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Shukla S, Salunke AA, Trivedi M, Patel K, Pandya S, Suthar R, Reddy T, Kapoor K, Yala P, Krishna G, Bharwani N, Pandya S. Clinicopathological and oncological outcomes in upper extremity Ewing's sarcoma: A single institutional experience. J Orthop 2024; 49:148-155. [PMID: 38682008 PMCID: PMC11043629 DOI: 10.1016/j.jor.2023.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Revised: 12/06/2023] [Accepted: 12/11/2023] [Indexed: 05/01/2024] Open
Abstract
Background Ewing's sarcoma is highly aggressive bone tumor having predilection for younger age groups with t (11,22) translocation, recombines the FLI-1 and EWS genes on chromosome 22. This disease requires multi-disciplinary treatment withneo-adjuvant chemotherapy followed by surgery or radiotherapy and adjuvant chemotherapy. This study was aimed to assess the demographic distribution, clinical behaviour and oncological outcome of Ewings Sarcoma involving upper extremity. Methods From 2015 to 2022, 45 patients of upper extremity Ewing's sarcoma underwent treatment at a territory cancer centre. A total of 26 patients treated with surgical management were included in the study comprising 15 males (57.7 %) and 11 females (42.3 %). Mean age of presentation was 26 years (3-43 years). The most common site for Ewings sarcoma of upper extremity was Humerus(42 %) followed by Scapula(27 %), Radius(15 %), Ulna(8 %), Metacarpals(4 %) and Clavicle(4 %). Out of 26 cases, 19 (73%) underwent limb salvage surgery and 7 (27%) underwent ampuation surgery. Results In limb salvage group reconstruction with Extra-corporeal radiotherapy (ECRT), Ulna centralization, Megaprosthesis and 3D printed scapula was performed following wide resection of tumor. In Amputation group ray resection in one case and forequarter amputation was performed in six cases. Mean serum LDH value was 335 IU/L (2.3X Normal value) and serum albumin was 4.04 gm/dl. Mean tumour necrosis after neo-adjuvant chemotherapy was 68 %. Out of 26 cases, 19(73 %) cases underwent limb salvage and 7 patients underwent amputation surgery. Out of 26, 13 (50 %) patients developed metastasis on follow up. The Event free survival (EFS) in current study was 70 % at 12 months and 40 % at 24 months. Mean Event free survival (EFS) in current study was 33.5 months (22.3-44.6) and Median Event free survival (EFS) in current study was 25 months (19.7-30.2). Conclusion This study characterises demographic and oncologic outcomes of upper extremity ewings sarcoma in Indian subpopulation. Pain and swelling were prominent clinical findings at presentation in patients with upper extremity Ewing's sarcoma. The survival rate following limb salvage surgery in Ewings sarcoma of upper extremity was comparable to that of patients with amputation surgery. Ewings sarcoma of upper extremity was associated with higher LDH level which was raised more than twice the normal range and can led to worse oncologic outcomes. A comparative study on upper extremity and lower extremity ewings sarcoma will be of help to improve literature on this rare disease.
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Affiliation(s)
- Shivang Shukla
- Gujarat Cancer and Research Institute, (Surgical Oncology), Ahmedabad, Gujarat, India
| | | | - Maharshi Trivedi
- Gujarat Cancer and Research Institute, (Medical Oncology), Ahmedabad, Gujarat, India
| | - Keval Patel
- Gujarat Cancer and Research Institute, (Surgical Oncology), Ahmedabad, Gujarat, India
| | - Shivam Pandya
- Gujarat Cancer and Research Institute, (Surgical Oncology), Ahmedabad, Gujarat, India
| | - Ritesh Suthar
- Gujarat Cancer and Research Institute, (Nuclear Medicine), Ahmedabad, Gujarat, India
| | - Tarun Reddy
- Gujarat Cancer and Research Institute, (Surgical Oncology), Ahmedabad, Gujarat, India
| | - Kanika Kapoor
- Gujarat Cancer and Research Institute, (Surgical Oncology), Ahmedabad, Gujarat, India
| | - Poojitha Yala
- Gujarat Cancer and Research Institute, (Surgical Oncology), Ahmedabad, Gujarat, India
| | - Geetha Krishna
- Gujarat Cancer and Research Institute, (Surgical Oncology), Ahmedabad, Gujarat, India
| | - Nandlal Bharwani
- Gujarat Cancer and Research Institute, (Surgical Oncology), Ahmedabad, Gujarat, India
| | - Shashank Pandya
- Gujarat Cancer and Research Institute, (Surgical Oncology), Ahmedabad, Gujarat, India
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Efficacy of Local Control Strategies for Ewing Sarcoma After Neoadjuvant Chemotherapy: A Network Meta-analysis. Indian Pediatr 2020. [DOI: 10.1007/s13312-020-1850-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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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
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Majeed SS, Muhammad HA, Ali JS, Khudhair HH, Said A, Arif SO, Murad KM, Gendari AH, Muhsin BM, Mohammed SA, Mula-Hussain L. Treatment Outcomes of Pediatric Patients With Ewing Sarcoma in a War-Torn Nation: A Single-Institute Experience From Iraq. J Glob Oncol 2019; 5:1-9. [PMID: 30707662 PMCID: PMC6426536 DOI: 10.1200/jgo.18.00122] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
PURPOSE Ewing sarcoma (ES) is a relatively rare, highly malignant tumor of the musculoskeletal system. It is the second most common malignant bone tumor in children and adolescents in the age group of 5 to 20 years. The aim of this study was to identify the treatment outcomes of pediatric patients with ES in Sulaimani governorate, Iraq. PATIENTS AND METHODS This was a retrospective study that reviewed the medical records of pediatric patients with ES who were managed between 2009 and 2015, with follow-up until late 2017. Patient- and tumor-related factors were correlated with clinical outcomes. RESULTS A total of 31 pediatric patients with ES were included in this study. All the patients received chemotherapy and radiotherapy, whereas only 14 patients underwent surgical resection and just eight had free surgical margins. The median age at diagnosis was 13 years, 58% were male, and 42% were female. The presenting symptoms at diagnosis were mostly pain (67.7%) and palpable mass (25.8%). The primary tumor was located in the extremities (51.6%), the thoracic cage (19.4%), the pelvis (16.1%), and the lumbar vertebrae (12.9%). Approximately two thirds of the patients (61.3%) had localized disease at the time of presentation. The 5-year overall survival was 19%, and the 5-year recurrence-free survival was 34%. CONCLUSION Clinical outcomes of ES in pediatric patients in our war-torn nation, Iraq, are still markedly inferior to the published outcomes from stable, developed nations. Additional large and multicenter national studies are required. Diagnostic and therapeutic measures need improvement, and multidisciplinary and comprehensive cancer-integrated approaches are vital for better outcomes.
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Affiliation(s)
| | - Hawzheen A Muhammad
- Komar University of Science and Technology, Sulaimani, Kurdistan, Iraq.,University of Sulaimani, Sulaimani, Kurdistan, Iraq
| | - Jalil S Ali
- Zhianawa Cancer Center, Sulaimani, Kurdistan, Iraq
| | | | - Ayah Said
- University of Toronto, Toronto, Ontario, Canada
| | - Shkar O Arif
- Zhianawa Cancer Center, Sulaimani, Kurdistan, Iraq
| | | | - Ali H Gendari
- Mosul Oncology and Nuclear Medicine Hospital, Mosul, Ninevah, Iraq
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Jones CW, Shatrov J, Jagiello JM, Millington S, Hong A, Boyle R, Stalley PD. Clinical, functional and radiological outcomes of extracorporeal irradiation in limb salvage surgery for bone tumours. Bone Joint J 2017; 99-B:1681-1688. [PMID: 29212693 DOI: 10.1302/0301-620x.99b12.bjj-2016-0462.r2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Accepted: 07/11/2017] [Indexed: 11/12/2022]
Abstract
AIMS We present a retrospective review of patients treated with extracorporeally irradiated allografts for primary and secondary bone tumours with the mid- and long-term survivorship and the functional and radiographic outcomes. PATIENTS AND METHODS A total of 113 of 116 (97.4%) patients who were treated with extracorporeally irradiated allografts between 1996 and 2014 were followed up. Forms of treatment included reconstructions, prostheses and composite reconstructions, both with and without vascularised grafts. Survivorship was determined by the Kaplan-Meier method. Clinical outcomes were assessed using the Musculoskeletal Tumor Society (MSTS) scoring system, the Toronto Extremity Salvage Score (TESS) and Quality of Life-C30 (QLQ-30) measures. Radiographic outcomes were assessed using the International Society of Limb Salvage (ISOLS) radiographic scoring system. RESULTS There were 61 (54%) men with a mean age of 22 years (6 to 70) and 52 (46%) women with a mean age of 26 years (3 to 85). There were 23 deaths. The five-year patient survivorship was 82.3% and the ten-year patient survivorship was 79.6%. The mean follow-up of the 90 surviving patients was 80.3 months (2 to 207). At the last follow-up, 105 allografts (92.9%) were still in place or had been at the time of death; eight (7%) had failed due to infection, local recurrence or fracture. Outcome scores were comparable with or superior to those in previous studies. The mean outcome scores were: MSTS 79% (sd 8); TESS 83% (sd 19); QLQ 82% (sd 16); ISOLS 80.5% (sd 19). Pearson correlation analysis showed a strong relationship between the MSTS and ISOLS scores (r = 0.71, p < 0.001). CONCLUSION This study shows that extracorporeal irradiation is a versatile reconstructive technique for dealing with large defects after the resection of bone tumours with good functional and radiographic outcomes. Functional outcomes as measured by MSTS, TESS and QLQ-30 were strongly correlated to radiographic outcomes. Cite this article: Bone Joint J 2017;99-B:1681-8.
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Affiliation(s)
- C W Jones
- Royal Prince Alfred Hospital, 50 Missenden Rd, Camperdown NSW 2050, Sydney, Australia
| | - J Shatrov
- Royal Prince Alfred Hospital, 50 Missenden Rd, Camperdown NSW 2050, Sydney, Australia
| | - J M Jagiello
- Royal National Orthopaedic Hospital, Brockley Hill, Stanmore HA7 4LP, UK
| | - S Millington
- London Bridge Hospital, 27 Tooley Street, London SE1 2PR, UK
| | - A Hong
- The University of Sydney, Sydney, Australia
| | - R Boyle
- Royal Prince Alfred Hospital, 50 Missenden Rd, Camperdown NSW 2050, Sydney, Australia
| | - P D Stalley
- Royal Prince Alfred Hospital, 50 Missenden Rd, Camperdown NSW 2050, Sydney, Australia
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Gerrand C, Athanasou N, Brennan B, Grimer R, Judson I, Morland B, Peake D, Seddon B, Whelan J. UK guidelines for the management of bone sarcomas. Clin Sarcoma Res 2016; 6:7. [PMID: 27148438 PMCID: PMC4855334 DOI: 10.1186/s13569-016-0047-1] [Citation(s) in RCA: 140] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Accepted: 03/09/2016] [Indexed: 01/02/2023] Open
Abstract
This document is an update of the British Sarcoma Group guidelines published in 2010. The aim is to provide a reference standard for the clinical care of patients in the UK with bone sarcomas. Recent recommendations by the European Society of Medical Oncology, The National Comprehensive Cancer Network and The National Institute for Health and Care Excellence have been incorporated, and the literature since 2010 reviewed. The standards represent a consensus amongst British Sarcoma Group members in 2015. It is acknowledged that these guidelines will need further updates as care evolves. The key recommendations are that bone pain or a palpable mass should always lead to further investigation and that patients with clinico-radiological findings suggestive of a primary bone tumour at any site in the skeleton should be referred to a specialist centre and managed by a fully accredited bone sarcoma multidisciplinary team. Treatment recommendations are provided for the major tumour types and for localised, metastatic and recurrent disease. Follow up schedules are suggested.
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Affiliation(s)
- Craig Gerrand
- />Newcastle upon Tyne Hospitals NHS Foundation Trust, Freeman Hospital, Newcastle upon Tyne, NE7 7DN UK
| | | | | | - Robert Grimer
- />Royal Orthopaedic Hospital, Birmingham, B31 2AP UK
| | | | - Bruce Morland
- />Birmingham Children’s Hospital, Birmingham, B4 6NH UK
| | - David Peake
- />Queen Elizabeth Hospital, Birmingham, B15 2TH UK
| | | | | | - On behalf of the British Sarcoma Group
- />Newcastle upon Tyne Hospitals NHS Foundation Trust, Freeman Hospital, Newcastle upon Tyne, NE7 7DN UK
- />Nuffield Orthopaedic Centre, Oxford, OX3 7LD UK
- />Royal Manchester Children’s Hospital, Manchester, M13 9WL UK
- />Royal Orthopaedic Hospital, Birmingham, B31 2AP UK
- />The Royal Marsden, Sutton, SM2 5PT UK
- />Birmingham Children’s Hospital, Birmingham, B4 6NH UK
- />Queen Elizabeth Hospital, Birmingham, B15 2TH UK
- />University College Hospital, London, NW1 2PG UK
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Werier J, Yao X, Caudrelier JM, di Primio G, Ghert M, Gupta AA, Kandel R, Verma S. Evidence-based guideline recommendations on treatment strategies for localized Ewing's sarcoma of bone following neo-adjuvant chemotherapy. Surg Oncol 2016; 25:92-7. [PMID: 27312034 DOI: 10.1016/j.suronc.2016.03.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Revised: 03/14/2016] [Accepted: 03/16/2016] [Indexed: 11/30/2022]
Abstract
OBJECTIVES (1) To provide recommendations regarding the choice of surgery, radiation therapy (RT), or the combination of surgery plus RT in patients with localized Ewing's sarcoma of bone following neoadjuvant chemotherapy. (2) To determine the appropriate surgical planning imaging (pre-chemotherapy magnetic resonance imaging [MRI] or post-chemotherapy MRI) to identify optimal resection margins in patients with localized Ewing's sarcoma who undergo surgery following neoadjuvant chemotherapy. METHODS MEDLINE, EMBASE, the Cochrane Library (1999 to February 2015), main guideline websites, and relevant annual meeting abstracts (2012 to January 2015) were searched. Internal and external reviews were conducted. RECOMMENDATIONS 1. Recommendation (1) - In patients with localized Ewing's sarcoma of bone following neoadjuvant chemotherapy: (a) Surgery alone or RT alone are two reasonable treatment options; the combination of surgery plus RT is not recommended as an initial treatment option. (b) The local treatment for an individual patient should be decided by a multidisciplinary tumour board together with the patient after consideration of the following: (1) patient characteristics (e.g., age, tumour location, tumour size, response to neoadjuvant chemotherapy, and existing comorbidities), (2) the potential benefit weighed against the potential complications from surgery and/or toxicities associated with RT, and (3) patient preferences. 2. Recommendation (2) - In patients with localized Ewing's sarcoma who will undergo surgery: (a) Both pre-chemotherapy and post-chemotherapy MRI scans should be taken into consideration for surgical planning. In certain anatomic locations with good chemotherapy response, the post-chemotherapy MRI may be the appropriate imaging modality to plan surgical resection margins.
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Affiliation(s)
- Joel Werier
- The Ottawa Hospital Regional Cancer Centre, Ottawa, Ontario, Canada.
| | - Xiaomei Yao
- Cancer Care Ontario, Program in Evidence-Based Care, McMaster University, Hamilton, Ontario, Canada.
| | | | - Gina di Primio
- St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
| | | | - Abha A Gupta
- The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Rita Kandel
- Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Shailendra Verma
- The Ottawa Hospital Regional Cancer Centre, Ottawa, Ontario, Canada
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Werier J, Yao X, Caudrelier JM, Di Primio G, Ghert M, Gupta AA, Kandel R, Verma S. A systematic review of optimal treatment strategies for localized Ewing's sarcoma of bone after neo-adjuvant chemotherapy. Surg Oncol 2016; 25:16-23. [DOI: 10.1016/j.suronc.2015.11.002] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Accepted: 11/03/2015] [Indexed: 10/22/2022]
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D’Andrea FP, Safwat A, Kassem M, Gautier L, Overgaard J, Horsman MR. Cancer stem cell overexpression of nicotinamide N-methyltransferase enhances cellular radiation resistance. Radiother Oncol 2011; 99:373-8. [DOI: 10.1016/j.radonc.2011.05.086] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2011] [Revised: 05/26/2011] [Accepted: 05/27/2011] [Indexed: 12/29/2022]
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Grimer R, Athanasou N, Gerrand C, Judson I, Lewis I, Morland B, Peake D, Seddon B, Whelan J. UK Guidelines for the Management of Bone Sarcomas. Sarcoma 2010; 2010:317462. [PMID: 21253474 PMCID: PMC3022187 DOI: 10.1155/2010/317462] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2010] [Accepted: 10/20/2010] [Indexed: 12/29/2022] Open
Abstract
These guidelines have been developed in order to provide an overview and a set of broad-based key recommendations for the management of patients with bone sarcomas in the UK. They have taken into consideration the most up-to-date scientific literature along with the recent recommendations by the European Society of Medical Oncology. The principles of the NICE guidance on both "improving outcomes for patients with sarcomas" and "improving outcomes with children and young people with cancer" have been incorporated. As care evolves, it is acknowledged that these guidelines will need updating. The key recommendations are that bone pain or a palpable mass should always lead to further investigation and patients with clinicoradiological findings suggestive of a primary bone tumour should be sent to a reference centre. Patients should then have their care managed at such a specialist centre by a fully accredited multidisciplinary team.
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Puri A, Gulia A, Agarwal MG, Jambhekar NA, Laskar S. Extracorporeal irradiated tumor bone: A reconstruction option in diaphyseal Ewing's sarcomas. Indian J Orthop 2010; 44:390-6. [PMID: 20924479 PMCID: PMC2947725 DOI: 10.4103/0019-5413.69310] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Limb salvage in extremity tumors is now established as an oncologically safe option without compromising long-term survival. En bloc resection followed by extracorporeal radiation and reimplantation is a biological reconstruction option in diaphyseal Ewing's sarcomas. We analyzed the results of 12 cases of diaphyseal Ewing's sarcomas treated using this modality. MATERIALS AND METHODS Between March 2006 and March 2008, 12 patients with Ewing's sarcoma underwent enbloc resection and reconstruction, with reimplantation of the sterilized tumor bone, after extracorporeal irradiation. There were eight males and four females, with a mean age of 14 years (range 2 to 22 years). The femur was the most common bone involved (n=8) followed by the tibia and the humerus (two cases each). All these patients were non-metastatic at presentation and received chemotherapy as per the existing hospital protocol. The mean length of the bone resected was 20 cm (range 11 to 25 cm). The specimen was irradiated with 50 Gy prior to reimplantation and stabilized with the host bone, using suitable internal fixation. Standard biplanar radiographs were assessed for evidence of union on the follow-up visits. The functional status was assessed using the Musculoskeletal Tumor Society Scoring system at the time of the last follow up. The mean follow up duration was 29 months (range 12 to 57 months). RESULTS Two patients (17%) had early infection with graft removal, hence are excluded from any analysis of union, however they are included when analysing complications such as infection. Rest 10 cases were analyzed for bony union at the osteotomy sites. Sixteen (84%) of the 19 osteotomy sites united primarily, without any intervention. Implant failure and non-union was seen at three diaphyseal osteotomy sites. The average time for union of all osteotomy sites was 7.2 months (range 3 to 13 months).The average time for union of the metaphyseal osteotomy sites was 5.9 months (range 3 to 12 months) and of diaphyseal osteotomy sites was 8.3 months (range 4 to 13 months). The mean Musculoskeletal Tumor Society Score was 27 (range 19 to 30) with a mean of 27. Nine of the ten patients with lower limb involvement were independent ambulators without additional aids. At the time of the last review, six patients were free of disease and six patients had died from the disease. There were two recurrences around the operative site. Both were associated with disseminated disease and in both the recurrences were in the soft tissue, away from the irradiated graft. CONCLUSION Extracorporeal irradiation is a useful, convenient technique for limb salvage in diaphyseal Ewing's sarcomas when there is reasonable residual bone stock. It is oncologically safe and has good functional results. A radiation dose of 50 Gy for sterilizing the bone ensures adequate tumor kill, while minimizing the deleterious effects on the biomechanical and biological properties of the bone. The use of appropriate implants for adequate internal fixation and supplementary bone grafting at the index surgery may help reduce the need for subsequent additional interventions to achieve union. The limitations of this procedure are that it is not applicable in tumor bones that are structurally weak and in bones with pathological fractures.
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Affiliation(s)
- Ajay Puri
- Department of Orthopedic Oncology, Tata Memorial Hospital, Mumbai, India,Address for correspondence: Dr. Ajay Puri, Associate Professor, Department of Orthopedic Oncology, Room No: 26, Tata Memorial Hospital, E. Borges Road, Parel, Mumbai - 400 012, India. E-mail:
| | - Ashish Gulia
- Department of Orthopedic Oncology, Tata Memorial Hospital, Mumbai, India
| | - MG Agarwal
- Department of Orthopedic Oncology, Tata Memorial Hospital, Mumbai, India
| | - NA Jambhekar
- Department of Pathology, Tata Memorial Hospital, Mumbai, India
| | - S Laskar
- Department of Radiation Oncology, Tata Memorial Hospital, Mumbai, India
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