in a few highly specialized institutions. However, with the latest advances in cryobiology, ovarian tissue cryopreservation is rapidly becoming a more widely offered technique by many medical centers around the world. The indications now extend beyond cancer. Even though the risk of re-implanting pre-existing cancer cells is minimal or non-existent for most types of cancer, this risk needs to be ascertained according to the cancer type and disease stage. The objective of this manuscript is to review the indications, risks and benefits of ovarian tissue cryopreservation.
Collapse
Affiliation(s)
- Murat Sonmezer
- The Center for Reproductive Medicine and Infertility, The Weill Medical College of Cornell University, New York, NY 10021, USA.
| | | | | |
Collapse
|
44
|
Abstract
Nearly all bone and soft tissue sarcomas will require surgical management. Early consultation with a surgeon who is experienced in sarcomas, before a biopsy is performed, will avoid potential errors that may complicate subsequent surgery. Advances in imaging, neoadjuvant therapies, and reconstructive techniques have improved the ability to resect adequately most bone and soft tissue sarcomas. The use of oncologic and functional outcomes assessment tools facilitates the development of improved treatments for sarcoma patients. Results from major centers reveal that most patients who have a nonmetastatic bone or soft tissue sarcoma will survive 5 years after surgery when combined with either chemotherapy or radiation.
Collapse
Affiliation(s)
- Edward Y Cheng
- Department of Orthopaedic Surgery, University of Minnesota, 2512 South 7th Street, R200, Minneapolis, MN 55454, USA.
| |
Collapse
|
45
|
Mankin HJ, Hornicek FJ. Internal hemipelvectomy for the management of pelvic sarcomas. Surg Oncol Clin N Am 2005; 14:381-96. [PMID: 15817245 DOI: 10.1016/j.soc.2004.11.010] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Henry J Mankin
- Orthopaedic Oncology Service, Massachusetts General Hospital, Harvard Medical School, Gray 6 Orthopaedics, Boston, 02114, USA.
| | | |
Collapse
|
46
|
Mack LA, Temple WJ. Extended Pelvic Resection for Sarcoma or Visceral Tumors Invading Musculoskeletal Pelvis. Surg Oncol Clin N Am 2005; 14:397-417. [PMID: 15817246 DOI: 10.1016/j.soc.2004.11.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Affiliation(s)
- Lloyd A Mack
- Tom Baker Cancer Centre, Calgary, Alberta, Canada
| | | |
Collapse
|