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Bordbar M, Sarfaraz A, Haghpanah S, Zekavat O, Zareifar S, Zarei T. The Outcome of Children With Malignant Bone Tumors: A Single-Center Experience. Glob Pediatr Health 2021; 8:2333794X211042238. [PMID: 34471652 PMCID: PMC8404661 DOI: 10.1177/2333794x211042238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 08/07/2021] [Indexed: 11/24/2022] Open
Abstract
Malignant bone tumors (MBT) account for 3% to 5% of cancers in children younger than 15 years. We aimed to report the outcome of children with MBT in 10 years in Southern Iran. During the study period, 100 patients (57 Osteosarcoma, 43 Ewing sarcoma) with an M/F ratio of 1.56 and a median age of 13.8 years (3.8-17.9) were diagnosed. Metastasis occurred in 27% of patients, mostly in the first 3 months of diagnosis. The mean survival time of MBT altogether was 94.1 months (95% CI: 86.5-101.7). The 5-year overall survival and event-free survivals were 85.2% (95% CI: 74%-91.8%) and 69.2% (95% CI: 56%-79%), respectively. Metastasis was the only independent risk factor of death in our study cohort (Hazard ratio 36.7, 95% CI: 4.8-282.6, P = .001) MBT in children mostly occur in adolescent boys. About one-third of them become metastatic, which is significantly associated with poor outcomes.
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Affiliation(s)
| | - Ali Sarfaraz
- Hematology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Sezaneh Haghpanah
- Hematology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Omidreza Zekavat
- Hematology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Soheila Zareifar
- Hematology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Tahereh Zarei
- Hematology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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Stachelek GC, Ligon JA, Vogel J, Levin AS, Llosa NJ, Ladle BH, Meyer CF, Terezakis SA, Morris CD, Ladra MM, Pratilas CA. Predictors of Recurrence and Patterns of Initial Failure in Localized Ewing Sarcoma: A Contemporary 20-Year Experience. Sarcoma 2021; 2021:6681741. [PMID: 33953640 PMCID: PMC8068528 DOI: 10.1155/2021/6681741] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 03/30/2021] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND The majority of patients with localized Ewing sarcoma will remain disease-free long term, but for those who suffer recurrence, successful treatment remains a challenge. Identification of clinicopathologic factors predictive of recurrence could suggest areas for treatment optimization. We sought to describe our experience regarding predictors of recurrence and patterns of first failure in patients receiving modern systemic therapy for nonmetastatic Ewing sarcoma. METHODS The medical records of pediatric and adult patients treated for localized Ewing sarcoma between 1999 and 2019 at Johns Hopkins Hospital were retrospectively analyzed. Local control was surgery, radiotherapy, or both. Recurrence-free survival (RFS) was calculated using the Kaplan-Meier method. Univariable and multivariable Cox proportional-hazards modeling was performed to obtain hazard ratios (HR) for recurrence. RESULTS In 94 patients with initially localized disease, there were 21 recurrences: 4 local, 14 distant, and 3 combined. 5-year and 10-year RFS were 75.6% and 70.5%, respectively. On multivariable analysis including age at diagnosis and tumor size, <95% tumor necrosis following neoadjuvant chemotherapy (NAC; HR 14.3, p = 0.028) and radiological tumor size change during NAC (HR 1.04 per 1% decrease in size change, p = 0.032) were independent predictors of recurrence. Among patients experiencing distant recurrence, pulmonary metastases were present in 82% and were the only identifiable site of disease in 53%. CONCLUSIONS Poor pathologic or radiologic response to NAC is predictive of recurrence in patients with localized Ewing sarcoma. Suboptimal tumor size reduction following chemotherapy provides a means to risk-stratify patients who do not undergo definitive resection. Isolated pulmonary recurrence was a common event.
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Affiliation(s)
- Gregory C. Stachelek
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - John A. Ligon
- Department of Pediatric Oncology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jennifer Vogel
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Adam S. Levin
- Department of Orthopedic Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Nicolas J. Llosa
- Department of Pediatric Oncology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Brian H. Ladle
- Department of Pediatric Oncology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Christian F. Meyer
- Department of Medical Oncology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Stephanie A. Terezakis
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Carol D. Morris
- Department of Orthopedic Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Matthew M. Ladra
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Christine A. Pratilas
- Department of Pediatric Oncology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Gerrand C, Bate J, Seddon B, Dirksen U, Randall RL, van de Sande M, O’Donnell P, Tuckett J, Peake D, Jeys L, Saifuddin A, Grainger M, Whelan J. Seeking international consensus on approaches to primary tumour treatment in Ewing sarcoma. Clin Sarcoma Res 2020; 10:21. [PMID: 33292535 PMCID: PMC7672819 DOI: 10.1186/s13569-020-00144-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 11/06/2020] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND The local treatment of Ewing sarcoma of bone involves surgery, radiotherapy or both. The selection of treatment depends on the anatomical extent of the tumour, the effectiveness of the proposed treatment, its morbidity, and the expectation of cure. However, not only are there variations in the approach to local treatment between individual patients, but also between treatment centres and countries. Our aim was to explore variation in practice and develop consensus statements about local treatment. METHODS A three stage modified Delphi technique was used with international collaborators. This involved an expert panel to identify areas of controversy, an online survey of international collaborators and a consensus meeting in London, UK in June 2017. In the consensus meeting, teams of clinicians discussed the local management of selected cases and their responses were collected with electronic voting. RESULTS Areas of greater or less consensus were identified. The lack of evidence underpinning different approaches was noted and areas for collaborative research became apparent. CONCLUSION This has demonstrated that there is an international consensus around many aspects of the local treatment of Ewing sarcoma of bone, including the use of specialist MultiDisciplinary Team (MDT) meetings with access to all appropriate treatments. However, considerable variation remains including the use of different staging investigations, decision making, definitions of response, and radiotherapy doses and timing. Further collaborative work should be undertaken to determine the impact of these variations in order to define best practice.
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Affiliation(s)
- Craig Gerrand
- Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, HA7 4LP Middlesex UK
| | - Jessica Bate
- Southampton Children’s Hospital, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Beatrice Seddon
- University College Hospital, 250 Euston Road, London, NW1 2PG UK
| | - Uta Dirksen
- Pediatrics III, Sarcoma Centre, West German Cancer Centre, German Cancer Consortium (DKTK), Center Essen, University Hospital Essen, University Duisburg, Hufelandstr. 55, 45122 Essen, Germany
| | - R. Lor Randall
- Department of Orthopaedic Surgery, UC Davis Health, 4860 Y Street, Suite 3800, Sacramento, CA 95817 USA
| | | | - Paul O’Donnell
- Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, HA7 4LP Middlesex UK
| | - John Tuckett
- Freeman Hospital, Newcastle-upon-Tyne, NE7 7DN UK
| | - David Peake
- Oncology-University Hospitals Birmingham NHS Foundation Trust, Birmingham, B15 2TH UK
| | - Lee Jeys
- Royal Orthopaedic Hospital, Bristol Road South, Birmingham, B31 2AP UK
| | - Asif Saifuddin
- Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, HA7 4LP Middlesex UK
| | - Mel Grainger
- University Hospital Birmingham, Edgbaston, Birmingham, B15 2GW UK
| | - Jeremy Whelan
- University College Hospital, 250 Euston Road, London, NW1 2PG UK
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Salah S, Halalsheh H, Abuhijla F, Ismael T, Yaser S, Shehadeh A, Abdelal S, Sultan I, Almousa A, Abu Hijlih R. The impact of local control timing in Ewing sarcoma. Rep Pract Oncol Radiother 2020; 25:255-259. [PMID: 32140082 PMCID: PMC7049602 DOI: 10.1016/j.rpor.2020.02.001] [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: 07/14/2019] [Revised: 12/07/2019] [Accepted: 02/19/2020] [Indexed: 02/07/2023] Open
Abstract
AIM To assess the impact of delay in local control on survival outcomes of Ewing sarcoma (ES) patients. BACKGROUND The cornerstone of therapy of localized ES includes chemotherapy and local control with surgery or radiotherapy. We sought to assess the impact of delay (>15 weeks) in timing of local control on survival outcomes of ES patients. METHODS Data of consecutive patients with primary non-metastatic ES of the extremities, treated at a single institution were collected. The impact of delay of timing for local control, demographics, and disease characteristics on overall survival (OS) was analyzed. RESULTS A total of 43 patients with ES of the extremity were included. All patients received neoadjuvant chemotherapy. Local control was by surgery in 36 patients and definitive radiation in 7. A total of 16 patients had delay in local control. At a median follow of up of 48 months, patients with delay in local control had significantly inferior OS compared to those with optimal local control timing (5-year OS 56% vs. 80%, respectively, p = 0.044). Other factors that predicted inferior OS included definitive radiation as opposed to definitive surgery (5-year OS 25% vs. 79%, respectively, p = 0.041) and tumor necrosis <90% as opposed to ≥90% (5-year OS 55% vs. 90%, respectively, p = 0.01). CONCLUSION Delay in definitive therapy, local control with radiation as opposed to surgery and poor post-chemotherapy tumor necrosis predict inferior OS in ES. Adopting strategies to minimize delay in local control could improve survival outcomes.
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Affiliation(s)
- Samer Salah
- Medical Oncology Department, King Hussein Cancer Center, Queen Rania Al-Abdullah Street 202, Amman-Jordan
- Corresponding author.
| | - Hadeel Halalsheh
- Pediatric Oncology Department, King Hussein Cancer Center, Queen Rania Al-Abdullah Street 202, Amman-Jordan
| | - Fawzi Abuhijla
- Radiation Oncology Department, King Hussein Cancer Center, Queen Rania Al-Abdullah Street 202, Amman-Jordan
| | - Taleb Ismael
- Pediatric Oncology Department, King Hussein Cancer Center, Queen Rania Al-Abdullah Street 202, Amman-Jordan
| | - Sameer Yaser
- Medical Oncology Department, King Hussein Cancer Center, Queen Rania Al-Abdullah Street 202, Amman-Jordan
| | - Ahmad Shehadeh
- Orthopedic Oncology Department, King Hussein Cancer Center, Queen Rania Al-Abdullah Street 202, Amman-Jordan
| | - Samer Abdelal
- Orthopedic Oncology Department, King Hussein Cancer Center, Queen Rania Al-Abdullah Street 202, Amman-Jordan
| | - Iyad Sultan
- Pediatric Oncology Department, King Hussein Cancer Center, Queen Rania Al-Abdullah Street 202, Amman-Jordan
| | - Abdelatif Almousa
- Radiation Oncology Department, King Hussein Cancer Center, Queen Rania Al-Abdullah Street 202, Amman-Jordan
| | - Ramiz Abu Hijlih
- Radiation Oncology Department, King Hussein Cancer Center, Queen Rania Al-Abdullah Street 202, Amman-Jordan
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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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Miller BJ, Gao Y, Duchman KR. Does surgery or radiation provide the best overall survival in Ewing's sarcoma? A review of the National Cancer Data Base. J Surg Oncol 2017; 116:384-390. [DOI: 10.1002/jso.24652] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Accepted: 03/28/2017] [Indexed: 12/23/2022]
Affiliation(s)
- Benjamin J. Miller
- Department of Orthopaedics and Rehabilitation; University of Iowa Hospitals and Clinics; Iowa City Iowa
| | - Yubo Gao
- Department of Orthopaedics and Rehabilitation; University of Iowa Hospitals and Clinics; Iowa City Iowa
| | - Kyle R. Duchman
- Department of Orthopaedics and Rehabilitation; University of Iowa Hospitals and Clinics; Iowa City Iowa
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