Local and systemic control of Ewing's bone sarcoma family tumors of the ribs

Prognostic factors in primary nonmetastatic Ewing sarcoma of the rib in children and young adults

BACKGROUND

The rarity of Ewing sarcoma of rib has resulted in paucity of data, particularly on the prognostic factors and pattern of relapses. We analyzed the recurrences in patients with primary nonmetastatic Ewing sarcoma of the rib and examined prognostic factors of poor outcome.

METHODS

From January 2004 to January 2011, 37 patients were treated. After induction chemotherapy, complete (from costal cartilage to vertebra) or partial excision of involved rib with or without adjacent ribs was performed. Postoperative radiotherapy was administered for positive margins, poor response to chemotherapy, and large primary tumors with significant soft tissue component at presentation.

RESULTS

Disease relapsed in 16 patients: at the local site (n = 5), both local and distant (n = 2), and distant site only (n = 9). The projected 5-year cause-specific, relapse-free survival and local control were 50%, 44%, and 72%. Poor response to chemotherapy (>5% residual tumor) and resection of adjacent lung parenchyma (a surrogate for tumor extension) were adverse prognostic factors for relapse-free survival in multivariate analysis.

CONCLUSION

Relapses occurred more often at distant sites and had a poor outcome. In this study, poor histologic response to chemotherapy (P = .04) and the infiltration of adjacent lung parenchyma (P = .01) are adverse prognostic factors.

Diagnostic difficulties and delays with chest wall chondrosarcoma: a Swedish population based Scandinavian Sarcoma Group study of 106 patients

BACKGROUND

Bone sarcomas in Sweden are generally referred to a multidisciplinary team at specialized sarcoma centers. This practice is strictly followed for sarcomas of long bones, but not for chest wall chondrosarcomas. Delay in diagnosis and treatment is often considerable for bone sarcomas. This report focuses on the symptoms and diagnostic problems of chest wall chondrosarcoma and factors related to long doctor's delay.

METHODS

The material included all 106 consecutive patients with chondrosarcoma of the chest wall diagnosed in Sweden 1980-2002. Pathological specimens were re-evaluated and graded by the Scandinavian Sarcoma Group pathology board. Files from the very first medical visit for symptoms related to the chondrosarcoma were traced and used to characterize the initial symptoms and calculate patient's and doctor's delay.

RESULTS

The most prominent initial symptom for the chest wall chondrosarcomas was a palpable mass found in 69% (73/106) of the patients at the first visit. Two-thirds of the patients experienced no local chest pain. A tumor was suspected at the first visit in 83% of the patients. Patients delay was median 3 (0-118) months and doctor's delay was 4.5 (0.1-197) months. Doctor's delay was >6 months for 40% of the patients. Patients with an initial plain chest radiograph interpreted as normal (35 patients), and/or normal or inconclusive results of a fine-needle aspiration biopsy had longer doctor's delay. Fine-needle aspiration cytology done at non-specialty units resulted in only 26% correct malignant diagnoses; at sarcoma centers 94% were correctly diagnosed. Long total delay was unfavorable. Patients who died from the chondrosarcoma had longer total delay (p<0.05).

CONCLUSION

Chest wall chondrosarcoma presents as a lump, usually painless. Plain chest radiographs and fine-needle aspiration cytology, when done at a non-specialty center, are often normal or inconclusive. Patients should be referred to sarcoma centers for diagnosis and treatment.