Local therapy in non-metastatic primary Ewing sarcoma of the mandible and maxilla in children

Nuances in the Treatment of Ewing Sarcoma of the Head and Neck in a Low-Middle-Income Country Setting: A Multi-Disciplinary Approach

BACKGROUND

Ewing sarcoma of the head and neck (ES-HN) is a rare subsite of ES, where therapeutic outcomes need to be explored further.

METHODS

This retrospective study includes ES-HN patients registered at our center between 2003 and 2019. Demographic details and treatment outcomes were recorded from the hospital database. Prognostic factors for survival were identified by Cox regression.

RESULTS

Eighty-five patients were included. Metastatic disease was seen in nine patients (10.59%). Local therapy included radiotherapy alone (n = 38; 44.7%), surgery plus radiotherapy (n = 15; 17.6%), or surgery alone (n = 8; 9.4%). The median overall survival (OS) was 37.4 months. On multivariable analysis, osseous primary (HR 0.40; p = 0.009) and male sex (HR 0.43; p = 0.023) were associated with superior OS. Leucocytosis (HR 3.46; p = 0.001) was associated with inferior OS.

CONCLUSIONS

ES-HN has favorable biology with metastases being rare at baseline. However, leucocytosis, extra-osseous disease, and female sex are poor prognostic factors. In resource-challenged settings, difficulties in administering local therapy may contribute to inferior outcomes.

Ewing's Sarcoma of Mandible: A Case Report with Review of Literature

Background

Ewing sarcoma (ES), a rare malignancy, comprises whatever the age, 4-15% of all primary bone tumors. It represents 1% of all malignant tumors in children and is the fourth most common bone malignancy after myeloma, osteosarcoma, and chondrosarcoma.

Case description

A 12-year-old boy came to the Oral Surgery Department of Bretonneau Hospital referred by his dentist with a rapidly evolving swelling in the left mandibula for 6 weeks, which was initially diagnosed as a facial cellulitis. Cone beam computed tomography (CBCT) showed a poorly defined, expansile, and osteolytic tumor on the left side of the mandible. Clinical and radiographic findings were in favor of an aggressive primitive bone tumor. A mandibular biopsy under general anesthesia was performed in the Department of Surgical Oncology at Institut Curie in Paris, revealing an ES.

Conclusion

Mandibular ES can mimic dental infections when swelling is the main clinical manifestation, which can lead to a delayed diagnosis. A correlation between clinical, radiological, histopathological, and immunohistochemical with cytogenetics is needed to confirm the diagnosis. Moreover, smaller tumors have better survival.Dentists must therefore be aware of the clinical signs of ES in order to quickly refer patients to a specialized department.

How to cite this article

Bellut N, Lutz CM, Lesnik M, et al. Ewing's Sarcoma of Mandible: A Case Report with Review of Literature. Int J Clin Pediatr Dent 2024;17(2):187-190.

A rare case of Ewing sarcoma metastasis to the oral cavity

Ewing sarcoma in the head and neck is rare, and metastasis from other bones to the mandible accounts for 0.7% of cases. This report presents a case of oral metastasis in a 24-year-old male patient diagnosed with Ewing sarcoma of the femur (p53 gene mutation and EWSR1-ERG fusion). The chief complaint was numbness in the mandible and pain for 1 month and a hardened, ulcerated exophytic lesion in the right retromolar region. Imaging exams revealed an unspecified thinning of the cortical bone of the inferior alveolar canal in the right mandibular ramus, associated with erosion of the alveolar bone. Histopathological analysis confirmed metastasis of Ewing sarcoma. The patient presented an aggressive disease progression and died 1 month after the oral diagnosis. It is important to recognize the signs and symptoms compatible with rare clinical outcomes, leading to an early diagnosis that can improve patients' quality of life and survival.

Ewing's Sarcoma of the Head and Neck: Margins are not just for surgeons

Background, Methods

To describe the characteristics, treatments (systemic/local), and outcome (oncological/functional) of French patients with head and neck Ewing's sarcomas (HNES) registered in the Euro‐Ewing 99 (EE99) database. Specific patient‐level data were reviewed retrospective.

Results

Forty‐seven HNES patients in the EE99 database had a median age of 11 years, 89% had bone tumors (skull 55%, mandible 21%, maxilla 11%), 89% had small tumors (<200 mL), and they were rarely metastatic (9%). Local treatment was surgery radiotherapy (55%), exclusively surgery (28%), or radiotherapy (17%). Metastatic relapses occurred in five patients with high relapse risk factors (metastasis at diagnosis, poor histological response, large tumors). Local progression/relapses (LR) after exclusive radiotherapy occurred in three patients with persistent extra‐osseous residue and in four patients considered R0 margins (postchemotherapy surgery, without postoperative radiotherapy [PORT]), reclassified by pathological review as R1a. Pathological review reclassified 72% of R0 margins: 11/18 to R1a and 2/18 to R2. Five patients had confirmed R0 margins after postchemotherapy surgery without PORT and had no LR Eight patients had R2 margins (initial surgery without previous chemotherapy, with PORT) and had no LR With a median follow‐up of 9.3 years, the 3‐year LR rate, EFS, and OS were 84.8%, 78.6%, and 89.3%, respectively. Among the 5‐year survivors, 88% had long‐term sequelae.

Conclusion

To optimize HNES management, patients should be treated from diagnosis in expert centers with multidisciplinary committees to discuss treatment strategy (type of surgery, need for PORT) and validate surgical margins.