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Lenga P, Dao Trong P, Kleineidam H, Unterberg AW, Krieg SM, Ishak B. Advances in the multidisciplinary surgical approach to primary spinal sarcomas: insights from a retrospective case series on outcomes and survival. Acta Neurochir (Wien) 2024; 166:326. [PMID: 39105874 DOI: 10.1007/s00701-024-06199-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2024] [Accepted: 07/15/2024] [Indexed: 08/07/2024]
Abstract
INTRODUCTION The management of spinal sarcomas is complex, given their widespread involvement and high recurrence rates. Despite consensus on the need for a multidisciplinary approach with surgery at its core, there is a lack of definitive guidelines for clinical decision-making. This study examines a case series of primary spinal sarcomas, focusing on the surgical strategies, clinical results, and survival data to inform and guide therapeutic practices. METHODS We conducted a retrospective analysis of patients who underwent surgical resection for primary spinal sarcomas between 2005 and 2022. The study focused on gathering data on patient demographics, surgical details, postoperative complications, overall hospital stay, and mortality within 90 days post-surgery. RESULTS The study included 14 patients with a primary diagnosis of spinal sarcoma, with an average age of 48.6 ± 12.6 years. Chondrosarcoma emerged as the most common tumor type, representing 57.1% of cases, followed by Ewing sarcoma at 35.7%, and synovial sarcoma at 7.1%. Patients with chondrosarcoma were treated with en-bloc resection, while the patient with synovial sarcoma underwent intra-lesional excision and those with Ewing sarcoma received decompression and tumor debulking. Postoperative assessments revealed significant improvements in neurological conditions. Notably, functional status as measured by the Karnofski Performance Index (KPI), improved substantially post-surgery (from 61.4 to 80.0%) The mean follow-up was 34.9 ± 9.2 months. During this time period one patient experienced fatal bleeding after en-bloc resection complications involving the vena cava. None of the patient needed further surgery. CONCLUSIONS Our 16-year study offers vital insights into managing primary spinal sarcomas, showcasing the effectiveness of surgical intervention, particularly en-bloc resection. Despite their rarity and complexity, our multidisciplinary treatment approach yields improved outcomes and highlights the potential for refined surgical strategies to become standardized care in this challenging domain.
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Affiliation(s)
- Pavlina Lenga
- Department of Neurosurgery, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany.
- Medical Faculty of Heidelberg University, Heidelberg, Germany.
| | - Philip Dao Trong
- Department of Neurosurgery, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
- Medical Faculty of Heidelberg University, Heidelberg, Germany
| | - Helena Kleineidam
- Department of Neurosurgery, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
- Medical Faculty of Heidelberg University, Heidelberg, Germany
| | - Andreas W Unterberg
- Department of Neurosurgery, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
- Medical Faculty of Heidelberg University, Heidelberg, Germany
| | - Sandro M Krieg
- Department of Neurosurgery, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
- Medical Faculty of Heidelberg University, Heidelberg, Germany
| | - Basem Ishak
- Department of Neurosurgery, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
- Medical Faculty of Heidelberg University, Heidelberg, Germany
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Primary Sarcomas of the Spine: A Systematic Review and Pooled Data Analysis. Clin Spine Surg 2023:01933606-990000000-00125. [PMID: 36823708 DOI: 10.1097/bsd.0000000000001432] [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: 02/19/2022] [Accepted: 12/01/2022] [Indexed: 02/25/2023]
Abstract
STUDY DESIGN A systematic review of the literature and pooled data analysis of treatment outcomes of primary sarcomas of the spine. OBJECTIVE To examine the current literature and treatment options for primary sarcomas of the spine. SUMMARY OF BACKGROUND DATA A paucity of literature exists on treatment outcomes of primary sarcomas of the spine. MATERIALS AND METHODS Two authors searched PubMed to identify articles for review, and a pooled data analysis was performed to determine overall survival for each type of surgical resection on spine sarcomas. RESULTS In total, 1776 articles were identified, and 11 met our inclusion criteria for review. In chondrosarcoma, overall survival was significantly higher with en bloc excision when compared with piecemeal resection (HR for piecemeal resection: 4.11; 95% CI: 2.08-8.15). Subgroup analysis showed that the addition of radiation therapy after piecemeal excision increased overall survival to 60 months from 48 months with piecemeal excision alone. In osteosarcoma, there was no significant difference in overall survival between en bloc and piecemeal resection (HR for piecemeal resection: 1.76; 95% CI: 0.776-3.99). In Ewing's sarcoma, overall survival was significantly higher when a successful en bloc resection was achieved and coupled with chemotherapy and radiation therapy for local control (HR for piecemeal resection: 7.96; 95% CI: 2.12-20.1). Interestingly, when a successful en bloc resection could not be achieved, chemotherapy and radiation therapy alone had significantly higher survival than piecemeal resection (HR for piecemeal resection: 2.63; 95% CI: 1.01-6.84). A significantly higher number of local recurrences were associated with the piecemeal resection group in all types of spine sarcomas. CONCLUSION This review and pooled data seem to favor en bloc excision for local control as the treatment of choice in primary sarcomas of the spine.
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Wang J, Ni XZ, Yang ML, Huang X, Hou SM, Peng C, Cao JS, Liu TL. Prognostic factors and treatment outcomes of spinal osteosarcoma: Surveillance, epidemiology, and end results database analysis. Front Oncol 2023; 13:1083776. [PMID: 36937397 PMCID: PMC10014918 DOI: 10.3389/fonc.2023.1083776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Accepted: 02/10/2023] [Indexed: 03/05/2023] Open
Abstract
Objective Spinal osteosarcoma is a rare osseous neoplasm. The aim of this study is to make a comprehensive analysis of the demographic features, clinicopathologic characteristics and factors affecting prognosis of spinal osteosarcoma using the Surveillance, Epidemiology and End Results (SEER) database. Methods SEER data were reviewed to identify patients diagnosed with spinal osteosarcoma between 1975 and 2016 and determine their overall survival (OS) and disease-specifc survival (DSS). Univariate and multivariate analyses were performed using the Cox-regression proportional hazards model and Kaplan-Meier method. Results A total of 668 patients (53.1% males) with spinal osteosarcoma were identified. The mean age at diagnosis was 45.2 years, including 67.5% patients younger than 60 years. The median OS of these patients was 15 months, and the 5-year OS was 16.8%. Multivariate analysis showed that age ≥60 year (HR=2.271, p = 0.008), high grade (HR=1.323, p = 0.008), regional stage (HR=1.658, p = 0.017), metastasis stage (HR=3.045, p < 0.001) and no-surgery treatment (HR=1.761, p < 0.001) were adversely associated with OS; gender (HR=0.657, p = 0.044), tumor grade (HR=1.616, p = 0.006), tumor stage (HR=3.329, p = 0.011; HR=7.983, p < 0.001) and radiotherapy (HR=0.606, p = 0.031) were independent prognostic factors affecting DSS. Conclusion Based on SEER data analysis, male, high tumor grade, regional stage, metastasis stage and radiotherapy are independent predictors of poor survival of patients with spinal osteosarcoma. The clinical treatment of spinal osteosarcoma still faces serious challenges. Future research should focus on the clinical impact and survival outcomes of the emerging targeted and immune therapies for the sake of improving the survival stalemate of spinal osteosarcoma.
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Carballo Cuello CM, De Jesus O, de Jesús Espinosa A, Fernández-de Thomas RJ, Murray G, Pastrana EA. Prognosis and Outcome of Cervical Primary Extraosseous Intradural Extramedullary Ewing Sarcoma: A Systematic Review. Cureus 2022; 14:e26665. [PMID: 35959190 PMCID: PMC9360665 DOI: 10.7759/cureus.26665] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/08/2022] [Indexed: 01/08/2023] Open
Abstract
Primary spinal extraosseous Ewing sarcoma (ES) is a rare mesenchymal tumor characterized by high malignancy, occurring in a few patients with ES. The occurrence of this tumor in the intradural extramedullary spinal region is infrequent. This systematic review examines primary extraosseous intradural extramedullary ES in the cervical region to provide specific outcomes and evaluate the role of adjuvant chemoradiation in overall prognosis. A systematic review was conducted to identify all cervical primary extraosseous intradural extramedullary ES reported in the literature. The search included the databases of PubMed, Google Scholar, Medline, Embase, and Scopus from inception to June 2021. Inclusion criteria include a reported death outcome or a minimum one-year follow-up. Our search retrieved 21 articles that involved the cervical spine, but only 11 cases met the inclusion criteria. Of the nine patients who demonstrated disease progression, six experienced local failure, two had distant craniospinal axis failure, and one had systemic metastases. Five patients died of the disease at a median of 11 months after diagnosis. Our analysis showed a one-, two-, and five-year progression-free survival (PFS) of 36.4%, 36.4%, and 12.1%, respectively. The one-, two-, and five-year overall survival rates were 72.7%, 62.3%, and 46.8%, respectively. Three of the five (60%) patients who died received craniospinal radiotherapy. Of the six patients who survived, two received craniospinal radiotherapy (33%), and one received whole spine radiotherapy (17%). This review showed that patients with cervical primary extraosseous intradural extramedullary ES had poor progression-free survival and overall survival rates. The addition of adjunct craniospinal radiotherapy did not improve the prognosis of these patients.
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Meazza C, Luksch R, Luzzati A. Managing axial bone sarcomas in childhood. Expert Rev Anticancer Ther 2021; 21:747-764. [PMID: 33593222 DOI: 10.1080/14737140.2021.1891886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Introduction: Axial osteosarcoma and Ewing sarcoma are rare, aggressive neoplasms with a worse prognosis than with tumors involving the extremities because they are more likely to be associated with larger tumor volumes, older age, primary metastases, and a poor histological response to chemotherapy. The 5-year OS rates are reportedly in the range of 18-41% for axial osteosarcoma, and 46-64% for Ewing sarcoma.Area covered: The treatment of axial bone tumors is the same as for extremity bone tumors, and includes chemotherapy, surgery and/or radiotherapy.Expert opinion: Local treatment of axial tumors is particularly difficult due to their proximity to neurological and vascular structures, which often makes extensive and en bloc resections impossible without causing significant morbidity. The incidence of local relapse is consequently high, and this is the main issue in the treatment of these tumors. Radiotherapy is an option in the case of surgical resections with close or positive margins, as well as for inoperable tumors. Delivering high doses of RT to the spinal cord can be dangerous. Given the complexity and rarity of these tumors, it is essential for this subset of patients to be treated at selected reference institutions with specific expertise and multidisciplinary skills.
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Affiliation(s)
- Cristina Meazza
- Pediatric Oncology Unit, Medical Oncology and Emathology Department, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milano, Italy
| | - Roberto Luksch
- Pediatric Oncology Unit, Medical Oncology and Emathology Department, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milano, Italy
| | - Alessandro Luzzati
- Orthopedic Oncology and Spinal Reconstruction Surgery, Orthopedic Oncology Department, IRCCS Istituto Ortopedico Galeazzi, Milano, Italy
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Wei H, Dong C, Wu J, Zhu Y, Ma H. Total en bloc spondylectomy combined with the satellite rod technique for spinal tumors. J Orthop Surg Res 2020; 15:536. [PMID: 33198816 PMCID: PMC7670808 DOI: 10.1186/s13018-020-02058-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Accepted: 11/02/2020] [Indexed: 12/13/2022] Open
Abstract
Background Instrumentation failure (IF) is a common complication after total en bloc spondylectomy (TES) in spinal tumors. This study aims to evaluate the clinical outcomes of TES combined with the satellite rod technique for the treatment of primary and metastatic spinal tumors. Methods The clinical data of 15 consecutively treated patients with spinal tumors who underwent TES combined with the satellite rod technique by a single posterior approach from June 2015 to September 2018 were analyzed retrospectively. Radiographic parameters including the local kyphotic angle (LKA), anterior vertebral height (AVH), posterior vertebral height (PVH), and intervertebral titanium mesh cage height (ITMCH) were assessed preoperatively, postoperatively, and at the final follow-up. The visual analog scale (VAS), Oswestry Disability Index (ODI), and American Spinal Injury Association (ASIA) scale were used to assess quality of life and neurological function. The operative duration, volume of blood loss, and complications were also recorded. Results The mean operation time and volume of blood loss were 361.7 min and 2816.7 mL, respectively. During an average follow-up of 31.1 months, 2 patients died of tumor recurrence and multiple organ metastases, while recurrence was not found in any other patients. Solid fusion was achieved in all but one patient, and no implant-related complications occurred during the follow-up. The VAS, ODI, and ASIA scores significantly improved from before to after surgery (P < 0.05). The LKA, AVH, and PVH significantly improved from before to immediately after surgery and to the final follow-up (P < 0.05), and the postoperative and final follow-up values did not significantly differ (P > 0.05). Conclusions TES combined with the satellite rod technique can yield strong three-dimensional fixation and reduce the occurrence of rod breakage, thereby improving the long-term quality of life of patients with spinal tumors.
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Affiliation(s)
- Hongyu Wei
- Department of Orthopaedic Surgery, China-Japan Friendship Hospital, 2 Yinghuadong Road, Chaoyang District, Beijing, 100029, China.
| | - Chunke Dong
- Department of Orthopaedic Surgery, China-Japan Friendship Hospital, 2 Yinghuadong Road, Chaoyang District, Beijing, 100029, China.,Beijing University of Chinese Medicine, 11 North Third Ring East Road, Chaoyang District, Beijing, 100029, China
| | - Jun Wu
- Department of Orthopaedic Surgery, People's Hospital of Ningxia Hui Autonomous Region, 301 Zhengyuan North Street, Jinfeng District, Yingchuan, 750002, China
| | - Yuting Zhu
- Beijing Tongzhou Integrative Medicine Hospital, 89 Chezhan Road, Tongzhou District, Beijing, 101100, China
| | - Haoning Ma
- Department of Orthopaedic Surgery, China-Japan Friendship Hospital, 2 Yinghuadong Road, Chaoyang District, Beijing, 100029, China
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Oliveira C, Vital L, Serdoura F, Pinho AR, Veludo V. Spondylectomy for Primary Ewing Lumbar Sarcoma in Children. Rev Bras Ortop 2020; 55:649-652. [PMID: 33093732 PMCID: PMC7575362 DOI: 10.1016/j.rboe.2017.10.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Accepted: 10/19/2017] [Indexed: 11/16/2022] Open
Abstract
Primary Ewing sarcoma in the spine is very rare, and the treatment for it is multidisciplinary. There is no consensus regarding the optimal method of local control; however, en bloc resection is associated with an improvement in survival rates. The authors report a case of a 5-year-old girl who initially presented low back pain, and was diagnosed with Ewing sarcoma after being submitted to imaging studies by radiography, magnetic resonance and bone biopsy. A spondylectomy was performed in accordance with the Euro Ewing protocol. At the three-year follow-up, the patient had no restrictions regarding her daily activities, and there has been no evidence of recurrence to date.
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Affiliation(s)
- Carolina Oliveira
- Department of Orthopedic Surgery, Unidade Local de Saúde do Alto Minho, Viana do Castelo, Portugal
| | - Luísa Vital
- Department of Orthopedic Surgery, Hospital de São João, Faculdade de Medicina, Universidade do Porto, Porto, Porto, Portugal
| | - Francisco Serdoura
- Department of Orthopedic Surgery, Hospital de São João, Faculdade de Medicina, Universidade do Porto, Porto, Porto, Portugal
| | - André Rodrigues Pinho
- Department of Orthopedic Surgery, Hospital de São João, Faculdade de Medicina, Universidade do Porto, Porto, Porto, Portugal
| | - Vitorino Veludo
- Department of Orthopedic Surgery, Hospital de São João, Faculdade de Medicina, Universidade do Porto, Porto, Porto, Portugal
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González ÁS. TUMORES PRIMARIOS DE LA COLUMNA VERTEBRAL: SOSPECHA, LINEAMIENTOS TERAPÉUTICOS Y NUEVAS TECNOLOGÍAS. REVISTA MÉDICA CLÍNICA LAS CONDES 2020. [DOI: 10.1016/j.rmclc.2020.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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9
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Sofulu Ö, Erol B. Evaluation of factors affecting survival rate in primary bone sarcomas with extremity and pelvis involvement. ACTA ORTHOPAEDICA ET TRAUMATOLOGICA TURCICA 2020; 54:234-244. [PMID: 32544060 DOI: 10.5152/j.aott.2020.03.79] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE This study is an evaluation of the overall survival rate and factors affecting survival in patients with osteosarcoma, chondrosarcoma, or Ewing's sarcoma. This study aimed to determine the effect of factors related to the preoperative period, patient, tumor, treatment, and postoperative period on survival. METHODS A total of 114 patients (64 male and 50 female) with osteosarcoma, chondrosarcoma, or Ewing's sarcoma treated between 2005 and 2013 were included in this study. All the patients received standard treatment and were followed up regularly. In all, 44 cases of (conventional and telangiectatic) osteosarcoma, 30 cases of Ewing's sarcoma, and 40 cases of high-grade chondrosarcoma were identified using the Bone and Soft Tissue Tumor Registry. Gender, age, tumor size and localization, pathological fractures, histopathological type, grade, surgical treatment, adjuvant treatments, relapse of the disease, and postoperative complication data were obtained from follow-up forms. The learning curve of institutional expertise was also evaluated. The patient survival rate was calculated using the Kaplan-Meier method, and log-rank statistical methods were used to compare survival rates. RESULTS The mean length of survival of the patients was 72 months. There was a 56% 5-year survival rate, and the event-free survival rate was 53%. The survival of patients with Ewing's sarcoma whose prodromal period was less than 12 weeks was significantly higher than that of the other groups (p=0.031). The survival of patients with tumor size greater than 150 cc, with local recurrence and distant metastases was low for all groups. Survival rates were significantly lower in osteosarcoma and Ewing's sarcoma patients with stage III tumor or metastasis at diagnosis. The survival of patients with osteosarcoma diagnosed between 2010 and 2013 was significantly higher than that of the earlier group (p=0.02). CONCLUSION Decreasing the prodromal period (early diagnosis) can improve survival by preventing the local and systemic spread of the tumor. Increase in the surgical experience is likely to have a positive effect on survival rates, especially for patients with osteosarcoma. The relapse of the disease is a poor prognostic factor for survival despite aggressive surgery and adjuvant therapies. LEVEL OF EVIDENCE Level IV, Therapeutic study.
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Affiliation(s)
- Ömer Sofulu
- Department of Orthopaedic Surgery and Traumatology, Marmara University, School of Medicine, İstanbul, Turkey
| | - Bülent Erol
- Department of Orthopaedic Surgery and Traumatology, Marmara University, School of Medicine, İstanbul, Turkey
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Duckett MM, Phung SK, Nguyen L, Khammanivong A, Dickerson E, Dusenbery K, Lawrence J. The adrenergic receptor antagonists propranolol and carvedilol decrease bone sarcoma cell viability and sustained carvedilol reduces clonogenic survival and increases radiosensitivity in canine osteosarcoma cells. Vet Comp Oncol 2019; 18:128-140. [PMID: 31778284 DOI: 10.1111/vco.12560] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Revised: 09/28/2019] [Accepted: 11/19/2019] [Indexed: 11/30/2022]
Abstract
Adrenergic receptor (AR) expression has been demonstrated at several sites of primary and metastatic tumour growth and may influence proliferation, survival, metastasis and angiogenesis. AR antagonists like propranolol and carvedilol inhibit proliferation, induce apoptosis and synergize with chemotherapy agents in some cancers. Radiation resistance is mediated in many cells by upregulation of pro-survival pathways, which may be influenced by ARs. Studies evaluating AR antagonists combined with radiation are limited. The purpose of this study was to determine the effect of propranolol and carvedilol on viability and radiosensitivity in sarcoma cell lines. The hypothesis was that propranolol and carvedilol would increase radiosensitivity in four primary bone sarcoma cell lines. Single agent propranolol or carvedilol inhibited cell viability in all cell lines in a concentration-dependent manner. The mean inhibitory concentrations (IC50 ) for carvedilol were approximately 4-fold lower than propranolol and may be clinically relevant in vivo. Immunoblot analysis confirmed AR expression in both human and canine sarcoma cell lines; however, there was no correlation between baseline AR protein expression and radiosensitivity. Short duration treatment with carvedilol and propranolol did not significantly affect clonogenic survival. Prolonged exposure to propranolol and carvedilol significantly decreased the surviving fraction of canine osteosarcoma cells after 3Gy radiation. Based on our results and possible in vivo activity in dogs, further studies investigating the effects of carvedilol on sarcoma are warranted.
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Affiliation(s)
- Megan M Duckett
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, University of Minnesota, St Paul, Minnesota
| | - Shee Kwan Phung
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, University of Minnesota, St Paul, Minnesota
| | - Linh Nguyen
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, University of Minnesota, St Paul, Minnesota
| | - Ali Khammanivong
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, University of Minnesota, St Paul, Minnesota.,Masonic Cancer Center, Masonic Cancer Research Building, University of Minnesota, Minneapolis, Minnesota
| | - Erin Dickerson
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, University of Minnesota, St Paul, Minnesota.,Masonic Cancer Center, Masonic Cancer Research Building, University of Minnesota, Minneapolis, Minnesota
| | - Kathryn Dusenbery
- Department of Radiation Oncology, Medical School, University of Minnesota, Minneapolis, Minnesota
| | - Jessica Lawrence
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, University of Minnesota, St Paul, Minnesota.,Masonic Cancer Center, Masonic Cancer Research Building, University of Minnesota, Minneapolis, Minnesota
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Tailored Posterior-Only Approach for C2 Vertebral Body Lesions: Our Surgical Experience in 10 Patients. World Neurosurg 2019; 133:e730-e738. [PMID: 31605844 DOI: 10.1016/j.wneu.2019.09.155] [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: 07/31/2019] [Revised: 09/26/2019] [Accepted: 09/27/2019] [Indexed: 11/20/2022]
Abstract
BACKGROUND C2 vertebral body (axis) lesions are often approached anteriorly and combined with posterior stabilization of the craniovertebral junction (CVJ). The anterior approach has its limitations. A posterolateral corridor is an alternative access to the C2 body lesions, and this alone may suffice in selected cases. We describe our experience with C2 body lesions, dealt primarily through a posterior approach, and propose an algorithm in the management of such cases. METHODS Ten patients with axis lesions were operated through a midline posterior approach followed by posterior stabilization of the CVJ in the same sitting. Their preoperative and follow-up clinico-radiologic details were reviewed. RESULTS The lesions included aneurysmal bone cysts (n = 2), fibrous dysplasia (n = 2), chordoma (n = 2), Ewing sarcoma (n = 1), metastases (n = 1), post-traumatic malunion (n = 1), and post-inflammatory deformity (n = 1). All patients presented with worsening neck pain. Five also had spastic quadriparesis. There were no perioperative complications. All showed clinical improvement at follow-up. Only 2 patients (chordoma: n = 1; aneurysmal bone cyst: n = 1) required an additional anterior procedure. CONCLUSIONS Adequate debulking or total excision of lesion, neural decompression, and stabilization of the CVJ for axis body lesions can be achieved through a single midline posterior approach in most cases. If required, an anterior approach may be later added depending on the final histopathology.
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Pombo B, Cristina Ferreira A, Cardoso P, Oliveira A. Clinical effectiveness of Enneking appropriate versus Enneking inappropriate procedure in patients with primary osteosarcoma of the spine: a systematic review with meta-analysis. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2019; 29:238-247. [PMID: 31410619 DOI: 10.1007/s00586-019-06099-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Revised: 06/28/2019] [Accepted: 08/05/2019] [Indexed: 12/23/2022]
Abstract
PURPOSE Primary osteosarcoma of the spine is a rare osseous tumour. En bloc resection, in contrast to intralesional resection, is the only procedure able to provide Enneking appropriate (EA) margins, which has improved local control and survival of patients with primary osteosarcoma of the spine. The objective of this study is to compare the risk of local recurrence, metastases development and survival in patients with primary osteosarcoma of the spine submitted to Enneking appropriate (EA) and Enneking inappropriate (EI) procedures. METHODS A systematic search was performed on EBSCO, PubMed and Web of Science, between 1966 and 2018, to identify studies evaluating patients submitted to resection of primary osteosarcoma of the spine. Two reviewers independently assessed all reports. The outcomes were local recurrence, metastases development and survival at 12, 24 and 60 months. RESULTS Five studies (108 patients) were included for systematic review. These studies support the conclusion that EA procedure has a lower local recurrence rate (RR 0.33, 95% CI 0.17-0.66), a lower metastases development rate (RR 0.39, 95% CI 0.17-0.89) and a higher survival rate at 24 months (RR 1.78, 95% CI 1.24-2.55) and 60 months (RR 1.97, 95% CI 1.14-3.42) of follow-up; however, at 12 months, there is a non-significant difference. CONCLUSIONS EA procedure increases the ratio of remission and survival after 24 months of follow-up. Multidisciplinary oncologic groups should weigh the morbidity of an en bloc resection, knowing that in the first year the probability of survival is the same for EA and EI procedures. These slides can be retrieved under Electronic Supplementary Material.
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Affiliation(s)
- Bruno Pombo
- Orthopaedic Department, Centro Hospitalar Universitário do Porto, Porto, Portugal.
| | | | - Pedro Cardoso
- Orthopaedic Department, Centro Hospitalar Universitário do Porto, Porto, Portugal
- Instituto Ciências Biomédicas Abel Salazar, University of Porto, Porto, Portugal
| | - António Oliveira
- Orthopaedic Department, Centro Hospitalar Universitário do Porto, Porto, Portugal
- Instituto Ciências Biomédicas Abel Salazar, University of Porto, Porto, Portugal
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Zaldivar-Jolissaint JF, Bobinski L, Duff JM. Multilevel Pedicular Osteotomies for En Bloc Resection of a Primary Ewing Sarcoma of the Subaxial Cervical Spine with Pedicle Screw Reconstruction. World Neurosurg 2019; 132:303-308. [PMID: 31394361 DOI: 10.1016/j.wneu.2019.07.208] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Accepted: 07/28/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND Primary Ewing sarcoma of the mobile spine is a rare disease. Its management requires careful surgical planning, because radical, margin-free excision is directly correlated with prognosis. Extensive bone removal in the cervical spine can lead to instability and cause postoperative iatrogenic cervical deformity. Thus, spinal instrumentation plays an important role in restoring postresection spinal stability and improving quality of life. METHODS We present a novel technique that allows successful removal of a large Ewing sarcoma of the subaxial cervical spine, infiltrating and traversing the posterior bone elements, and extending into the paraspinal muscles. This technique involves radical en bloc resection of posteriorly located cervical tumors via multilevel pediculotomy, with terminal vertebrae pedicle screw reconstruction. RESULTS Terminal vertebrae cervical pedicle screw reconstruction allowed wide surgical excision with satisfactory oncologic and mechanical results. CONCLUSIONS This technique enables 1-stage total tumor resection and stabilization and may be a viable alternative to radical en bloc resection of posteriorly located epidural malignant lesions of the cervical spine in selected cases.
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Affiliation(s)
| | - Lukas Bobinski
- Spine Unit, Department of Orthopedic Surgery, University Hospital of Umea, Umea, Sweden
| | - John Michael Duff
- Neurosurgery Department, Clinique de Genolier, Genolier, Switzerland
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Pennington Z, Ahmed AK, Cottrill E, Westbroek EM, Goodwin ML, Sciubba DM. Systematic review on the utility of magnetic resonance imaging for operative management and follow-up for primary sarcoma-lessons from extremity sarcomas. ANNALS OF TRANSLATIONAL MEDICINE 2019; 7:225. [PMID: 31297390 DOI: 10.21037/atm.2019.01.59] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Primary sarcomas of the vertebral column affect roughly 5 in every million persons annually, of which half to one-third are malignant. Treatment of these lesions requires multimodal management, often employing attempts at en bloc resection of the lesion with negative margins. This may be facilitated using magnetic resonance imaging for preoperative margin planning, but current literature is lacking regarding the use of such imaging to accurately predict planned surgical margins. Here we review prior studies describing the use of magnetic resonance imaging for en bloc resection of sarcomas of the extremities to identify learning points for application to the treatment of spinal neoplasms. We conducted a systematic review of the PubMed and EMBASE literature. Included studies described the accuracy of MRI for preoperative evaluation of tumor margins, intraoperative guidance for en bloc resection, or post-operative evaluation of residual or recurrent disease. All included studies described patients treated for osseous or soft tissue sarcoma of the limbs. We found 1,705 unique references of which 27 met criteria for inclusion. Seven studies reported MR had an overall diagnostic accuracy of 93.6-96% for preoperative margin evaluation with non-contrast T1 most accurately reflecting true margins. In the nine articles reporting results of MR-guided resection, negative margins were achieved in 88.8-100% of cases with a closest margin of 2-4 mm. Eleven articles combined reported the accuracy of MR for residual disease or local recurrence, with a mean sensitivity and specificity of 71.7% and 79.3%, respectively for residual disease and 87.9% and 85.9%, respectively for local recurrence. The current literature for appendicular musculoskeletal sarcoma suggests that MR is highly accurate for defining tumor margins preoperatively, guiding osteotomy cuts intraoperatively, and documenting recurrence or residual disease. Further evidence is necessary to evaluate the degree to which it can accurately guide osteotomy planning for en bloc resection of vertebral primaries.
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Affiliation(s)
- Zach Pennington
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - A Karim Ahmed
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ethan Cottrill
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Erick M Westbroek
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Matthew L Goodwin
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Daniel M Sciubba
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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15
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Charest-Morin R, Fisher CG, Sahgal A, Boriani S, Gokaslan ZL, Lazary A, Reynolds J, Bettegowda C, Rhines LD, Dea N. Primary Bone Tumor of the Spine-An Evolving Field: What a General Spine Surgeon Should Know. Global Spine J 2019; 9:108S-116S. [PMID: 31157142 PMCID: PMC6512194 DOI: 10.1177/2192568219828727] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
STUDY DESIGN A narrative review of the literature. OBJECTIVE This article reviews the general principles of treatment and investigation for primary bone tumors of the spine. Furthermore, it explores the emerging alternatives. METHODS A review was performed using Medline, Embase, and Cochrane databases. RESULTS Primary bone tumors of the spine are rare entities that general spine surgeons may encounter only a few times in their career. The treatment algorithm of these complex tumors is filled with nuances and is evolving constantly. For these reasons, patients should be referred to experienced tertiary or quaternary centers who can offer a comprehensive multidisciplinary approach. For most malignant spinal bone tumors, surgery remains the cornerstone of treatment. Respecting oncologic principles has been associated with improved survival and decreased local recurrence in multiple settings. However, even in experienced centers, these surgeries carry a significant risk of adverse events and possible long-term neurologic impairment. The associated morbidity of these procedures and the challenges of local recurrence have encouraged professionals caring for these patients to explore alternatives or adjuncts to surgical treatment. CONCLUSIONS Over the past few years, several advances have occurred in medical oncology, radiation oncology and interventional radiology, changing the treatment paradigm for some tumors. Other advances still need to be refined before being applied in a clinical setting.
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Affiliation(s)
- Raphaële Charest-Morin
- University of British Columbia, Vancouver, British Columbia, Canada
- Vancouver General Hospital, Vancouver, British Columbia, Canada
| | - Charles G Fisher
- University of British Columbia, Vancouver, British Columbia, Canada
- Vancouver General Hospital, Vancouver, British Columbia, Canada
| | - Arjun Sahgal
- Sunnybrook Odette Cancer Center, Toronto, Ontario, Canada
- University of Toronto, Toronto, Ontario, Canada
| | | | - Ziya L Gokaslan
- The Warren Alpert Medical School of Brown University, Providence, RI, USA
- Rhode Island Hospital, Providence, RI, USA
- The Miriam Hospital, Providence, RI, USA
| | - Aron Lazary
- National Center for Spinal Disorders and Buda Health Center, Budapest, Hungary
| | | | | | | | - Nicolas Dea
- University of British Columbia, Vancouver, British Columbia, Canada
- Vancouver General Hospital, Vancouver, British Columbia, Canada
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16
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Berger GK, Nisson PL, James WS, Kaiser KN, Hurlbert RJ. Outcomes in different age groups with primary Ewing sarcoma of the spine: a systematic review of the literature. J Neurosurg Spine 2019; 30:664-673. [PMID: 30771777 DOI: 10.3171/2018.10.spine18795] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Accepted: 10/04/2018] [Indexed: 01/12/2023]
Abstract
OBJECTIVE Ewing sarcoma (ES) is among the most prevalent of bone sarcomas in young people. Less often, it presents as a primary lesion of the spine (5%-15% of patients with ES). METHODS A systematic literature search was performed, querying several scientific databases per PRISMA guidelines. Inclusion criteria specified all studies of patients with surgically treated ES located in the spine. Patient age was categorized into three groups: 0-13 years (age group 1), 14-20 years (age group 2), and > 21 (age group 3). RESULTS Eighteen studies were included, yielding 28 patients with ES of the spine. Sixty-seven percent of patients experienced a favorable outcome, with laminectomies representing the most common (46%) of surgical interventions. One-, 2-, and 5-year survival rates were 82% (n = 23), 75% (n = 21), and 57% (n = 16), respectively. Patients in age group 2 experienced the greatest mortality rate (75%) compared to age group 1 (9%) and age group 3 (22%). The calculated relative risk score indicated patients in age group 2 were 7.5 times more likely to die than other age groups combined (p = 0.02). CONCLUSIONS Primary ES of the spine is a rare, debilitating disease in which the role of surgery and its impact on one's quality of life and independence status has not been well described. This study found the majority of patients experienced a favorable outcome with respect to independence status following surgery and adjunctive treatment. An increased risk of recurrence and death was also present among the adolescent age group (14-20 years).
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Affiliation(s)
- Garrett K Berger
- 1College of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | | | - Whitney S James
- 3Division of Neurosurgery, High Desert Surgery Center, Prescott, Arizona
| | - Kristen N Kaiser
- 1College of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - R John Hurlbert
- 4Division of Neurosurgery, University of Arizona, Tucson; and
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Paraskeva K, Giakoumettis D, Nikas I, Georgoulis G, Sfakianos G, Themistocleous MS. Primary Ewing sarcoma of the axis-C2: A case report and the review of the literature. Neurol Neurochir Pol 2018; 52:534-542. [DOI: 10.1016/j.pjnns.2018.02.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2017] [Revised: 02/23/2018] [Accepted: 02/25/2018] [Indexed: 12/12/2022]
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Ewing Sarcoma of the Spine: Prognostic Variables for Survival and Local Control in Surgically Treated Patients. Spine (Phila Pa 1976) 2018; 43:622-629. [PMID: 28837533 DOI: 10.1097/brs.0000000000002386] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Multicenter, ambispective observational study. OBJECTIVE To quantify mortality and local recurrence after surgical treatment of spinal Ewing sarcoma (ES) and to determine whether an Enneking appropriate procedure and surgical margins (en bloc resection with wide/marginal margins) are associated with improved prognosis. SUMMARY OF BACKGROUND DATA Treatment of primary ES of the spine is complex. Ambiguity remains regarding the role and optimal type of surgery in the treatment of spinal ES. METHODS The AOSpine Knowledge Forum Tumor developed a multicenter database including demographics, diagnosis, treatment, mortality, and recurrence rate data for spinal ES. Patients were stratified based on surgical margins and Enneking appropriateness. Survival and recurrence were analyzed using Kaplan-Meier curves and log-rank tests. RESULTS Fifty-eight patients diagnosed with primary spinal ES underwent surgery. Enneking appropriateness of surgery was known for 55 patients; 24 (44%) treated Enneking appropriately (EA) and 31 (56%) treated Enneking inappropriately (EI). A statistically significant difference in favor of EA-treated patients was found with regards to survival (P = 0.034). Neoadjuvant and postoperative chemotherapy was significantly associated with increased survival (P = 0.008). Local recurrence occurred in 22% (N = 5) of patients with an EA procedure versus 38% (N = 11) of patients with an EI procedure. The timing of chemotherapy treatment was significantly different between the Enneking cohorts (P < 0.001) and all EA-treated patients received chemotherapy treatment. Although, local recurrence was not significantly different between Enneking cohorts (P = 0.140), intralesional surgical margins and patients who received a previous spine tumor operation were associated with increased local recurrence (P = 0.025 and P = 0.018, respectively). CONCLUSION Surgery should be undertaken when an en bloc resection with wide/marginal margins is feasible. An EA surgery correlates with improved survival, but the impact of other prognostic factors needs to be evaluated. En bloc resection with wide/marginal margins is associated with local control. LEVEL OF EVIDENCE 3.
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Image-Guided Lateral Mass Osteotomy for En Bloc Resection of Cervical Ewing Sarcoma: A Technical Note. World Neurosurg 2017; 104:628-633. [DOI: 10.1016/j.wneu.2017.05.071] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2017] [Revised: 05/09/2017] [Accepted: 05/11/2017] [Indexed: 11/22/2022]
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Arshi A, Sharim J, Park DY, Park HY, Yazdanshenas H, Bernthal NM, Shamie AN. Prognostic determinants and treatment outcomes analysis of osteosarcoma and Ewing sarcoma of the spine. Spine J 2017; 17:645-655. [PMID: 27856382 PMCID: PMC5561729 DOI: 10.1016/j.spinee.2016.11.002] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Revised: 10/26/2016] [Accepted: 11/09/2016] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Osteosarcoma (OGS) and Ewing sarcoma (EWS) are the two classic primary malignant bone tumors. Due to the rarity of these tumors, evidence on demographics, survival determinants, and treatment outcomes for primary disease of the spine are limited and derived from small case series. PURPOSE To use population-level data to determine the epidemiology and prognostic indicators in patients with OGS and EWS of the osseous spine. STUDY DESIGN/SETTING Large-scale retrospective study. PATIENT SAMPLE Patients diagnosed with OGS and EWS of the spine in the Surveillance, Epidemiology, and End Results (SEER) registry from 1973 to 2012. OUTCOME MEASURES Overall survival (OS) and disease-specific survival (DSS). METHODS Two separate queries of the SEER registry were performed to identify patients with OGS and EWS of the osseous spine from 1973-2012. Study variables included age, sex, race, year of diagnosis, tumor size, extent of disease (EOD), and treatment with surgery and/or radiation therapy. Primary outcome was defined as OS and DSS in months. Univariate survival analysis was performed using the Kaplan-Meier method and the log-rank test. Multivariate analysis was performed using Cox proportional hazards regression models. RESULTS The search identified 648 patients with primary OGS and 736 patients with primary EWS of the spine from 1973 to 2012. Mean age at diagnosis was 48.1 and 19.9 years for OGS and EWS, respectively, with OGS showing a bimodal distribution. The median OS and DSS were 1.3 and 1.7 years, respectively, for OGS, with OGS in Paget's disease having worse OS (0.7 years) relative to the mean (log-rank p=.006). The median OS and DSS for EWS were 3.9 and 4.3 years, respectively. Multivariate cox regression analysis showed that age (OS p<.001, DSS p<.001), decade of diagnosis (OS p=.049), surgical resection (OS p<.001, DSS p<.001), and EOD (OS p<.001, DSS p<.001) were independent positive prognostic indicators for spinal OGS; radiation therapy predicted worse OS (hazard ratio [HR] 1.48, confidence interval [CI] 1.05-2.10, p=.027) and DSS (HR 1.74, CI 1.13-2.66, p=.012) for OGS. For EWS, age (OS p<.001, DSS p<.001), surgical resection (OS p=.030, DSS p=.046), tumor size (OS p<.001, DSS p<.001), and EOD (OS p<.001, DSS p<.001) were independent determinants of improved survival; radiation therapy trended toward improved survival but did not achieve statistical significance for both OS (HR 0.76, CI 0.54-1.07, p=.113) and DSS (0.76, CI 0.54, 1.08, p=.126). CONCLUSIONS Age, surgical resection, and EOD are key survival determinants for both OGS and EWS of the spine. Radiation therapy may be associated with worse outcomes in patients with OGS, and is of potential benefit in EWS. Overall prognosis has improved in patients with OGS of the spine over the last four decades.
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Affiliation(s)
| | | | | | | | | | | | - Arya N. Shamie
- Corresponding author. Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, 1250 16th Street, Suite 3145D, Santa Monica, CA 90404, USA. Tel.: +1 (310) 440 2999; fax: +1 (310) 601 1869. (A.N. Shamie)
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Goedhart LM, Gerbers JG, Ploegmakers JJW, Jutte PC. Delay in Diagnosis and Its Effect on Clinical Outcome in High-grade Sarcoma of Bone: A Referral Oncological Centre Study. Orthop Surg 2017; 8:122-8. [PMID: 27384720 DOI: 10.1111/os.12239] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2015] [Accepted: 03/21/2016] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To investigate delay in diagnosis by both patients and doctors, and to evaluate its effect on outcomes of high-grade sarcoma of bone in a single-referral oncological center. METHODS Fifty-four patients with osteosarcoma, 29 with Ewing sarcoma and 19 with chondrosarcoma were enrolled in this retrospective study. Delay in diagnosis was defined as the period between initial clinical symptoms and histopathological diagnosis at our center. The delays were categorized as patient- or doctor-related. Short total delays were defined as <4 months; prolonged delays >4 months were assumed to have prognostic relevance. RESULTS Total delay in diagnosis was 688.0 days in patients with chondrosarcoma, which is significantly longer than the 163.3 days for osteosarcoma (P < 0.01) and 160.2 days for Ewing sarcoma (P < 0.01). Most doctor-related delays were at the pre-hospital stage, occurring at the general practitioner (GP)'s office. However, prolonged total delays (≥4 months) did not result in lower survival rates. Five-year-overall survival rates were 67.0% for osteosarcoma, 49.0% for Ewing sarcoma and 60.9% for chondrosarcoma. Survival was significantly lower for patients with metastatic disease for all three types of sarcoma. CONCLUSION Prolonged delay in diagnosis does not result in lower survival. Metastatic disease has a pronounced effect on survival. Aggressive tumor behavior results in shorter delays. Minimizing GP-related delays could be achieved by adopting a lower threshold for obtaining plain radiographs at the pre-hospital stage.
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Affiliation(s)
- Louren M Goedhart
- Department of Orthopaedics, University Medical Center, University of Groningen, Groningen, The Netherlands
| | - Jasper G Gerbers
- Department of Orthopaedics, University Medical Center, University of Groningen, Groningen, The Netherlands
| | - Joris J W Ploegmakers
- Department of Orthopaedics, University Medical Center, University of Groningen, Groningen, The Netherlands
| | - Paul C Jutte
- Department of Orthopaedics, University Medical Center, University of Groningen, Groningen, The Netherlands
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22
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Dea N, Gokaslan Z, Choi D, Fisher C. Spine Oncology – Primary Spine Tumors. Neurosurgery 2017; 80:S124-S130. [DOI: 10.1093/neuros/nyw064] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Accepted: 11/10/2016] [Indexed: 01/12/2023] Open
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23
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Luzzati A, Scotto G, Perrucchini G, Baaj AA, Zoccali C. Salvage Revision Surgery After Inappropriate Approach for Primary Spine Tumors: Long Term Follow-Up in 56 Cases. World Neurosurg 2017; 98:329-333. [DOI: 10.1016/j.wneu.2016.11.043] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2016] [Revised: 11/04/2016] [Accepted: 11/07/2016] [Indexed: 11/28/2022]
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24
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Sacral Osteoneogenesis after Complete Sacrectomy in a Patient with Ewing Sarcoma. Case Rep Orthop 2017. [PMID: 29527369 PMCID: PMC5748121 DOI: 10.1155/2017/7824687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Ewing sarcomas are the second most common primary malignant bone tumors in childhood and adolescence which rapidly metastasize. Due to improvement of treatment options in recent years, the survival rate has significantly increased. Nevertheless, lethality is still high, and neurologic symptoms are frequent. To the best of our knowledge, this is the first reported case of a sacral osteoneogenesis after complete sacrectomy in a patient with Ewing sarcoma.
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25
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Optimizing the Adverse Event and HRQOL Profiles in the Management of Primary Spine Tumors. Spine (Phila Pa 1976) 2016; 41 Suppl 20:S212-S217. [PMID: 27753783 DOI: 10.1097/brs.0000000000001821] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Systematic literature review. OBJECTIVE To investigate if evidence-based principles of oncologic resection for primary spinal tumors are correlated with an acceptable morbidity and mortality profile and satisfactory health-related quality of life (HRQOL) measures. SUMMARY OF BACKGROUND DATA Respecting oncologic principles for primary spinal tumor surgery is correlated with lower recurrence rates. These interventions are, however, often highly morbid. METHODS A systematic literature review was performed to address the objectives by searching MEDLINE and EBMR databases. Articles that met our inclusion criteria were reviewed. GRADE guidelines were used for recommendation formulation. RESULTS A total of 25 articles addressing the morbidity and mortality profile of primary spinal tumor surgery were identified. For sacral tumors, complication rates of up to 100% have been reported and complication-related death ranged from 0% to 27%. Mobile spine tumor complication rates varied from 13% to 73.7% and complication-related death ranged from 0% to 7.7%. Seven articles examining HRQOL for this patient population were identified. The limited literature showed comparable patient HRQOL profiles to those with benign conditions such as degenerative disc disease. CONCLUSION Respecting oncologic principles for primary spinal tumors are correlated with high adverse event rates. We recommend that primary spinal tumor surgeries be performed in experienced centers with multidisciplinary support teams and that prospective adverse event collection be promoted (strong recommendation/very low certainty of the evidence). Oncologic resection of primary tumors of the spine is associated with HRQOL that more closely approximates normative values with increasing duration of follow-up, but decreases with disease recurrence. We recommend primary spinal tumor surgery be performed with a curative intent whenever possible, even at the expense of greater initial morbidity to optimize long-term HRQOL (strong recommendation/very low certainty of the evidence). LEVEL OF EVIDENCE N/A.
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26
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Chihak MA, Ahmed SK, Lachance DH, Nageswara Rao AA, Laack NN. Patterns of failure and optimal radiotherapy target volumes in primary intradural extramedullary Ewing sarcoma. Acta Oncol 2016; 55:1057-61. [PMID: 27050758 DOI: 10.3109/0284186x.2016.1150605] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Melanie A. Chihak
- Division of Pediatric Hematology/Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - Safia K. Ahmed
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | | | | | - Nadia N. Laack
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota, USA
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Sciubba DM, De la Garza Ramos R, Rory Goodwin C, Abu-Bonsrah N, Bydon A, Witham TF, Bettegowda C, Gokaslan ZL, Wolinsky JP. Clinical, surgical, and molecular prognostic factors for survival after spinal sarcoma resection. Neurosurg Focus 2016; 41:E9. [DOI: 10.3171/2016.5.focus16118] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
OBJECTIVE
The goal of this study was to investigate the local recurrence rate and long-term survival after resection of spinal sarcomas.
METHODS
A retrospective review of patients who underwent resection of primary or metastatic spinal sarcomas between 1997 and 2015 was performed. Tumors were classified according to the Enneking classification, and resection was categorized as Enneking appropriate (EA) if the specimen margins matched the Enneking recommendation, and as Enneking inappropriate (EI) if they did not match the recommendation. The primary outcome measure for all tumors was overall survival; local recurrence was also an outcome measure for primary sarcomas. The association between clinical, surgical, and molecular (tumor biomarker) factors and outcomes was also investigated.
RESULTS
A total of 60 patients with spinal sarcoma were included in this study (28 men and 32 women; median age 38 years). There were 52 primary (86.7%) and 8 metastatic sarcomas (13.3%). Thirty-nine tumors (65.0%) were classified as high-grade, and resection was considered EA in 61.7% of all cases (n = 37). The local recurrence rate was 10 of 52 (19.2%) for primary sarcomas; 36.8% for EI resection and 9.1% for EA resection (p = 0.010). Twenty-eight patients (46.7%) died during the follow-up period, and median survival was 26 months. Overall median survival was longer for patients with EA resection (undefined) compared with EI resection (13 months, p < 0.001). After multivariate analysis, EA resection significantly decreased the hazard of local recurrence (HR 0.24, 95% CI 0.06–0.93; p = 0.039). Age 40 years or older (HR 4.23, 95% CI 1.73–10.31; p = 0.002), previous radiation (HR 3.44, 95% CI 1.37–8.63; p = 0.008), and high-grade sarcomas (HR 3.17, 95% CI 1.09–9.23; p = 0.034) were associated with a significantly increased hazard of death, whereas EA resection was associated with a significantly decreased hazard of death (HR 0.22, 95% CI 0.09–0.52; p = 0.001).
CONCLUSIONS
The findings in the present study suggest that EA resection may be the strongest independent prognostic factor for improved survival in patients with spinal sarcoma. Additionally, patients who underwent EA resection had lower local recurrence rates. Patients 40 years or older, those with a history of previous radiation, and those with high-grade tumors had an increased hazard of mortality in this study.
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Affiliation(s)
- Daniel M. Sciubba
- 1Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland; and
| | - Rafael De la Garza Ramos
- 1Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland; and
| | - C. Rory Goodwin
- 1Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland; and
| | - Nancy Abu-Bonsrah
- 1Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland; and
| | - Ali Bydon
- 1Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland; and
| | - Timothy F. Witham
- 1Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland; and
| | - Chetan Bettegowda
- 1Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland; and
| | - Ziya L. Gokaslan
- 2Department of Neurosurgery, The Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Jean-Paul Wolinsky
- 1Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland; and
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Clarke MJ, Price DL, Cloft HJ, Segura LG, Hill CA, Browning MB, Brandt JM, Lew SM, Foy AB. En bloc resection of a C-1 lateral mass osteosarcoma: technical note. J Neurosurg Pediatr 2016; 18:46-52. [PMID: 26966885 DOI: 10.3171/2015.12.peds15496] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Osteosarcoma is an aggressive primary bone tumor. It is currently treated with multimodality therapy including en bloc resection, which has been demonstrated to confer a survival benefit over intralesional resection. The authors present the case of an 8-year-old girl with a C-1 lateral mass osteosarcoma, which was treated with a 4-stage en bloc resection and spinal reconstruction. While technically complex, the feasibility of en bloc resection for spinal osteosarcoma should be explored in the pediatric population.
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Affiliation(s)
| | | | | | | | | | - Meghen B Browning
- Department of Pediatric Oncology, Medical College of Wisconsin, Milwaukee
| | - Jon M Brandt
- Department of Pediatric Oncology, St. Vincent Hospital, Green Bay; and
| | - Sean M Lew
- Department of Pediatric Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Andrew B Foy
- Department of Pediatric Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin
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29
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Dekutoski MB, Clarke MJ, Rose P, Luzzati A, Rhines LD, Varga PP, Fisher CG, Chou D, Fehlings MG, Reynolds JJ, Williams R, Quraishi NA, Germscheid NM, Sciubba DM, Gokaslan ZL, Boriani S, _ _. Osteosarcoma of the spine: prognostic variables for local recurrence and overall survival, a multicenter ambispective study. J Neurosurg Spine 2016; 25:59-68. [DOI: 10.3171/2015.11.spine15870] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE
Primary spinal osteosarcomas are rare and aggressive neoplasms. Poor outcomes can occur, as obtaining marginal margins is technically demanding; further Enneking-appropriate en bloc resection can have significant morbidity. The goal of this study is to identify prognostic variables for local recurrence and mortality in surgically treated patients diagnosed with a primary osteosarcoma of the spine.
METHODS
A multicenter ambispective database of surgically treated patients with primary spine osteosarcomas was developed by AOSpine Knowledge Forum Tumor. Patient demographic, diagnosis, treatment, perioperative morbidity, local recurrence, and cross-sectional survival data were collected. Tumors were classified in 2 cohorts: Enneking appropriate (EA) and Enneking inappropriate (EI), as defined by pathology margin matching Enneking-recommended surgical margins. Prognostic variables were analyzed in reference to local recurrence and survival.
RESULTS
Between 1987 and 2012, 58 patients (32 female patients) underwent surgical treatment for primary spinal osteosarcoma. Patients were followed for a mean period of 3.5 ± 3.5 years (range 0.5 days to 14.3 years). The median survival for the entire cohort was 6.7 years postoperative. Twenty-four (41%) patients died, and 17 (30%) patients suffered a local recurrence, 10 (59%) of whom died. Twenty-nine (53%) patients underwent EA resection while 26 (47%) patients underwent EI resection with a postoperative median survival of 6.8 and 3.7 years, respectively (p = 0.048). EI patients had a higher rate of local recurrence than EA patients (p = 0.001). Patient age, previous surgery, biopsy type, tumor size, spine level, and chemotherapy timing did not significantly influence recurrence and survival.
CONCLUSIONS
Osteosarcoma of the spine presents a significant challenge, and most patients die in spite of aggressive surgery. There is a significant decrease in recurrence and an increase in survival with en bloc resection (EA) when compared with intralesional resection (EI). The effect of adjuvant and neoadjuvant chemotherapeutics, as well as method of biopsy, requires further exploration.
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Affiliation(s)
| | | | - Peter Rose
- 3Orthopedics, Mayo Clinic, Rochester, Minnesota
| | - Alessandro Luzzati
- 4Oncologia Ortopedica e Ricostruttiva del Rachide, Istituto Ortopedico Galeazzi, Milan, Italy
| | - Laurence D. Rhines
- 5Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Peter P. Varga
- 6National Center for Spinal Disorders and Buda Health Center, Budapest, Hungary
| | - Charles G. Fisher
- 7Division of Spine, Department of Orthopaedics, University of British Columbia and Vancouver Coastal Health, Vancouver, British Columbia, Canada
| | - Dean Chou
- 8Department of Neurological Surgery, University of California, San Francisco, California
| | - Michael G. Fehlings
- 9Division of Neurosurgery, Department of Surgery, University of Toronto and Toronto Western Hospital, Toronto, Ontario, Canada
| | - Jeremy J. Reynolds
- 10Spinal Division, Oxford University Hospitals NHS Trust, Oxford, United Kingdom
| | - Richard Williams
- 11Department of Orthopaedics, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Nasir A. Quraishi
- 12Center for Spine Studies and Surgery, Queens Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
| | | | - Daniel M. Sciubba
- 14Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Ziya L. Gokaslan
- 15Department of Neurosurgery, The Warren Alpert Medical School of Brown University, Providence, Rhode Island; and
| | - Stefano Boriani
- 16Unit of Oncologic and Degenerative Spine Surgery, Rizzoli Institute, Bologna, Italy
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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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Sewell MD, Tan KA, Quraishi NA, Preda C, Varga PP, Williams R. Systematic Review of En Bloc Resection in the Management of Ewing's Sarcoma of the Mobile Spine with Respect to Local Control and Disease-Free Survival. Medicine (Baltimore) 2015; 94:e1019. [PMID: 26166072 PMCID: PMC4504586 DOI: 10.1097/md.0000000000001019] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
There is no consensus on the optimal method of local control in Ewing's sarcoma (ES) of the mobile spine. Recent reports have suggested that en bloc resection may improve local control and survival. The authors therefore performed a systematic review to answer the following questions: (1) What is the outcome of en bloc resection for ES of the mobile spine with respect to local control and disease-free survival (DFS)? (2) How should residual ES of the mobile spine be treated?Inclusion criteria were articles published between the years 1960 and 2014 in English that contained more than five patients. This yielded 204 articles, from which 4 were selected for detailed analysis. The literature was graded for quality, summarized, and presented to a group of spinal oncology experts with consensus recommendations made.All 4 studies were retrospective case series graded as very low quality evidence. Local control strategies included radiotherapy (RT) alone, surgery and RT, or surgery alone. There was no standardized outcome reported across studies with respect to the type of surgical procedure, margins, and outcomes of interest such as local recurrence (LR) and DFS. When the en bloc procedures were pooled together, 2 of the 21 patients with available LR data developed LR (9.5%), and 5 of the 7 patients with available DFS data were disease free at a mean of 76 months. The remaining 2 died at 10 and 29 months, respectively. No studies were identified detailing the treatment of residual ES of the mobile spine.There is no consensus on the optimal method of local control for spinal ES or the treatment of residual disease. A weak recommendation supports that when the en bloc resection is technically possible, in combination with RT, this appears to provide superior local control than RT alone, or incomplete excision and RT. The effect on survival is indeterminate.
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Affiliation(s)
- Mathew David Sewell
- From the Princess Alexandra Hospital, Brisbane, Australia (MDS, CP, RW); University of New South Wales, Faculty of Medicine, Sydney, Australia (K-AT); Centre for Spine Studies and Surgery, Queens Medical Centre, Nottingham, UK (NAQ); and The National Centre for Spinal Disorders, Budapest, Hungary (PPV)
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Abstract
Treatment options for metastatic and primary spinal tumors have expanded in recent years, in part due to the advances made in stereotactic radiosurgery. For metastatic spinal tumors, our institution utilizes the neurologic, oncologic, mechanical, and systemic (NOMS) decision framework, which provides a treatment paradigm based on the neurologic, oncologic, mechanical and systemic status of the patient. Radiosurgery as a supplement to surgical decompression has allowed for less-invasive surgical procedures carrying minimal morbidity while still providing effective local tumor control. Although wide en bloc excision has traditionally been the goal for the treatment of high-grade primary spine tumors, recent studies have shown promise for radiosurgery in providing control in tumors such as chordomas and high-grade sarcomas. Despite advances in radiosurgery, there continues to be limitations in providing effective conformational doses with minimal toxicity to critical structures. One of the ways to circumvent this and supplement external beam radiation is through the use of brachytherapy delivered by radioactive plaque or seeds.
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Affiliation(s)
- James K C Liu
- Spine Tumor Center, Department of Neurosurgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
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Mattei TA, Teles AR, Mendel E. Modern surgical techniques for management of soft tissue sarcomas involving the spine: outcomes and complications. J Surg Oncol 2014; 111:580-6. [PMID: 25413665 DOI: 10.1002/jso.23805] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2014] [Accepted: 07/29/2014] [Indexed: 01/10/2023]
Abstract
Several types of soft tissue sarcomas may locally extend to the spine. The best therapeutic strategy for such lesions strongly depends on the histological diagnosis. In this article the authors provide an up-to-date review of current guidelines regarding the management of soft tissue sarcomas involving the spine. Special attention is given to outcomes and complications of modern surgical series in order to highlight current challenges in the management of such lesions.
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Affiliation(s)
- Tobias A Mattei
- Department of Neurosurgery, The Brain & Spine Center, Invision Health, Buffalo, New York
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Fisher CG, Goldschlager T, Boriani S, Varga PP, Rhines LD, Fehlings MG, Luzzati A, Dekutoski MB, Reynolds JJ, Chou D, Berven SH, Williams RP, Quraishi NA, Bettegowda C, Gokaslan ZL. An evidence-based medicine model for rare and often neglected neoplastic conditions. J Neurosurg Spine 2014; 21:704-10. [DOI: 10.3171/2014.7.spine13954] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Object
The National Institutes of Health recommends strategies to obtain evidence for the treatment of rare conditions such as primary tumors of the spine (PTSs). These tumors have a low incidence and are pathologically heterogeneous, and treatment approaches are diverse. Appropriate evidence-based care is imperative. Failure to follow validated oncological principles may lead to unnecessary mortality and profound morbidity. This paper outlines a scientific model that provides significant evidence guiding the treatment of PTSs.
Methods
A four-stage approach was used: 1) planning: data from large-volume centers were reviewed to provide insight; 2) recruitment: centers were enrolled and provided the necessary infrastructure; 3) retrospective stage: existing medical records were reviewed and completed with survival data; and 4) prospective stage: prospective data collection has been implemented. The AOSpine Knowledge Forum Tumor designed six modules: demographic, clinical, diagnostic, therapeutic, local recurrence, survival, and perioperative morbidity data fields and provided funding.
Results
It took 18 months to implement Stages 1–3, while Stage 4 is ongoing. A total of 1495 tumor cases were captured and diagnosed as one of 18 PTS histotypes. In addition, a PTS biobank network has been created to link clinical data with tumor pathology and molecular analysis.
Conclusions
This scientific model has not only aggregated a large amount of PTS data, but has also established an international collaborative network of spine oncology centers. Access to large volumes of data will generate further research to guide and enhance PTS clinical management. This model could be applied to other rare neoplastic conditions. Clinical trial registration no.: NCT01643174 (ClinicalTrials.gov).
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Affiliation(s)
- Charles G. Fisher
- 1Division of Spine, Department of Orthopaedics, University of British Columbia and Vancouver CoastalHealth, Vancouver, British Columbia
| | - Tony Goldschlager
- 1Division of Spine, Department of Orthopaedics, University of British Columbia and Vancouver CoastalHealth, Vancouver, British Columbia
- 14Monash Institute of Medical Research, Monash University, Clayton, Victoria, Australia; and
| | - Stefano Boriani
- 2Unit of Oncologic and Degenerative Spine Surgery, Rizzoli Institute, Bologna
| | - Peter Paul Varga
- 3National Center for Spinal Disorders and Buda Health Center, Budapest, Hungary
| | - Laurence D. Rhines
- 4Department of Neurosurgery, MD Anderson Cancer Center, The University of Texas, Houston, Texas
| | - Michael G. Fehlings
- 5Division of Neurosurgery, Department of Surgery, University of Toronto and Toronto Western Hospital, Toronto, Ontario, Canada
| | - Alessandro Luzzati
- 6Oncologia Ortopedica e Ricostruttiva del Rachide, Istituto Ortopedico Galeazzi, Milano, Italy
| | | | | | - Dean Chou
- Departments of 9Neurological Surgery and
| | - Sigurd H. Berven
- 10Orthopaedic Surgery, University of California, San Francisco, California
| | - Richard P. Williams
- 11Department of Orthopaedics, Princess Alexandra Hospital, Brisbane, Queensland
| | - Nasir A. Quraishi
- 12Center for Spine Studies and Surgery, Queens Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom;
| | - Chetan Bettegowda
- 13Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Ziya L. Gokaslan
- 13Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Amendola L, Cappuccio M, De Iure F, Bandiera S, Gasbarrini A, Boriani S. En bloc resections for primary spinal tumors in 20 years of experience: effectiveness and safety. Spine J 2014; 14:2608-17. [PMID: 24561037 DOI: 10.1016/j.spinee.2014.02.030] [Citation(s) in RCA: 82] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2013] [Revised: 01/28/2014] [Accepted: 02/18/2014] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Many studies have demonstrated that en bloc surgical resection of primary spinal tumors with adequate margins results in improved local disease control and survival compared with intralesional excision. Nevertheless, the use of this procedure is under debate because most of the current evidence is provided by small and heterogeneous series of cases. PURPOSE To validate the application of en bloc resection for the treatment of aggressive benign and primary malignant spinal tumors. STUDY DESIGN This is a prospective cohort study. PATIENT SAMPLE From August 1990 to March 2010, 103 consecutive patients affected by primary spinal tumors were enrolled in the study. All patients were submitted to the same clinical and imaging workup. OUTCOME MEASURES Analysis of local recurrence (LR) and tumor-related mortality, reliability of preoperative surgical planning, and morbidity and mortality. In addition, the effects of possible predictors of these events were studied. METHODS The parameters for the effectiveness and safety of en bloc resections performed on primary spinal tumors were considered as primary end points of this study, and two research questions were formulated. The analysis of the procedure effectiveness considered the identification of possible predictors of LR and tumor-related mortality. Information about safety is collected so as to clarify the possibility to respect the preoperative planning and to identify possible predictors of morbidity and mortality. Data from clinical and imaging examination were collected in a database and were used to answer the proposed research questions. RESULTS All patients were followed for a minimum of 24 months or until death. At the final assessment, 69 patients resulted with no evidence of disease with a mean follow-up of 100 months. Among the 103 patients, tumor recurred in 22 cases with a mean follow-up period of 39 months after surgery. A Cox regression multivariate analysis shows that marginal and intralesional resections are independent predictors of LR (hazard ratio [HR] 9.45, 95% confidence interval [CI] 1.06-84.47 and HR 38.62, 95% CI 4.67-319.21, respectively, compared with wide resection) and tumor-related mortality (in particular, HR 17.10, 95% CI 3.80-77.04 for intralesional resection compared with the wide one). The same analysis demonstrates that en bloc resection performed in recurrent cases or patients previously submitted to open biopsy (nonintact cases) have a LR risk higher than intact cases (HR 3.45, 95% CI 1.38-8.63). The success rate of en bloc resections in achieving adequate margins is 82.4%, and Weinstein-Boriani-Biagini surgical staging can also predict the margins in a high percentage of cases (75.7%). Complications occurred in 41.7% of patients with a higher rate observed in the nonintact group and for surgery with a double-approach or multisegmental resections. The mortality rate related to surgery complications was 1.9%, whereas tumor-related mortality was 15.5%. CONCLUSIONS Statistical analysis of the long-term results referred to 103 patients affected by aggressive benign and malignant primary spine tumors indicates that an en bloc resection is associated with a high rate of complications. Nevertheless, it decreases the risk of LR and tumor-related mortality. En bloc resection is a highly demanding procedure but can be performed to an acceptable degree of safety.
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Affiliation(s)
- Luca Amendola
- Department of Orthopedics and Traumatology-Spine Surgery, Maggiore Hospital, "C. A. Pizzardi," Largo Nigrisoli 1, Bologna 40100, Italy.
| | - Michele Cappuccio
- Department of Orthopedics and Traumatology-Spine Surgery, Maggiore Hospital, "C. A. Pizzardi," Largo Nigrisoli 1, Bologna 40100, Italy
| | - Federico De Iure
- Department of Orthopedics and Traumatology-Spine Surgery, Maggiore Hospital, "C. A. Pizzardi," Largo Nigrisoli 1, Bologna 40100, Italy
| | - Stefano Bandiera
- Department of Oncologic and Degenerative Spine Surgery, Rizzoli Institute, Via Pupilli 1, Bologna, Italy
| | - Alessandro Gasbarrini
- Department of Oncologic and Degenerative Spine Surgery, Rizzoli Institute, Via Pupilli 1, Bologna, Italy
| | - Stefano Boriani
- Department of Oncologic and Degenerative Spine Surgery, Rizzoli Institute, Via Pupilli 1, Bologna, Italy
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Kroczak T, Sharda R, Drachenberg D, Al-Essawi T. Renal primitive neuroectodermal tumour: Case series and brief review. Can Urol Assoc J 2014; 8:E241-4. [PMID: 24839490 DOI: 10.5489/cuaj.1770] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Renal primitive neuroectodermal tumor is a rare malignancy. These tumours rarely present with caval involvement. We report 2 cases of primitive neuroectodermal tumours (PNETs) with inferior vena cava involvement. The initial presentation and outcomes differed significantly. The diagnosis was confirmed using histologic and pathologic analysis. We present a brief literature review and an outline of typical clinical and pathologic features of renal PNETs.
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Affiliation(s)
- Tadeusz Kroczak
- Section of Urology, Department of Surgery, St. Boniface Hospital University of Manitoba, Winnipeg, MB
| | - Rajan Sharda
- Section of Urology, Department of Surgery, Cornwall Community Hospital, Cornwall, ON
| | - Darrel Drachenberg
- Section of Urology, Department of Surgery, St. Boniface Hospital University of Manitoba, Winnipeg, MB
| | - Turki Al-Essawi
- Section of Urology, Department of Surgery, Health Sciences Centre University of Manitoba, Winnipeg, MB
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Abstract
OBJECTIVES The objective of the authors was to provide an up-to-date review about the epidemiology, diagnosis, and surgical management of the malignant primary sacral tumors. METHODS A PubMed search was conducted using a combination of the following items: (('Spinal Neoplasms'[Mesh]) AND 'Sacrum'[Mesh]) NOT ('Metastasis' OR 'Metastases' OR 'Benign'). The literature review and the author's own surgical experiences were used to assess the current treatment strategies of the malignant sacral tumors. RESULTS Twenty case series were identified, which studies discuss in detail the surgical strategies, the postoperative complications, the functional and oncologic outcome, and the recurrence-free and disease-specific survival of this rare patient category. DISCUSSION Sacral tumors are rare pathologies. Their management generates a complex medical problem, as they usually are diagnosed in advanced stages with extended dimensions involving the sacral nerves and surrounding organs. The evaluation and complex treatment of these rare tumors require a multidisciplinary approach, optimally at institutions with comprehensive care and experience. Although conventional oncologic therapeutic methods should be used as neoadjuvant or adjuvant therapies in certain histological types, en bloc resection with wide surgical margins is essential for long-term local oncologic control. This is often technically difficult to achieve, as just a few centers in the world perform sacral tumor surgeries on a regular basis, and have enough wide experience. Therefore international cooperation and organization of multicenter tumor registries are essential to develop evidence based treatment protocols.
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Boriani S, Bandiera S, Colangeli S, Ghermandi R, Gasbarrini A. En bloc resection of primary tumors of the thoracic spine: indications, planning, morbidity. Neurol Res 2014; 36:566-76. [PMID: 24725289 DOI: 10.1179/1743132814y.0000000369] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
OBJECTIVES We aimed to describe surgical planning, technique, and complications of en bloc resection in the thoracic spine in patients who opted for surgery with en bloc resection and a tumor-free margin. METHODS Oncologic and functional results were recorded for 134 patients (53% male, age 44 ± 18 years) who had undergone en bloc resection for primary tumors (90 cases) and bone metastases (44 cases). Patients were followed until death or the latest follow-up examination (0-211 months, median 47 months). Surgeries were performed from 1990 to 2007 by the same team. An ongoing critical analysis of local control rates, surgical complications, and expected versus actual loss of function enabled the authors to refine the surgical technique and propose seven different types of resection. RESULTS AND DISCUSSION En bloc resection is a demanding procedure and requires careful planning after a careful decision-making process. The patient has to correctly understand the purpose of the surgery, based on oncological staging, in order to accept or decide against the procedure after weighing the possible morbidity and functional loss against the expected final result. TECHNIQUES OF EN BLOC RESECTION: Seven different strategies to perform en bloc resection in the thoracic spine, based on four combinations of surgical approaches (anterior, posterior, anterior followed by posterior, and posterior followed by simultaneous anterior and posterior) are identified and proposed. This planning is based on Weinstein-Boriani-Biagini (WBB) surgical staging. The surgical plan was designed to achieve the required oncologic margin with the minimum achievable morbidity.
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Kaloostian PE, Zadnik PL, Etame AB, Vrionis FD, Gokaslan ZL, Sciubba DM. Surgical Management of Primary and Metastatic Spinal Tumors. Cancer Control 2014; 21:133-9. [DOI: 10.1177/107327481402100205] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Background The axial skeleton is a common site for primary tumors and metastatic disease, with metastatic disease being much more common. Primary and metastatic spinal tumors have a diverse range of aggressiveness, ranging from benign lesions to highly infiltrative malignant tumors. Methods The authors reviewed the results of articles describing the treatment and outcomes of patients with metastatic disease or primary tumors of the spinal column. Results En bloc resection is the mainstay of treatment for malignant primary tumors of the spinal column. Intralesional resection is generally appropriate for benign primary tumors. Low-quality evidence supports the use of chemotherapy in select primary tumors; however, radiation therapy is often used for incompletely resected or unresectable lesions. Surgical considerations for the treatment of metastatic disease are more nuanced and require that the health care professional consider patient performance status and the pathology of the primary tumor. Conclusions The treatment of metastatic and primary tumors of the spinal column requires a multidisciplinary approach in order to offer patients the best opportunity for long-term survival.
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Affiliation(s)
- Paul E. Kaloostian
- Department of Neurosurgery at Johns Hopkins Hospital, Baltimore, Maryland
| | - Patricia L. Zadnik
- Department of Neurosurgery at Johns Hopkins Hospital, Baltimore, Maryland
| | - Arnold B. Etame
- H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida
- Departments of Neurosurgery and Orthopedics, University of South Florida Morsani College of Medicine, Tampa, Florida
| | - Frank D. Vrionis
- H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida
- Departments of Neurosurgery and Orthopedics, University of South Florida Morsani College of Medicine, Tampa, Florida
| | - Ziya L. Gokaslan
- Department of Neurosurgery at Johns Hopkins Hospital, Baltimore, Maryland
| | - Daniel M. Sciubba
- Department of Neurosurgery at Johns Hopkins Hospital, Baltimore, Maryland
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Katonis P, Datsis G, Karantanas A, Kampouroglou A, Lianoudakis S, Licoudis S, Papoutsopoulou E, Alpantaki K. Spinal osteosarcoma. CLINICAL MEDICINE INSIGHTS-ONCOLOGY 2013; 7:199-208. [PMID: 24179411 PMCID: PMC3813616 DOI: 10.4137/cmo.s10099] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Although osteosarcoma represents the second most common primary bone tumor, spinal involvement is rare, accounting for 3%–5% of all osteosarcomas. The most frequent symptom of osteosarcoma is pain, which appears in almost all patients, whereas more than 70% exhibit neurologic deficit. At a molecular level, it is a tumor of great genetic complexity and several genetic disorders have been associated with its appearance. Early diagnosis and careful surgical staging are the most important factors in accomplishing sufficient management. Even though overall prognosis remains poor, en-block tumor removal combined with adjuvant radiotherapy and chemotherapy is currently the treatment of choice. This paper outlines histopathological classification, epidemiology, diagnostic procedures, and current concepts of management of spinal osteosarcoma.
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Affiliation(s)
- P Katonis
- Department of Orthopaedics, University Hospital, University of Crete, Heraklion, Greece
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Zils K, Bielack S, Wilhelm M, Werner M, Schwarz R, Windhager R, Hofmann-Wackersreuther G, Andus T, Kager L, Kuehne T, Reichardt P, von Kalle T. Osteosarcoma of the mobile spine. Ann Oncol 2013; 24:2190-5. [DOI: 10.1093/annonc/mdt154] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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44
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Cho W, Chang UK. Survival and recurrence rate after treatment for primary spinal sarcomas. J Korean Neurosurg Soc 2013; 53:228-34. [PMID: 23826479 PMCID: PMC3698233 DOI: 10.3340/jkns.2013.53.4.228] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2012] [Revised: 02/12/2013] [Accepted: 04/08/2013] [Indexed: 11/27/2022] Open
Abstract
Objective We have limited understanding on the presentation and survival of primary spinal sarcomas. The survival, recurrence rate, and related prognostic factors were investigated after treatment for primary sarcomas of the spine. Methods Retrospective analysis of medical records and radiological data was done for 29 patients in whom treatment was performed due to primary sarcoma of the spine from 2000 to 2010. As for treatment method, non-radical operation, radiation therapy, and chemotherapy were simultaneously or sequentially combined. Overall survival (OS), progression free survival (PFS), ambulatory function, and pain status were analyzed. In addition, factors affecting survival and recurrence were analyzed : age (≤42 or ≥43), gender, tumor histologic type, lesion location (mobile spine or rigid spine), weakness at diagnosis, pain at diagnosis, ambulation at diagnosis, initial treatment, radiation therapy, kind of irradiation, surgery, chemotherapy and distant metastasis. Results Median OS was 60 months, the recurrence rate was 79.3% and median PFS was 26 months. Patients with distant metastasis showed significantly shorter survival than those without metastasis. No factors were found to be significant relating to recurrence. Prognostic factor associated with walking ability was the presence of weakness at diagnosis. Conclusion Primary spinal sarcomas are difficult to cure and show high recurrence rate. However, the development of new treatment methods is improving survival.
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Affiliation(s)
- Wonik Cho
- Department of Neurosurgery, Korea Cancer Center Hospital, Korea Institute of Radiological and Medical Science, Seoul, Korea
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Rowe RG, Thomas DG, Schuetze SM, Hafez KS, Lawlor ER, Chugh R. Ewing sarcoma of the kidney: case series and literature review of an often overlooked entity in the diagnosis of primary renal tumors. Urology 2013; 81:347-53. [PMID: 23374800 DOI: 10.1016/j.urology.2012.10.016] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2012] [Revised: 09/06/2012] [Accepted: 10/10/2012] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To evaluate our own experience with primary Ewing sarcoma family tumors (ESFTs) of the kidney and to review cases of this in published reports. MATERIALS AND METHODS Institutional cases of renal ESFT were identified in our pathology database. The retrieved records were reviewed for relevant data. Published cases of renal ESFTs were identified from the National Library of Medicine Medline database and restricted to English language studies. The factors associated with initial surgical management (diagnostic biopsy vs surgical resection) were analyzed using chi-square analysis. RESULTS We diagnosed and treated 10 cases of renal ESFT from 2002 to 2011 and identified an additional 97 published cases describing this tumor. A review of these 107 cases revealed that renal ESFTs more often presented with distant metastases than did ESFTs of the bone or soft tissue. Moreover, patients rarely received preoperative (neoadjuvant) chemotherapy, the current standard of care for ESFT, often because of early total tumor resection without diagnostic biopsy. Younger patients and patients with distant metastases were more likely to undergo diagnostic biopsy as initial management (P <.0001), allowing for use of neoadjuvant chemotherapy. CONCLUSION ESFTs of the kidney should be considered in the differential diagnosis of renal masses. Preoperative biopsy should be considered to identify these tumors to allow for delivery of neoadjuvant chemotherapy.
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Affiliation(s)
- R Grant Rowe
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI 48109-5848, USA
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Mukherjee D, Chaichana KL, Parker SL, Gokaslan ZL, McGirt MJ. Association of surgical resection and survival in patients with malignant primary osseous spinal neoplasms from the Surveillance, Epidemiology, and End Results (SEER) database. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2012; 22:1375-82. [PMID: 23263168 DOI: 10.1007/s00586-012-2621-4] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/09/2012] [Revised: 11/26/2012] [Accepted: 12/08/2012] [Indexed: 10/27/2022]
Abstract
OBJECTIVE Malignant osseous spinal neoplasms are aggressive tumors associated with poor outcomes despite aggressive multidisciplinary measures. While surgical resection has been shown to improve short-term local disease control, it remains debated whether surgical resection is associated with improved overall survival in patients with malignant primary osseous spinal neoplasms. The aim of this manuscript is to review survival data from a US cancer registry spanning 30 years to determine if surgical resection was independently associated with overall survival. METHODS The SEER registry (1973-2003) was queried to identify cases of histologically confirmed primary spinal chordoma, chondrosarcoma, osteosarcoma, or Ewing's sarcoma of the mobile spine and pelvis. Patients with systemic metastasis were excluded. Age, gender, race, tumor location, and primary treatments were identified. Extent of local tumor invasion was classified as confined within periosteum versus extension beyond periosteum to surrounding tissues. The association of surgical resection with overall survival was assessed via Cox analysis adjusting for age, radiotherapy, and tumor invasiveness. RESULTS 827 patients were identified with non-metastatic primary osseous spinal neoplasms (215 chordoma, 282 chondrosarcoma, 158 osteosarcoma, 172 Ewing's sarcoma). Overall, median survival was histology specific (chordoma, 96 months; Ewing's sarcoma, 90 months; chondrosarcoma, 88 months; osteosarcoma, 18 months). Adjusting for age, radiation therapy, and extent of local tumor invasion in patients with isolated (non-metastatic) spine tumors, surgical resection was independently associated with significantly improved survival for chordoma [hazard ratio (95 % confidence interval; 0.617 (0.25-0.98)], chondrosarcoma [HR (95 %CI); 0.153 (0.07-0.36)], osteosarcoma [HR (95 %CI); 0.382 (0.21-0.69)], and Ewing's sarcoma [HR (95 %CI); 0.494 (0.26-0.96)]. CONCLUSION In our analysis of a 30-year US population-based cancer registry (SEER), patients undergoing surgical resection of primary spinal chordoma, chondrosarcoma, Ewing's sarcoma, or osteosarcoma demonstrated prolonged overall survival independent of patient age, extent of local invasion, or location. Surgical resection may play a role in prolonging survival in the multi-modality treatment of patients with these malignant primary osseous spinal neoplasms.
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Affiliation(s)
- Debraj Mukherjee
- Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA.
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Williams R, Foote M, Deverall H. Strategy in the surgical treatment of primary spinal tumors. Global Spine J 2012; 2:249-66. [PMID: 24353976 PMCID: PMC3864485 DOI: 10.1055/s-0032-1329886] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2012] [Accepted: 08/04/2012] [Indexed: 11/18/2022] Open
Abstract
Primary spine tumors are rare, accounting for only 4% of all tumors of the spine. A minority of the more common primary benign lesions will require surgical treatment, and most amenable malignant lesions will proceed to attempted resection. The rarity of malignant primary lesions has resulted in a paucity of historical data regarding optimal surgical and adjuvant treatment and, although we now derive benefit from standardized guidelines of overall care, management of each neoplasm often proceeds on a case-by-case basis, taking into account the individual characteristics of patient operability, tumor resectability, and biological potential. This article aims to provide an overview of diagnostic techniques, staging algorithms and the authors' experience of surgical treatment alternatives that have been employed in the care of selected benign and malignant lesions. Although broadly a review of contemporary management, it is hoped that the case illustrations given will serve as additional "arrows in the quiver" of the treating surgeon.
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Affiliation(s)
- Richard Williams
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia,Address for correspondence and reprint requests Richard Williams Institute of Health and Biomedical Innovation, Queensland University of Technology8/259 Wickham Tce, Brisbane 4000, QueenslandAustralia
| | - Matthew Foote
- Department of Radiation Oncology, Princess Alexandra Hospital, University of Queensland, Brisbane, Queensland, Australia
| | - Hamish Deverall
- Department of Orthopaedics, Princess Alexandra Hospital, University of Queensland, Brisbane, Queensland, Australia
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Chang UK, Cho WI, Lee DH, Kim MS, Cho CK, Lee SY, Jeon DG. Stereotactic radiosurgery for primary and metastatic sarcomas involving the spine. J Neurooncol 2012; 107:551-7. [DOI: 10.1007/s11060-011-0777-0] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2011] [Accepted: 11/29/2011] [Indexed: 10/14/2022]
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Association of Extent of Local Tumor Invasion and Survival in Patients with Malignant Primary Osseous Spinal Neoplasms from the Surveillance, Epidemiology, and End Results (SEER) Database. World Neurosurg 2011; 76:580-5. [DOI: 10.1016/j.wneu.2011.05.016] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2010] [Revised: 04/28/2011] [Accepted: 05/04/2011] [Indexed: 11/18/2022]
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Rosenthal J, Pawlowska AB. High-dose chemotherapy and stem cell rescue for high-risk Ewing's family of tumors. Expert Rev Anticancer Ther 2011; 11:251-62. [PMID: 21342043 DOI: 10.1586/era.10.215] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The prognosis for high-risk Ewing's tumors has been improved by multimodal radiation and chemotherapy. Ewing's family of tumors requires risk-adapted treatment. Risk stratification is dependent on stage, tumor localization and volume, and the pattern of disease spread at the time of diagnosis and the time of relapse. The concepts for high-dose therapy followed by hematopoietic cell transplantation in Ewing's family of tumors are based on dose-response and dose-intensity relationships. This article will discuss the use of high-dose therapy followed by hematopoietic cell transplantation, focusing on recent progress with respect to agent combinations, dose and outcomes of therapy.
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Affiliation(s)
- Joseph Rosenthal
- Pediatrics and Pediatric Hematology/Hematopoietic Cell Transplantation, City of Hope, 1500 E Duarte Road, Duarte, CA 91010, USA
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