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Wahlig BD, Broida SE, Rose PS, Robinson SI, Siontis BL, Houdek MT. Is Bone Marrow Aspiration and Biopsy of Clinical Importance in the Initial Staging of Extraskeletal Ewing Sarcoma? Clin Orthop Relat Res 2023; 481:2177-2182. [PMID: 37053072 PMCID: PMC10566934 DOI: 10.1097/corr.0000000000002661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Revised: 02/08/2023] [Accepted: 03/20/2023] [Indexed: 04/14/2023]
Abstract
BACKGROUND Extraskeletal Ewing sarcoma are rare tumors within the Ewing sarcoma family. Initial staging studies for extraskeletal Ewing sarcoma historically have included imaging and bone marrow aspiration and biopsy (BMAB). However, recent studies on Ewing sarcoma of bone have questioned the utility of BMAB in the initial staging of patients, but no studies of which we are aware have evaluated the role of BMAB in extraskeletal Ewing sarcoma. We suspected that BMAB was of low diagnostic yield in patients with extraskeletal Ewing sarcoma and exposed patients to potential morbidity without an impact on their clinical course. QUESTION/PURPOSE Is BMAB a useful test in the staging of extraskeletal Ewing sarcoma? METHODS Between January 1996 and December 2021, our institution evaluated 109 patients with a listed diagnosis of extraskeletal Ewing sarcoma. Those patients were retrospectively reviewed for this study. Of those, we considered patients with biopsy-confirmed diagnosis of extraskeletal Ewing sarcoma. Biopsy was performed based on institutional protocols, with all diagnoses assigned by a board-certified pathologist. Based on that criteria, 96% (105 of 109) were eligible. An additional 18% (20 of 109) were excluded because records of their initial diagnostic and staging workup were not available. This left 78% (85 of 109) for analysis. Of those, 52% (44 of 85) were male. The average age was 32 ± 16 years. Primary tumor locations included extremities in 26% (22 of 85), paraspinal in 20% (17 of 85), chest in 19% (16 of 85), retroperitoneum in 13% (11 of 85), intraabdominal in 12% (10 of 85), intrapelvic in 7% (6 of 85), and head or neck in 4% (3 of 85). Initial diagnostic and staging information, including the use of PET-CT, bone scan, CT chest, and BMAB, was collected. Metastatic disease at the time of presentation or during follow-up was noted. The utility of BMAB was determined by the rate of positive tests in those undergoing BMAB during the initial staging process. Descriptive statistical analysis was sufficient to address the study question, and therefore no comparative statistics were performed. RESULTS BMAB was obtained during the initial staging process in 64% (54 of 85) of patients. This BMAB was negative in all 54 patients, including those with known metastatic disease. CONCLUSION Diagnosing metastatic disease in extraskeletal Ewing sarcoma is important as the presence of metastases at diagnosis adversely affects prognosis. The routine use of BMAB in the staging process of extraskeletal Ewing sarcoma is of low diagnostic yield. BMAB is unlikely to diagnose metastatic involvement even in patients with known metastases to bone. We do not have enough data to suggest whether other modalities, such as PET-CT, might be more useful. Similar studies should be pursued to determine the utility of the remainder of staging modalities in patients with extraskeletal Ewing sarcoma to elucidate the most efficient and effective staging protocol. LEVEL OF EVIDENCE Level III, diagnostic study.
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Affiliation(s)
- Brian D. Wahlig
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Samuel E. Broida
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Peter S. Rose
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
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Muratori F, Foschi L, Roselli G, Frenos F, Tamburini A, Palomba A, Greto D, Loi M, Beltrami G, Capanna R, Mondanelli N, Campanacci DA. Ewing family tumors of the appendicular skeleton: a retrospective analysis of prognostic factors. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2021; 31:1557-1565. [PMID: 34324030 DOI: 10.1007/s00590-021-03077-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 07/11/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE Authors retrospectively analyzed possible prognostic factors in a series of patients affected by Ewing sarcoma of extremities (eEWS) and treated over a 20-year period at a single institution. METHODS Between 1997 and 2017, 88 bone eEWS were treated at our institution. Staging, age, gender, tumoral volume, local treatment, surgical margins, post-ChT necrosis were investigated for prognostic correlation with overall survival (OS) and event-free survival (EFS). Median follow-up was 74 months (1-236). RESULTS Staging of disease correlated with OS (81% vs 59%, p = 0.01) and not with EFS (68% vs 57%, p = 0.28) in localized vs metastatic eEWS at presentation. Age ≥ 14 years (p = 0.002) and volume ≥ 100 cm3 (p = 0.04) were significant negative prognostic factors. No difference was found in local treatment: OS was 76% vs 63% (p = 0.33), while EFS was 68% vs 49% (p = 0.06) after surgery alone or surgery + radiotherapy, respectively. Regarding surgical margins, OS was 76% vs 38% (p = 0.14), and EFS was 65% vs 33% (p = 0.14) in adequate vs not adequate, respectively. OS was 86% and 68% in good and poor responders, respectively (p = 0.13). CONCLUSION In eEWS, metastatic disease at presentation, age > 14 years and tumoral volume > 100 cm3 are negative prognostic factors. Intensified adjuvant ChT can improve prognosis in poor responders and metastatic patients.
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Affiliation(s)
- Francesco Muratori
- Department of Orthopaedic Oncology, Azienda Ospedaliera Universitaria Careggi, Largo Palagi 1, Firenze, Italy.
| | - Lorenzo Foschi
- Department of Orthopaedic Oncology, Azienda Ospedaliera Universitaria Careggi, Largo Palagi 1, Firenze, Italy
| | - Giuliana Roselli
- Department of Radiology, Azienda Ospedaliera Universitaria Careggi, Firenze, Italy
| | - Filippo Frenos
- Department of Orthopaedic Oncology, Azienda Ospedaliera Universitaria Careggi, Largo Palagi 1, Firenze, Italy
| | - Angela Tamburini
- Department of Paediatric Oncoematology, Azienda Ospedaliera Universitaria Meyer, Firenze, Italy
| | - Annarita Palomba
- Department of Pathology, Azienda Ospedaliera Universitaria Careggi, Firenze, Italy
| | - Daniela Greto
- Department of Radiotherapy, Azienda Ospedaliera Universitaria Careggi, Firenze, Italy
| | - Mauro Loi
- Department of Radiotherapy, Azienda Ospedaliera Universitaria Careggi, Firenze, Italy
| | - Giovanni Beltrami
- Department of Paediatric Orthopaedics, Azienda Ospedaliera Universitaria Meyer, Firenze, Italy
| | - Rodolfo Capanna
- Orthopaedic Clinic, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy
| | - Nicola Mondanelli
- Orthopaedic Clinic, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - Domenico Andrea Campanacci
- Department of Orthopaedic Oncology, Azienda Ospedaliera Universitaria Careggi, Largo Palagi 1, Firenze, Italy
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Soomers V, Husson O, Young R, Desar I, Van der Graaf W. The sarcoma diagnostic interval: a systematic review on length, contributing factors and patient outcomes. ESMO Open 2021; 5:S2059-7029(20)30008-9. [PMID: 32079621 PMCID: PMC7046415 DOI: 10.1136/esmoopen-2019-000592] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 01/06/2020] [Accepted: 01/14/2020] [Indexed: 12/27/2022] Open
Abstract
Sarcomas are rare and heterogeneous mesenchymal tumours of soft tissue or bone, making them prone to late diagnosis. In other malignancies, early diagnosis has an impact on stage of disease, complexity of therapeutic procedures, survival and health-related quality of life (HRQoL). Little is known about what length of diagnostic interval should be considered as delay in patients with bone (BS) or soft tissue sarcomas (STS). To quantify total interval (defined as time from first symptom to histological diagnosis) and its components, identify contributing factors to its length and determine the impact on patients’ outcome in terms of mortality and HRQoL. A systematic review was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Seventy-six articles out of 2310 met the predefined inclusion criteria. Total intervals, varied broadly; 9–120.4 weeks for BS and 4.3–614.9 weeks for STS. Older age and no initial radiological examinations were contributing factors for a long interval in BS, while in STS results were conflicting. The impact of length of total interval on clinical outcomes in terms of survival and morbidity remains ambiguous; no clear relation could be identified for both BS and STS. No study examined the impact on HRQoL. The length of total interval is variable in BS as well as STS. Its effect on outcomes is contradictory. There is no definition of a clinically relevant cut-off point that discriminates between a short or long total interval. Prospero: CRD42017062492.
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Affiliation(s)
- Vicky Soomers
- Medical Oncology, Radboudumc, Nijmegen, The Netherlands
| | - Olga Husson
- Institute of Cancer Research, London, London, UK.,Psychosocial research and epidemiology, Antoni van Leeuwenhoek Netherlands Cancer Institute, Amsterdam, Netherlands
| | - Robin Young
- Medical Oncology, Weston Park Hospital, Sheffield, Sheffield, UK
| | - Ingrid Desar
- Medical Oncology, Radboudumc, Nijmegen, Gelderland, The Netherlands
| | - Winette Van der Graaf
- Medical Oncology, Antoni van Leewenhoek Netherlands Cancer Institute, Amsterdam, The Netherlands.,Medical Oncology, Radboudumc, Nijmegen, The Netherlands
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Cesari M, Righi A, Colangeli M, Gambarotti M, Spinnato P, Ferraro A, Longhi A, Abate ME, Palmerini E, Paioli A, Ferrari C, Donati DM, Picci P, Ferrari S. Bone marrow biopsy in the initial staging of Ewing sarcoma: Experience from a single institution. Pediatr Blood Cancer 2019; 66:e27653. [PMID: 30724024 DOI: 10.1002/pbc.27653] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Revised: 01/08/2019] [Accepted: 01/22/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND Ewing sarcoma (ES) is the second most common bone tumor in adolescents and children. Staging workup for ES includes imaging and bone marrow biopsy (BMB). The effective role of BMB is now under discussion. PROCEDURE A monoinstitutional retrospective analysis reviewed clinical charts, imaging, and histology of patients with diagnosis of ES treated at the Rizzoli Institute between 1998 and 2017. RESULTS The cohort included 504 cases of ES of bone; 137 (27%) had metastases at diagnosis, while the remaining 367 had localized disease. Twelve patients had a positive BMB (2.4%). Eleven had distant metastases detected at initial workup staging with imaging assessment: six patients presented with bone metastases, five with both bone and lung metastases. Only one patient with ES of the foot (second metatarsus) was found to have bone marrow involvement with negative imaging evaluation (0.3%). CONCLUSIONS On the basis of our data, we suggest reconsidering the effective role of BMB in initial staging workup for patients with ES with no signs of metastases by modern imaging techniques. In metastatic disease, the assessment of the bone marrow status may remain useful to identify a group of patients at very high risk who could benefit from different treatment strategies.
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Affiliation(s)
- Marilena Cesari
- Chemotherapy Section, IRCCS-Rizzoli Orthopaedic Institute, Bologna, Italy
| | - Alberto Righi
- Department of Surgical Pathology, IRCCS-Rizzoli Orthopaedic Institute, Bologna, Italy
| | - Marco Colangeli
- Department of Orthopaedic Surgery, IRCCS-Rizzoli Orthopaedic Institute, Bologna, Italy
| | - Marco Gambarotti
- Department of Surgical Pathology, IRCCS-Rizzoli Orthopaedic Institute, Bologna, Italy
| | - Paolo Spinnato
- Department of Radiology, IRCCS-Rizzoli Orthopaedic Institute, Bologna, Italy
| | - Andrea Ferraro
- Department of Orthopaedic Surgery, IRCCS-Rizzoli Orthopaedic Institute, Bologna, Italy
| | - Alessandra Longhi
- Chemotherapy Section, IRCCS-Rizzoli Orthopaedic Institute, Bologna, Italy
| | | | - Emanuela Palmerini
- Chemotherapy Section, IRCCS-Rizzoli Orthopaedic Institute, Bologna, Italy
| | - Anna Paioli
- Chemotherapy Section, IRCCS-Rizzoli Orthopaedic Institute, Bologna, Italy
| | - Cristina Ferrari
- Laboratory of Experimental Oncology, IRCCS-Rizzoli Orthopaedic Institute, Bologna, Italy
| | - Davide Maria Donati
- Department of Orthopaedic Surgery, IRCCS-Rizzoli Orthopaedic Institute, Bologna, Italy
| | - Piero Picci
- Laboratory of Experimental Oncology, IRCCS-Rizzoli Orthopaedic Institute, Bologna, Italy
| | - Stefano Ferrari
- Chemotherapy Section, IRCCS-Rizzoli Orthopaedic Institute, Bologna, Italy
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Kadhim M, Oyoun NA, Womer RB, Dormans JP. Clinical and radiographic presentation of pelvic sarcoma in children. SICOT J 2018; 4:44. [PMID: 30339522 PMCID: PMC6195345 DOI: 10.1051/sicotj/2018040] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Accepted: 08/10/2018] [Indexed: 11/29/2022] Open
Abstract
Introduction: Pelvic sarcomas may present with vague symptoms. The aim of this study was to examine the characteristics and clinical presentations of different types of pelvic sarcoma in children. Methods: This is a retrospective cohort study of patients up to 21 years of age with the diagnosis of pelvic sarcoma between January 2000 and June 2013. Data on demographics, tumor type and location, and clinical presentation were collected from the medical records. Results: A total of 59 patients [37 males (62.7%) and 22 females (37.3%)] were examined in this study. Mean age at presentation was 11.3 ± 5 years (range 0.8–21 years). Thirty-six patients had Ewing sarcoma (61%), 9 osteosarcoma (6.8%), 4 undifferentiated sarcoma (6.8%), 2 (3.4%) rhabdomyosarcoma, 2 synovial cell sarcoma, and one (1.7%) of each fibrosarcoma, dermatofibrosarcoma, fibromyxoid sarcoma, chondrosarcoma, chordoma, and epithelioid sarcoma. Pain at presentation was reported in 41 patients, 13 mass, 8 limping, and 5 neurologic symptoms. Most of the bony tumors were painful (77%), while most of the soft tissue tumors were painless (70%). Nine patients presented with constitutional symptoms. Most patients presented within 4–12 months from symptoms beginning. Twenty-one patients (35.6%) presented with metastases (14 Ewing sarcoma, 6 osteosarcoma, and 1 synovial cell sarcoma). Pelvic radiographs showed lytic lesion in 11 patients, 4 sclerotic lesions, 6 mixed lesion, 6 had only soft tissue mass, 1 radiograph showed osteopenia, and 2 radiographs were reported normal. Conclusion: Ewing sarcoma was the most common pelvic sarcoma tumor in children. In most cases, pelvic sarcoma in children presented with pain mimicking other benign conditions. Some patients presented with metastatic disease with no prognostic clinical or radiographical signs or symptoms. Pelvic sarcoma should be considered a differential diagnosis as part of children work up.
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Affiliation(s)
- Muayad Kadhim
- Department of Orthopaedic Surgery, Louisiana State University Health Science Center, Children's Hospital of New Orleans, New Orleans, LA 70112, USA
| | - Nariman Abol Oyoun
- Department of Orthopeadic Surgery, Assiut University Hospital, Assiut, Egypt
| | - Richard B Womer
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA
| | - John P Dormans
- Department of Orthopaedics, Indiana University School of Medicine, Indianapolis, IN 46202, USA
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6
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Schlegel M, Zeumer M, Prodinger PM, Woertler K, Steinborn M, von Eisenhart-Rothe R, Burdach S, Rechl H, von Luettichau I. Impact of Pathological Fractures on the Prognosis of Primary Malignant Bone Sarcoma in Children and Adults: A Single-Center Retrospective Study of 205 Patients. Oncology 2018; 94:354-362. [PMID: 29656296 DOI: 10.1159/000487142] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2017] [Accepted: 01/23/2018] [Indexed: 12/18/2022]
Abstract
BACKGROUND The purpose of this study was to investigate whether pathological fractures (PF) influence the prognosis of patients with osteosarcoma (OS) or Ewing tumor (ET) regarding 5-year survival, occurrence of metastases, and local recurrence. METHODS We retrospectively analyzed 205 patients with metastatic and nonmetastatic OS or ET. Survival analysis was performed for all patients and differentiated for patients with OS (n = 127) and ET (n = 78) as well as for adults (n = 101) and children (n = 104). RESULTS Patients with PF showed survival rates of 64% compared to 83% for those without PF (p = 0.023). Local recurrence occurred in 7% of the patients without and in 24% of those with PF (p = 0.023). In patients with ET and in children, survival analysis showed no significant difference between patients with and without PF in survival and local recurrence rates. In patients with OS, survival rate decreased from 83 to 59% (p = 0.024) and local recurrence rate increased from 13 to 30% (p = 0.042). In adults, survival rate decreased from 78 to 51% (p = 0.004) and local recurrence rate increased from 13 to 42% (p < 0.001). In multivariate analysis, age and PF were associated with inferior survival. CONCLUSION This study suggests that the occurrence of PF has a negative impact on survival and implicates an increased risk of local recurrence. In children and in patients with ET, PF did not have a prognostic impact.
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Affiliation(s)
- Miriam Schlegel
- Department of Pediatrics, Wilhelm Sander Sarcoma Unit, Kinderklinik München Schwabing, Klinikum rechts der Isar, Fakultät für Medizin, Technische Universität München, Munich, Germany
| | - Martina Zeumer
- Department of Pediatrics, Wilhelm Sander Sarcoma Unit, Kinderklinik München Schwabing, Klinikum rechts der Isar, Fakultät für Medizin, Technische Universität München, Munich, Germany
| | - Peter Michael Prodinger
- Department of Orthopedic Surgery, Wilhelm Sander Sarcoma Unit, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Klaus Woertler
- Department of Radiology, Wilhelm Sander Sarcoma Unit, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Marc Steinborn
- Department of Radiology, Klinikum Schwabing, Comprehensive Cancer Center Munich, Munich, Germany
| | - Rüdiger von Eisenhart-Rothe
- Department of Orthopedic Surgery, Wilhelm Sander Sarcoma Unit, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Stefan Burdach
- Department of Pediatrics, Wilhelm Sander Sarcoma Unit, Kinderklinik München Schwabing, Klinikum rechts der Isar, Fakultät für Medizin, Technische Universität München, Munich, Germany
| | - Hans Rechl
- Department of Orthopedic Surgery, Wilhelm Sander Sarcoma Unit, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Irene von Luettichau
- Department of Pediatrics, Wilhelm Sander Sarcoma Unit, Kinderklinik München Schwabing, Klinikum rechts der Isar, Fakultät für Medizin, Technische Universität München, Munich, Germany
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Baptista AM, Zumárraga JP, Santos RPND, Haubert GDO, Camargo OPD. SERUM VALUES OF ALKALINE PHOSPHATASE AND LACTATE DEHYDROGENASE IN EWING'S SARCOMA. ACTA ORTOPEDICA BRASILEIRA 2016; 24:196-199. [PMID: 28243173 PMCID: PMC5035691 DOI: 10.1590/1413-785220162404161312] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To study the relationship between the serum levels of alkaline phosphatase (AP) and lactate dehydrogenase (LDH), and the percentage of tumor necrosis (TN) in patients with Ewing´s Sarcoma (ES) . METHODS This is a case series with retrospective evaluation of patients with diagnosis of ES divided into 2 groups: Group 1, patients whose serum levels of alkaline phosphatase (ALP) and lactate dehydrogenase (LDH) were obtained in the staging phase before preoperative chemotherapy (CT), and Group 2, patients whose values were measured after completion of the preoperative CT. The percentage of tumor necrosis (TN) of surgical specimens extracted in surgery was also evaluated . RESULTS Eighty four medical records from 1995 to 2015 were included. Both AP as LDH decreased in the patients studied, the pre CT value being higher than the post CT value. The average decrease of LHD was 272.95 U/L and AP was 10.17 U/L. The average tumor necrosis was 65.12 %. There was no statistical correlation between serums levels and the tumor necrosis percentage . CONCLUSION The serum levels values of AP and LDH are not predictors for chemotherapy-induced necrosis in patients with ES. Level of Evidence IV, Case Series.
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Lissat A, Joerschke M, Shinde DA, Braunschweig T, Meier A, Makowska A, Bortnick R, Henneke P, Herget G, Gorr TA, Kontny U. IL6 secreted by Ewing sarcoma tumor microenvironment confers anti-apoptotic and cell-disseminating paracrine responses in Ewing sarcoma cells. BMC Cancer 2015. [PMID: 26215971 PMCID: PMC4517368 DOI: 10.1186/s12885-015-1564-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Background The prognosis of patients with Ewing sarcoma (ES) has improved over the course of the last decades. However, those patients suffering from metastatic and recurrent ES still have only poor chances of survival and require new therapeutic approaches. Interleukin-6 (IL6) is a pleiotropic cytokine expressed by immune cells and a great variety of cancer cells. It induces inflammatory responses, enhances proliferation and inhibits apoptosis in cancer cells, thereby promoting chemoresistance. Methods We investigated expression of IL6, its receptors and the IL6 signal transduction pathway in ES tumor samples and cell lines applying reverse transcriptase PCR, immunoblot and immunohistochemistry. The impact of IL6 on cell viability and apoptosis in ES cell lines was analyzed by MTT and propidium iodide staining, migration assessed by chorioallantoic membrane (CAM) assay. Results Immunohistochemistry proved IL6 expression in the stroma of ES tumor samples. IL6 receptor subunits IL6R and IL6ST were expressed on the surface of ES cells. Treatment of ES cells with rhIL6 resulted in phosphorylation of STAT3. rhIL6 protected ES cells from serum starvation-induced apoptosis and promoted migration. IL6 blood serum levels were elevated in a subgroup of ES patients with poor prognosis. Conclusions These data suggest that IL6 contributes to ES tumor progression by increasing resistance to apoptosis in conditions of cellular stress, such as serum starvation, and by promotion of metastasis. Electronic supplementary material The online version of this article (doi:10.1186/s12885-015-1564-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Andrej Lissat
- Division of Pediatric Hematology and Oncology, Charité - University Medical Center, Berlin, Germany.
| | - Mandy Joerschke
- Division of Pediatric Hematology and Oncology, Department of Pediatrics and Adolescent Medicine, University Medical Center Freiburg, Freiburg, Germany.
| | - Dheeraj A Shinde
- Dheeraj Shinde, Institute of Oncology Research, Via Vincenzo Vela, Bellinzona, 66500, Switzerland.
| | | | - Angelina Meier
- Division of Pediatric Hematology and Oncology, Department of Pediatrics and Adolescent Medicine, University Medical Center Freiburg, Freiburg, Germany.
| | - Anna Makowska
- Division of Pediatric Hematology and Oncology, University Medical Center Aachen, Pauwelsstraße 30, Aachen, 52074, Germany.
| | - Rachel Bortnick
- Division of Pediatric Hematology and Oncology, Department of Pediatrics and Adolescent Medicine, University Medical Center Freiburg, Freiburg, Germany.
| | - Philipp Henneke
- Center for Chronic Immunodeficiency, University Medical Center Freiburg, Freiburg, Germany.
| | - Georg Herget
- Department of Traumatology and Orthopaedics, University Medical Center Freiburg, Freiburg, Germany.
| | - Thomas A Gorr
- Division of Pediatric Hematology and Oncology, Department of Pediatrics and Adolescent Medicine, University Medical Center Freiburg, Freiburg, Germany. .,Institute of Veterinary Physiology, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland.
| | - Udo Kontny
- Division of Pediatric Hematology and Oncology, University Medical Center Aachen, Pauwelsstraße 30, Aachen, 52074, Germany.
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Prognostic value of pretreatment serum lactate dehydrogenase level in patients with solid tumors: a systematic review and meta-analysis. Sci Rep 2015; 5:9800. [PMID: 25902419 PMCID: PMC5386114 DOI: 10.1038/srep09800] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2014] [Accepted: 02/04/2015] [Indexed: 02/06/2023] Open
Abstract
Although most studies have reported that high serum lactate dehydrogenase (LDH) levels are associated with poor prognosis in several malignancies, the consistency and magnitude of the impact of LDH are unclear. We conducted the first comprehensive meta-analysis of the prognostic relevance of LDH in solid tumors. Overall survival (OS) was the primary outcome; progression-free survival (PFS) and disease-free survival (DFS) were secondary outcomes. We identified a total of 68 eligible studies that included 31,857 patients. High LDH was associated with a HR for OS of 1.48 (95% CI = 1.43 to 1.53; P < 0.00001; I2 = 93%), an effect observed in all disease subgroups, sites, stages and cutoff of LDH. HRs for PFS and DFS were 1.70 (95% CI = 1.44 to 2.01; P < 0.00001; I2 = 13%) and 1.86(95% CI = 1.15 to 3.01; P = 0.01; I2 = 88%), respectively. Analysis of LDH as a continuous variable showed poorer OS with increasing LDH (HR 2.11; 95% CI = 1.35 to 3.28). Sensitivity analyses showed there was no association between LDH cutoff and reported HR for OS. High LDH is associated with an adverse prognosis in many solid tumors and its additional prognostic and predictive value for clinical decision-making warrants further investigation.
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10
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Case 2: a 10-year-old girl with hip pain. Pediatr Radiol 2015; 45:640-5. [PMID: 25896334 DOI: 10.1007/s00247-014-3213-8] [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: 01/30/2014] [Revised: 07/03/2014] [Accepted: 10/16/2014] [Indexed: 10/23/2022]
Abstract
In this continuing series designed for pediatric radiology trainees, the imaging management of hip pain and a discovered bony mass are dissected through a specific case of a preadolescent.
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11
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Edwards M, Halton J, Ramphal R, Johnston D. Is time of the essence? Delayed diagnosis of Ewing's sarcoma. BMJ Case Rep 2015; 2015:bcr-2014-208307. [PMID: 25628326 DOI: 10.1136/bcr-2014-208307] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Rarely in modern medicine are we able to observe the natural history of a patient with a sarcoma. This unusual case provides that opportunity. A CT scan was performed on the leg of a 15-year-old boy with a tender soft tissue mass on the lateral aspect of his left calf. Despite showing a lesion consistent with a sarcoma, neither the patient nor his family was informed. Almost a year and a half later, the patient returned and was diagnosed with Ewing's sarcoma. A staging work up showed no metastatic disease. After undergoing chemotherapy and a complete surgical resection of the tumour, the patient remains disease-free 10 years later, indicating that the biology of Ewing's sarcoma may be more important than time to diagnosis in determining outcome.
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Affiliation(s)
- Madeline Edwards
- Department of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada
| | - Jacqueline Halton
- Department of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada
| | - Raveena Ramphal
- Department of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada
| | - Donna Johnston
- Department of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada
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12
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Kopp LM, Hu C, Rozo B, White-Collins A, Huh WW, Yarborough A, Herzog CE, Hingorani P. Utility of bone marrow aspiration and biopsy in initial staging of Ewing sarcoma. Pediatr Blood Cancer 2015; 62:12-5. [PMID: 25174337 DOI: 10.1002/pbc.25212] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Accepted: 07/09/2014] [Indexed: 11/05/2022]
Abstract
BACKGROUND The current standard of care for initial staging of pediatric Ewing sarcoma (EWS) patients is to obtain a bilateral bone marrow aspiration and biopsy (BMAB). The incidence of bone marrow (BM) disease in patients deemed non-metastatic by conventional and metabolic imaging and the concordance of BM positivity with other clinical characteristics are not well established. PROCEDURE This study is a multi-institutional retrospective review of newly diagnosed EWS patients less than 40 years of age with initial staging that included imaging and BMAB. RESULTS A total of 116 patients were eligible with 85 patients considered non-metastatic and 31 considered metastatic by imaging. None of the 85 patients with non-metastatic disease were BMAB positive (0%; 95% CI: 0-4.2%); 13 of the 31 patients with metastases were BMAB positive (41.9%; 95% CI: 24.5-60.9%). Primary tumor size was significantly higher in patients with metastases (P = 0.017). Bone metastasis by imaging had high correlation with BMAB positivity (P = 0.0002). In addition, the number of bony metastatic sites was significantly higher in patients with a positive BMAB as compared to those with a negative BMAB (median 3.5 and 0.0, respectively; P < 0.001). CONCLUSIONS BMAB may not be required for initial staging of pediatric and young adult EWS patients deemed non-metastatic by imaging. In patients with metastatic disease, there is a high correlation of BM involvement with multiple bone metastases.
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Affiliation(s)
- Lisa M Kopp
- Department of Pediatrics, Division of Hematology/Oncology/BMT University of Arizona, Tucson, Arizona
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13
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Raciborska A, Bilska K, Rychlowska-Pruszynska M, Drabko K, Chaber R, Pogorzała M, Połczyńska K, Godziński J, Rodriguez-Galindo C, Wożniak W. Internal hemipelvectomy in the management of pelvic Ewing sarcoma - are outcomes better than with radiation therapy? J Pediatr Surg 2014; 49:1500-4. [PMID: 25280655 DOI: 10.1016/j.jpedsurg.2014.04.013] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2013] [Revised: 03/10/2014] [Accepted: 04/25/2014] [Indexed: 12/18/2022]
Abstract
BACKGROUND Pelvic Ewing sarcoma (ES) is commonly associated with a worse prognosis. Large size and location limit local control options to radiation therapy, and local recurrences are common. We evaluated the impact of hemipelvectomy and radiation on outcomes, including function. MATERIALS AND METHODS Thirty-nine patients (median age 13.5years) with ES of the pelvis and sacral bones were treated during the period 2000-2012. Fifteen were treated with definitive radiotherapy (RT), 9 patients underwent hemipelvectomy alone, and 15 were treated with combined hemipelvectomy and RT. RESULTS Twenty patients (51.2%) are alive with a median follow-up 3.2years from diagnosis. Median time from diagnosis to relapse was 1.3years. Three-year estimates of EFS and OS were 47% and 61%, respectively. Patients treated with surgery or surgery with RT had better outcome than patients treated with RT only (3-year OS 78% or 81% vs. 36%, respectively, p=0.00083). The outcome of patients with pelvic ES treated with hemipelvectomy was not significantly different from the outcome of all patients with Ewing sarcoma treated on the national Polish protocol. CONCLUSIONS Internal hemipelvectomy offers good chances of cure for patients with pelvic ES, with a reasonable rate of complications and good function.
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Affiliation(s)
- Anna Raciborska
- Department of Surgical Oncology for Children and Youth, Institute of Mother and Child, Warsaw, Poland.
| | - Katarzyna Bilska
- Department of Surgical Oncology for Children and Youth, Institute of Mother and Child, Warsaw, Poland
| | | | - Katarzyna Drabko
- Department of Pediatric Hematology, Oncology and Transplantology, Medical University of Lublin, Lublin, Poland
| | - Radosław Chaber
- Department and Clinic of Pediatric Oncology, Hematology and Bone Marrow Transplantation, Wroclaw Medical University, Wroclaw, Poland
| | - Monika Pogorzała
- Department of Pediatric Hematology and Oncology Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland
| | - Katarzyna Połczyńska
- Department of Pediatric Hematology and Oncology, Medical University of Gdansk, Gdansk, Poland
| | - Jan Godziński
- Department of Paediatric Surgery Marciniak Hospital, Chair of Emergency Medicine, Medical University, Wroclaw, Poland
| | - Carlos Rodriguez-Galindo
- Pediatric Oncology, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Harvard Medical School, Boston, TX
| | - Wojciech Wożniak
- Department of Surgical Oncology for Children and Youth, Institute of Mother and Child, Warsaw, Poland
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14
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Biswas B, Rastogi S, Khan SA, Shukla NK, Deo SVS, Agarwala S, Sharma DN, Thulkar S, Vishnubhatla S, Pathania S, Bakhshi S. Hypoalbuminaemia is an independent predictor of poor outcome in metastatic Ewing's sarcoma family of tumours: a single institutional experience of 150 cases treated with uniform chemotherapy protocol. Clin Oncol (R Coll Radiol) 2014; 26:722-9. [PMID: 24919857 DOI: 10.1016/j.clon.2014.05.006] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2013] [Revised: 03/28/2014] [Accepted: 05/12/2014] [Indexed: 01/30/2023]
Abstract
AIMS Data on metastatic Ewing's sarcoma family of tumours (ESFT) with uniform chemotherapy protocol are minimal. MATERIALS AND METHODS This was a single institutional patient review of patients treated between June 2003 and November 2011 and evaluated on an intent-to-treat analysis. All patients received uniform chemotherapy: neoadjuvant chemotherapy (NACT), surgery and/or radiotherapy as local treatment followed by adjuvant chemotherapy. Local treatment was offered if the patient achieved a complete response and/or a partial response at both the primary and the metastatic site. RESULTS In total, 150/374 (40%) ESFT patients were metastatic, with a median age of 15 years (range: 2-50); a tumour diameter of 10 cm (range: 1.8-26). Most common metastatic sites were lung only (53; 35%), bone only (35; 23%) and combined bone/lung (25; 17%). Twenty patients underwent surgery; 55 patients received radical radiotherapy after NACT. After a median follow-up of 26.1 months (range: 1.6-101.6), 5 year event-free survival (EFS), overall survival and local control rate (LCR) were 9.1 ± 3.3%, 16.9 ± 5.2% and 31.8 ± 7.9%, respectively. Univariate analysis showed serum albumin ≤3.4 g/dl (P < 0.001) to predict inferior EFS. Tumour size >8 cm (P = 0.05), haemoglobin ≤10 g/dl (P = 0.04), hypoalbuminaemia (P = 0.003) and radical radiotherapy as local treatment (P = 0.03) predicted inferior overall survival. No factor significantly predicted LCR, although age ≤15 years (P = 0.08) and radical radiotherapy as local treatment (P = 0.09) had a trend towards inferior LCR. Hypoalbuminaemia was the only prognostic factor to predict EFS on multivariate analysis. CONCLUSION This was the largest study of metastatic ESFT from Asia and identified a unique prognostic factor. In view of dismal prognosis with conventional chemotherapy in metastatic ESFT with hypoalbuminaemia, palliative intent therapy may be a potential therapeutic alternative for this subgroup of patients, especially in resource-challenged situations.
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Affiliation(s)
- B Biswas
- Department of Medical Oncology, Dr B.R. Ambedkar Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - S Rastogi
- Department of Orthopedics, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - S A Khan
- Department of Orthopedics, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - N K Shukla
- Department of Surgical Oncology, Dr B.R. Ambedkar Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - S V S Deo
- Department of Surgical Oncology, Dr B.R. Ambedkar Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - S Agarwala
- Department of Pediatric Surgery, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - D N Sharma
- Department of Radiotherapy, Dr B.R. Ambedkar Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - S Thulkar
- Department of Radiodiagnosis, Dr B.R. Ambedkar Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - S Vishnubhatla
- Department of Biostatistics, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - S Pathania
- Department of Medical Oncology, Dr B.R. Ambedkar Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - S Bakhshi
- Department of Medical Oncology, Dr B.R. Ambedkar Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India.
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15
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Brasme JF, Chalumeau M, Oberlin O, Valteau-Couanet D, Gaspar N. Time to diagnosis of Ewing tumors in children and adolescents is not associated with metastasis or survival: a prospective multicenter study of 436 patients. J Clin Oncol 2014; 32:1935-40. [PMID: 24841977 DOI: 10.1200/jco.2013.53.8058] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
PURPOSE The time to diagnosis (TtD) of Ewing tumors is one of the longest among pediatric tumors. Its precise consequences, however, have not been studied well. We analyzed the distribution of TtD for Ewing tumors in children and adolescents and its association with clinical features, tumor characteristics, surgical outcome, and long-term survival. PATIENTS AND METHODS We analyzed prospectively collected data from two multicenter clinical trials of patients younger than 21 years old who had Ewing bone tumors treated in France between 1988 and 2000. Clinical and tumoral features, TtD, and outcome associations were studied by univariable and multivariable analyses. RESULTS The median TtD for the 436 patients was 70 days (interquartile range, 27 to 146 days), with no significant decrease during the study period (P > .2). The factors associated with long TtD were older age and some tumor sites (pelvis, extremities of limbs). Increased tumor volume and decreased histologic response to chemotherapy were associated with long TtD on univariable analysis (P < .05) but not after adjustment. Presence of a nerve or spinal-cord compression at diagnosis, presence or site of metastasis, surgical treatment, mutilating surgery, complete resection, or survival were not associated with TtD. CONCLUSION TtD of Ewing tumors was long, especially for adolescents and for certain tumor sites, and did not improve over time. But TtD was not associated with metastasis, surgical outcome, or survival. These findings could be used to comfort parents at diagnosis and in expert testimony produced for malpractice claims.
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Affiliation(s)
- Jean-François Brasme
- Jean-François Brasme, Martin Chalumeau, INSERM U953; Jean-François Brasme, Martin Chalumeau, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris; Jean-François Brasme, Martin Chalumeau, Université Paris Descartes, Paris; Jean-François Brasme, Odile Oberlin, Dominique Valteau-Couanet, Nathalie Gaspar, Institut Gustave Roussy, Villejuif; Jean-François Brasme, Odile Oberlin, Dominique Valteau-Couanet, Nathalie Gaspar, Université Paris Sud, Le Kremlin Bicêtre, France.
| | - Martin Chalumeau
- Jean-François Brasme, Martin Chalumeau, INSERM U953; Jean-François Brasme, Martin Chalumeau, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris; Jean-François Brasme, Martin Chalumeau, Université Paris Descartes, Paris; Jean-François Brasme, Odile Oberlin, Dominique Valteau-Couanet, Nathalie Gaspar, Institut Gustave Roussy, Villejuif; Jean-François Brasme, Odile Oberlin, Dominique Valteau-Couanet, Nathalie Gaspar, Université Paris Sud, Le Kremlin Bicêtre, France
| | - Odile Oberlin
- Jean-François Brasme, Martin Chalumeau, INSERM U953; Jean-François Brasme, Martin Chalumeau, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris; Jean-François Brasme, Martin Chalumeau, Université Paris Descartes, Paris; Jean-François Brasme, Odile Oberlin, Dominique Valteau-Couanet, Nathalie Gaspar, Institut Gustave Roussy, Villejuif; Jean-François Brasme, Odile Oberlin, Dominique Valteau-Couanet, Nathalie Gaspar, Université Paris Sud, Le Kremlin Bicêtre, France
| | - Dominique Valteau-Couanet
- Jean-François Brasme, Martin Chalumeau, INSERM U953; Jean-François Brasme, Martin Chalumeau, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris; Jean-François Brasme, Martin Chalumeau, Université Paris Descartes, Paris; Jean-François Brasme, Odile Oberlin, Dominique Valteau-Couanet, Nathalie Gaspar, Institut Gustave Roussy, Villejuif; Jean-François Brasme, Odile Oberlin, Dominique Valteau-Couanet, Nathalie Gaspar, Université Paris Sud, Le Kremlin Bicêtre, France
| | - Nathalie Gaspar
- Jean-François Brasme, Martin Chalumeau, INSERM U953; Jean-François Brasme, Martin Chalumeau, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris; Jean-François Brasme, Martin Chalumeau, Université Paris Descartes, Paris; Jean-François Brasme, Odile Oberlin, Dominique Valteau-Couanet, Nathalie Gaspar, Institut Gustave Roussy, Villejuif; Jean-François Brasme, Odile Oberlin, Dominique Valteau-Couanet, Nathalie Gaspar, Université Paris Sud, Le Kremlin Bicêtre, France
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16
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Abstract
Ewing's sarcoma of bone is a primary bone sarcoma found predominantly in patients during their second decade of life. It is a high-grade aggressive small round blue cell tumor that is part of the Ewing's family of tumors. Its exact eitiology is unknown but it commonly demonstrates reproducible staining of CD99 and translocations of the EWS gene. Historically, this diagnosis was associated with near certain metastasis and subsequent mortality. However, current management consists of extensive chemotherapy in addition to local control with surgical resection and/or radiation. As a result, survival has improved to the 55-75% range in those patients who present without known metastases. Current research aims to continue this improvement by looking further into the associated gene abnormalities and possibly targeted therapies.
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Affiliation(s)
- Drew D Moore
- Department of Orthopedic Surgery and Rehabilitation Medicine, The University of Chicago, 5841 South Maryland, MC 3079, Chicago, IL, 60637, USA
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17
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Délais diagnostiques des sarcomes d’Ewing de l’enfant : distribution, déterminants et conséquences. Arch Pediatr 2013. [DOI: 10.1016/s0929-693x(13)71319-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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18
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Brasme JF, Morfouace M, Grill J, Martinot A, Amalberti R, Bons-Letouzey C, Chalumeau M. Delays in diagnosis of paediatric cancers: a systematic review and comparison with expert testimony in lawsuits. Lancet Oncol 2012; 13:e445-59. [PMID: 23026830 DOI: 10.1016/s1470-2045(12)70361-3] [Citation(s) in RCA: 115] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Delayed diagnosis of paediatric cancers is reported regularly and is a source of remorse for physicians and parents and a leading cause of malpractice claims. We did a systematic review of information about the distribution, determinants, and consequences of time to diagnosis of paediatric malignancies and compared these findings with those of court-appointed expert witnesses in malpractice claims in Canada and France. Time to diagnosis varied widely between tumour types in the 98 relevant studies (medians ranged from 2-260 weeks) without any significant decrease with time. Determinants of a long delay in diagnosis included older age, qualification of the first physician contacted, non-specific symptoms, histological type, and tumour localisation. Delayed diagnosis was associated with poor outcome for retinoblastoma and possibly for leukaemia, nephroblastoma, and rhabdomyosarcoma (data were insufficient for definitive conclusions). It was not associated with an adverse outcome for most CNS tumours, osteosarcoma or Ewing's sarcoma, and, paradoxically, was frequently associated with better outcomes than was short time to diagnosis in these cancers. A third of the court-appointed experts provided testimony concordant with the medical literature. The relations between delay in diagnosis and outcome are complex and probably depend more on tumour biology than on parental or medical factors.
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Affiliation(s)
- Jean-François Brasme
- INSERM U953, Epidemiological Research Unit on Perinatal Health and Women's and Children's Health, Hôpital Saint-Vincent-de-Paul, Paris, France.
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19
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Abstract
Sarcomas are the most common nonhematologic primary malignancies of bones in the pelvis. Chondrosarcoma, osteosarcoma, and Ewing's sarcoma are the most common sarcomas to originate from the pelvic bones. Various imaging modalities such as magnetic resonance imaging and computed tomography play an important role in the detection, characterization, and staging of these lesions. Biopsy, usually performed with imaging guidance, is essential for the histologic diagnosis of these tumors and for planning therapeutic options. Despite considerable advances in treatment options, sarcomas in the pelvic bones generally are associated with poorer outcomes than sarcomas in the appendicular skeleton because of the larger size of the lesions at the time of discovery and the difficulty of obtaining a wide surgical resection margin. In this review, we discuss the various types of pelvic bone sarcomas and the role of imaging in patients with these lesions.
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Affiliation(s)
- Prabhakar Rajiah
- Section of Musculoskeletal Radiology, Imaging Institute, Cleveland Clinic, Cleveland, OH, USA.
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20
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Scotti C, Marone EM, Brasca LE, Peretti GM, Chiesa R, Del Maschio A, Fraschini G, Camnasio F. Pseudoaneurysm overlying an osteochondroma: a noteworthy complication. J Orthop Traumatol 2010; 11:251-5. [PMID: 21103904 PMCID: PMC3014466 DOI: 10.1007/s10195-010-0116-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2009] [Accepted: 10/19/2010] [Indexed: 10/25/2022] Open
Abstract
Pseuodaneurysms are an extremely rare complication of osteochondromas. We describe a case of traumatic pseudoaneurysm of the brachial artery presenting as a soft tissue mass in a patient who was treated for an osteochondroma 3 years earlier. This case demonstrates that radiographic follow-up of large osteochondromas is mandatory and that, in patients with soft tissue masses and a history of osteochondroma, pseudoaneurysms should be included in the differential diagnosis.
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Affiliation(s)
- Celeste Scotti
- Department of Orthopaedics and Traumatology, San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
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21
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Dobbs MD, Lowas SR, Hernanz-Schulman M, Holt GE, Yu C, Kan JH. Impact of abdominopelvic CT on Ewing sarcoma management. Acad Radiol 2010; 17:1288-91. [PMID: 20634109 DOI: 10.1016/j.acra.2010.06.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2010] [Revised: 05/25/2010] [Accepted: 06/10/2010] [Indexed: 10/19/2022]
Abstract
RATIONALE AND OBJECTIVES Abdominopelvic computed tomography (APCT) is often performed in patients with skeletal Ewing sarcoma family of tumors during initial staging and for subsequent clinical indications, such as metastasis surveillance; however, its clinical impact is unknown. The purpose of this study was to evaluate whether these computed tomographic examinations alter oncologic management and therefore patient outcomes. MATERIALS AND METHODS One hundred eight consecutive patients with skeletal Ewing sarcoma family of tumors seen from 1985 to 2008 were retrospectively reviewed to identify imaging workup, pathology, primary site, evidence of metastatic disease, and patient outcomes. Data were analyzed using Wilcoxon's rank sum tests. RESULTS Sixty-five of the 108 patients (60%) underwent 342 abdominopelvic computed tomographic examinations during a mean follow-up period of 8.9 years. During this time period, only one of the 65 patients (1.5%) who underwent APCT was discovered to have abdominal metastatic disease. There was no significant difference in the incidence of metastatic disease to the skeleton or chest between the groups without and with APCT (P = .10). There were 26 pelvic and lumbosacral primaries (24%) and 82 limb primaries (76%). Subgroup analysis performed on the 82 patients with limb primaries without (n = 36) and with (n = 46) APCT showed no significant differences in metastatic incidence to the skeleton or chest (P = .14). CONCLUSIONS This study indicates that APCT, associated with increased radiation exposure and health expenditure, has a limited role in initial staging and follow-up in patients with skeletal Ewing sarcoma, particularly in patients with limb primaries.
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22
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Puchalski A. Ewing Sarcoma Family of Tumors. JOURNAL OF DIAGNOSTIC MEDICAL SONOGRAPHY 2010. [DOI: 10.1177/8756479310381530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The diagnosis and management of Ewing sarcoma is laborious and requires the correlation of multiple imaging modalities. This is an aggressive, malignant tumor of bone and soft tissue. Ewing sarcoma rarely affects individuals older than 20 years of age. Clinical symptoms are variable and nonspecific. Biopsy is the only definitive diagnosis. Multimodality medical imaging plays a great role in visualizing the tumor, documenting metastatic spread, tumor staging, associated complications, and response to therapy. Standard treatment of Ewing sarcoma is a multimodal therapeutic regimen, including chemotherapy, surgery, and radiation. Prognosis depends on tumor location, presence of metastases, and tumor size.
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Affiliation(s)
- Amy Puchalski
- St. Luke's Hospital and Health Network, Bethlehem, Pennsylvania,
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23
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Abstract
The Ewing sarcoma family of tumors (ESFT) consists of a group of tumors characterized by morphologically similar round-cell neoplasm and by the presence of a common chromosomal translocation. Although rare, such tumors constitute the third most frequent primary sarcoma of bone after osteosarcoma and chondrosarcoma. ESFT most commonly affects young children and adolescents. Because most patients with clinically apparent localized disease at diagnosis may also have occult metastatic (ie, systemic) disease, multidrug chemotherapy as well as local disease control with surgery and/or radiation therapy are indicated for all patients. Despite marked improvements in survival during the past 40 years for patients with localized disease, lesser improvements have been seen in patients with metastatic or recurrent disease. A better understanding of the complex biology of ESFT may lead to the successful development of biologically targeted therapies. As the regulatory pathways responsible for transformation, growth, and metastasis of ESFT become more refined, the number of potential therapeutic targets will expand.
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Chang YH, Wu CC, Chang KP, Yu JS, Chang YC, Liao PC. Cell Secretome Analysis Using Hollow Fiber Culture System Leads to the Discovery of CLIC1 Protein as a Novel Plasma Marker for Nasopharyngeal Carcinoma. J Proteome Res 2009; 8:5465-74. [DOI: 10.1021/pr900454e] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Ying-Hwa Chang
- Institute of Biopharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan, Molecular Medicine Research Center, Chang Gung University, Tao-Yuan, Taiwan, Department of Otolaryngology-Head Neck Surgery, Chang Gung Memorial Hospital, Lin-Kou, Taiwan, Department of Biochemistry and Molecular Biology, Chang Gung University, Tao-Yuan, Taiwan, Department of Environmental and Occupational Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan, and
| | - Chih-Ching Wu
- Institute of Biopharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan, Molecular Medicine Research Center, Chang Gung University, Tao-Yuan, Taiwan, Department of Otolaryngology-Head Neck Surgery, Chang Gung Memorial Hospital, Lin-Kou, Taiwan, Department of Biochemistry and Molecular Biology, Chang Gung University, Tao-Yuan, Taiwan, Department of Environmental and Occupational Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan, and
| | - Kai-Ping Chang
- Institute of Biopharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan, Molecular Medicine Research Center, Chang Gung University, Tao-Yuan, Taiwan, Department of Otolaryngology-Head Neck Surgery, Chang Gung Memorial Hospital, Lin-Kou, Taiwan, Department of Biochemistry and Molecular Biology, Chang Gung University, Tao-Yuan, Taiwan, Department of Environmental and Occupational Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan, and
| | - Jau-Song Yu
- Institute of Biopharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan, Molecular Medicine Research Center, Chang Gung University, Tao-Yuan, Taiwan, Department of Otolaryngology-Head Neck Surgery, Chang Gung Memorial Hospital, Lin-Kou, Taiwan, Department of Biochemistry and Molecular Biology, Chang Gung University, Tao-Yuan, Taiwan, Department of Environmental and Occupational Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan, and
| | - Yu-Chen Chang
- Institute of Biopharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan, Molecular Medicine Research Center, Chang Gung University, Tao-Yuan, Taiwan, Department of Otolaryngology-Head Neck Surgery, Chang Gung Memorial Hospital, Lin-Kou, Taiwan, Department of Biochemistry and Molecular Biology, Chang Gung University, Tao-Yuan, Taiwan, Department of Environmental and Occupational Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan, and
| | - Pao-Chi Liao
- Institute of Biopharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan, Molecular Medicine Research Center, Chang Gung University, Tao-Yuan, Taiwan, Department of Otolaryngology-Head Neck Surgery, Chang Gung Memorial Hospital, Lin-Kou, Taiwan, Department of Biochemistry and Molecular Biology, Chang Gung University, Tao-Yuan, Taiwan, Department of Environmental and Occupational Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan, and
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25
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Abstract
Ewing sarcoma accounts for about 2% to 3% of childhood tumors and can occur in any bone, but it is most often found in extremities and central axis. Ewing sarcoma affecting clavicle is uncommon. We report 5 cases of Ewing sarcoma of clavicle treated in our institution. The mean age at the time of diagnosis was 11.6 years (2 to 15 y). There were 3 males and 2 females. All patients received chemotherapy before and after the surgery. Likewise, radiotherapy was administrated after tumor excision in one patient. Different methods of surgical treatment were used and included: claviculectomy, claviculectomy and vascularized fibular autograft, and claviculectomy and clavicle allograft. One patient died during the follow-up because of the recurrence of the tumor and presence of metastatic disease. The remaining 4 patients had good functional outcomes with no pain of the shoulder at final follow-up. In conclusion, Ewing sarcoma of clavicle is a very rare tumor and different methods of surgical treatment can be used. Clavicle often can be resected with no need for reconstruction, especially in young children. Autografts or allografts can restore the normal anatomy of the shoulder.
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26
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Palmerini E, Staals EL, Ferrari S, Bacci G. Diagnosis and prognosis for the Ewing family of tumors. ACTA ACUST UNITED AC 2009; 3:445-52. [PMID: 23485211 DOI: 10.1517/17530050902832830] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Ewing's sarcoma was first described by James Ewing in 1921. It is the second most common bone sarcoma seen in children, adolescents and young adults after osteosarcoma and belongs to the group of 'small round blue cell tumors', showing an aggressive natural history. Once almost invariably fatal and treated only with palliative radiation, thanks to a multidisciplinary approach, the probability of survival at 5 years is now ∼ 65 - 75% for patients with localized disease. This percentage is no more than 20 - 25% for patients with metastatic disease at presentation. OBJECTIVE To review epidemiology, diagnosis and prognosis of Ewing's sarcoma family tumors (EFT) of bone. This entity includes a wide spectrum of tumors, from the less differentiated or classic Ewing's sarcoma to the more differentiated peripheral neuroectodermal tumor. A translocation involving the EWS gene on the chromosome 22 band q12 is characteristic of EFTs. CONCLUSION A complete clinical and radiological assessment is essential for initial patient evaluation. Owing to the rarity of this entity, whenever an EFT is suspected patients should be referred to a bone tumor treatment center before a diagnostic biopsy is performed. The molecular characterization of chromosomal translocations has an important role in the diagnosis of EFT.
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Affiliation(s)
- Emanuela Palmerini
- Istituto Ortopedico Rizzoli, Department of Musculoskeletal Oncology, Via Pupilli 1, 40136 Bologna, Italy +39 051 6366 829 ; +39 051 6366 277 ;
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Krieg AH, Mani M, Speth BM, Stalley PD. Extracorporeal irradiation for pelvic reconstruction in Ewing’s sarcoma. ACTA ACUST UNITED AC 2009; 91:395-400. [DOI: 10.1302/0301-620x.91b3.21164] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
We review the treatment of pelvic Ewing’s sarcoma by the implantation of extracorporeally-irradiated (ECI) autografts and compare the outcome with that of other reported methods. We treated 13 patients with ECI autografts between 1994 and 2004. There were seven males and six females with a median age of 15.7 years (interquartile range (IQR) 12.2 to 21.7). At a median follow-up of five years (IQR 1.8 to 7.4), the disease-free survival was 69% overall, and 75% if one patient with local recurrence after initial treatment elsewhere was excluded. Four patients died from distant metastases at a mean of 17 months (13 to 23). There were three complications which required operative intervention; one was a deep infection which required removal of the graft. The functional results gave a mean Musculoskeletal Tumor Society score of 85% (60% to 97%), a mean Toronto extremity salvage score of 86% (69% to 100%) and a mean Harris hip score of 92 (67 to 100). We conclude that ECI grafting is a suitable form of treatment for localised and resectable pelvic Ewing’s sarcoma.
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Affiliation(s)
- A. H. Krieg
- Orthopaedic Department University Children’s Hospital (UKBB), P. O. Box, Römergasse 8, 4005 Basel, Switzerland
| | - M. Mani
- Orthopaedic Department University Children’s Hospital (UKBB), P. O. Box, Römergasse 8, 4005 Basel, Switzerland
| | - B. M. Speth
- Orthopaedic Department University Children’s Hospital (UKBB), P. O. Box, Römergasse 8, 4005 Basel, Switzerland
| | - P. D. Stalley
- Orthopaedic Department Royal Prince Alfred Hospital, Missenden Road, Camperdown, New South Wales, Australia
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