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Primary and radiation induced skull base osteosarcoma: a systematic review of clinical features and treatment outcomes. J Neurooncol 2021; 153:183-202. [PMID: 33999382 DOI: 10.1007/s11060-021-03757-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 04/09/2021] [Indexed: 01/28/2023]
Abstract
PURPOSE We aim to systematically review and summarize the demographics, clinical features, management strategies, and clinical outcomes of primary and radiation-induced skull-base osteosarcoma (SBO). METHODS PubMed, Scopus, and Cochrane databases were used to identify relevant articles. Papers including SBO cases and sufficient clinical outcome data were included. A comprehensive clinical characteristic review and survival analysis were also conducted. RESULTS Forty-one studies describing 67 patients were included. The median age was 31 years (male = 59.7%). The middle skull-base was most commonly involved (52.7%), followed by anterior (34.5%) and posterior (12.7%) skull-base. Headache (27%), exophthalmos (18%), and diplopia (10%) were common presenting symptoms. Sixty-eight percent of patients had primary SBO, while 25% had radiation-induced SBO. Surgery was the main treatment modality in 89% of cases. Chemotherapy was administered in 65.7% and radiotherapy in 50%. Median progression-free survival (PFS) was 12 months, and the overall 5-year survival was 22%. The five-year survival rates of radiation-induced SBO and primary SBO were 39% and 16%, respectively (P < 0.05). CONCLUSION SBO is a malignant disease with poor survival outcomes. Surgical resection is the primary management modality, in conjunction with chemotherapy and radiotherapy. Radiation-induced SBO has a superior survival outcome as compared to its primary counterpart. Complete surgical resection showed a statistically insignificant survival benefit as compared to partial resection.
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2
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König M, Osnes TA, Lobmaier I, Bjerkehagen B, Bruland ØS, Sundby Hall K, Meling TR. Multimodal treatment of craniofacial osteosarcoma with high-grade histology. A single-center experience over 35 years. Neurosurg Rev 2016; 40:449-460. [PMID: 27858303 DOI: 10.1007/s10143-016-0802-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Revised: 10/06/2016] [Accepted: 11/09/2016] [Indexed: 11/28/2022]
Abstract
High-grade craniofacial osteosarcoma (CFOS) is an aggressive malignancy with a poor prognosis. Our goals were to evaluate treatment outcomes in those treated at a single referral institution over 35 years and to compare our results to the available literature. A retrospective analysis of all 42 patients treated between 1980 and 2015 at Oslo University Hospital, Norway, identified in a prospectively collected database, was conducted. Mean follow-up was 79.6 months. Overall survival at 2 and 5 years was 70.5 and 44.7%, respectively. The corresponding disease-specific survival rates were 73.0 and 49.8%. Treatment was surgery only in eight cases. Additional therapy was administered in 34 patients: chemotherapy in nine, radiotherapy in seven, and a combination of these in 18 cases. Stratified analysis by resection margins demonstrated significantly better survival at 2 and 5 years after radical surgical treatment. Neoadjuvant chemotherapy and subsequent adequate surgery resulted in better survival than surgery alone. Half of the patients either had a primary or familial cancer predisposition. This is the largest single-center study conducted on high-grade CFOS to date. Our experience indicates that neoadjuvant chemotherapy with complete surgical resection significantly improved survival, compared to surgery alone.
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Affiliation(s)
- Marton König
- Department of Neurosurgery, Oslo University Hospital - Rikshospitalet, 4950 Nydalen, Oslo, 0424, Norway. .,Department of Neurology, Ostfold Hospital Trust, 300, Gralum, 1714, Norway. .,Institute of Clinical Medicine, University of Oslo, 1711 Blindern, Oslo, 0318, Norway.
| | - Terje A Osnes
- Institute of Clinical Medicine, University of Oslo, 1711 Blindern, Oslo, 0318, Norway.,Department of Otorhinolaryngology, Oslo University Hospital - Rikshospitalet, 4950 Nydalen, 0424, Oslo, Norway
| | - Ingvild Lobmaier
- Department of Pathology, Oslo University Hospital - Radiumhospitalet, 4950 Nydalen, Oslo, 0424, Norway
| | - Bodil Bjerkehagen
- Department of Pathology, Oslo University Hospital - Radiumhospitalet, 4950 Nydalen, Oslo, 0424, Norway
| | - Øyvind S Bruland
- Institute of Clinical Medicine, University of Oslo, 1711 Blindern, Oslo, 0318, Norway.,Department of Oncology, Oslo University Hospital - Radiumhospitalet, 4950 Nydalen, Oslo, 0424, Norway
| | - Kirsten Sundby Hall
- Department of Oncology, Oslo University Hospital - Radiumhospitalet, 4950 Nydalen, Oslo, 0424, Norway
| | - Torstein R Meling
- Department of Neurosurgery, Oslo University Hospital - Rikshospitalet, 4950 Nydalen, Oslo, 0424, Norway.,Institute of Clinical Medicine, University of Oslo, 1711 Blindern, Oslo, 0318, Norway
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3
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Hadley C, Gressot LV, Patel AJ, Wang LL, Flores RJ, Whitehead WE, Luerssen TG, Jea A, Bollo RJ. Osteosarcoma of the cranial vault and skull base in pediatric patients. J Neurosurg Pediatr 2014; 13:380-7. [PMID: 24483254 DOI: 10.3171/2013.12.peds13359] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Cranial osteosarcoma is very rare in children, rendering the development of optimal treatment algorithms challenging. The authors present 3 cases of pediatric cranial osteosarcoma: a primary calvarial tumor, a cranial metastasis, and a primary osteosarcoma of the cranial base. A review of the literature demonstrates significant variation in the management of cranial osteosarcomas and the outcome for patients with these tumors. This series and literature review is presented to improve the understanding of pediatric cranial osteosarcoma and to reinforce the importance of maximal resection in optimizing outcome.
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Affiliation(s)
- Caroline Hadley
- Department of Neurosurgery, Baylor College of Medicine and Division of Pediatric Neurosurgery, Texas Children's Hospital
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4
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Novel Oncologic, Surgical, and Prosthetic Treatment of High-Grade Surface Osteosarcoma, Osteoblastic Mandible Type. J Oral Maxillofac Surg 2013; 71:e224-31. [DOI: 10.1016/j.joms.2012.11.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2012] [Revised: 11/06/2012] [Accepted: 11/06/2012] [Indexed: 11/23/2022]
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5
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Aggressive osteoblastoma of the temporal bone: a case report and review of the literature. Clin Imaging 2013; 37:386-9. [DOI: 10.1016/j.clinimag.2012.05.017] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2012] [Accepted: 05/24/2012] [Indexed: 11/21/2022]
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6
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Abstract
The most common primary malignant tumor of the bone is osteosarcoma. Primary involvement of the craniofacial bones in osteosarcoma is relatively rare. The mandible and the maxillae are the most commonly affected bones of the head. Here, we report a rare case of de novo high-grade osteogenic sarcoma of the mastoid region of the temporal bone and discuss the
diagnostic and therapeutic properties.
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Affiliation(s)
- Abdurrahman Işikdogan
- Department of Medical Oncology Ankara University Faculty of Medicine Ibni Sina Hospital, Sihhiye Ankara 06100 Turkey
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7
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Dagcinar A, Bayrakli F, Yapicier O, Ozek M. Primary meningeal osteosarcoma of the brain during childhood. Case report. J Neurosurg Pediatr 2008; 1:325-9. [PMID: 18377310 DOI: 10.3171/ped/2008/1/4/325] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Primary meningeal osteosarcomas are rare tumors, with only 19 reported cases in the literature; only 4 of these, including the present case, are in pediatric patients. In this report, the authors present the case of an 8-year-old boy with a history of generalized tonic-clonic seizures who was found to harbor a meningeal osteosarcoma within the sylvian fissure. Initial working diagnoses included meningioma and glioma. After tumor enlargement and progressive symptoms, the patient underwent a large frontotemporal craniotomy and complete resection of the lesion, which recurred 6 and 12 months after the initial surgery and was surgically treated after each recurrence. The rarity of primary meningeal osteosarcomas can make their diagnosis difficult, and histopathological evaluation is mandatory for diagnosis. Because of their fast progression, they must be treated aggressively by means of surgery, chemotherapy, and radiotherapy.
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Affiliation(s)
- Adnan Dagcinar
- Department of Neurosurgery, Marmara University School of Medicine, Istanbul, Turkey
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8
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Jasnau S, Meyer U, Potratz J, Jundt G, Kevric M, Joos UK, Jürgens H, Bielack SS. Craniofacial osteosarcoma Experience of the cooperative German-Austrian-Swiss osteosarcoma study group. Oral Oncol 2007; 44:286-94. [PMID: 17467326 DOI: 10.1016/j.oraloncology.2007.03.001] [Citation(s) in RCA: 86] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2006] [Revised: 03/05/2007] [Accepted: 03/06/2007] [Indexed: 10/23/2022]
Abstract
The aim of this retrospective analysis was to evaluate patient and tumor characteristics and treatment results and prognostic factors for patients with craniofacial osteosarcoma (CFOS). The COSS database was searched for patients with previously untreated, histologically confirmed craniofacial osteosarcoma with at least one follow-up examination. In a 28-year period extending from 1977 to 2004, 49 eligible patients were identified and their charts retrospectively analysed. The median age at diagnosis was 19.7 years (range: 4.6-57.2) with no gender predilection. Thirteen CFOS were second or even third primary malignancies. The jaws were the primary site in 27 patients (55% - mandible 15 (31%), maxilla 12 (24%)), while extragnathic bones were involved in 22 (45%). All 49 patients underwent surgery; in 37 (76%) combined with chemotherapy, in seven (14%) with chemotherapy and radiotherapy. Twenty-one patients (43%) received preoperative chemotherapy and the other 28 (57%) had primary surgery. A complete surgical remission was achieved in 32 patients, of whom 24 remained in local control. Actuarial five-year overall and event-free survival rates were 74% and 44%, respectively. Extragnathic site (p<.001) and documented postsurgical rest of the primary tumor (p<.001) were associated with inferior overall survival probabilities. All 24 patients who achieved and maintained local surgical control survived disease-free. Multidisciplinary treatment of CFOS within a multicenter setting resulted in long-term survival in well over two thirds of affected patients. Extragnathic sites and failure to achieve and maintain local surgical control emerged as strong negative prognostic factors.
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Affiliation(s)
- Sven Jasnau
- Universitätsklinikum Münster, Klinik und Poliklinik für Kinder- und Jugendmedizin, Pädiatrische Hämatologie und Onkologie, Münster, Germany
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9
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Watanabe T, Fuse T, Umezu M, Yamamoto M, Demura K, Niwa Y. Radiation-Induced Osteosarcoma 16 Years After Surgery and Radiation for Glioma-Case Report-. Neurol Med Chir (Tokyo) 2006; 46:51-4. [PMID: 16434828 DOI: 10.2176/nmc.46.51] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
A 35-year-old man developed osteosarcoma of the left parietal and occipital bones 16 years after radiotherapy for glioma in the right occipital lobe. Radiotherapy of the primary neoplasm used 50 Gy administered to a localized field through two lateral ports. The secondary neoplasm arose contralateral to the primary lesion but within the irradiated field. The tumor had a multilocular cyst with considerable intracranial extension, and symptoms of elevated intracranial pressure were prominent early in the course. After a short-lived initial remission following surgical intervention and chemotherapy, the patient deteriorated because of tumor recurrence and died 18 months after the diagnosis. Radiation-induced osteosarcoma is a well-known but rare complication of radiotherapy for brain neoplasms with a poor prognosis.
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Affiliation(s)
- Takayuki Watanabe
- Department of Neurosurgery, National Hospital Organization Shizuoka Medical Center, Japan
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10
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Sen O, Atalay B, Ozerdem OR, Altinors N, Hurcan C, Bal N, Sener L. Management of fronto-orbital sphenoidal and facial osteosarcoma: a case with uncommon localization. J Craniofac Surg 2005; 16:470-3. [PMID: 15915118 DOI: 10.1097/01.scs.0000157247.86084.79] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Osteogenic sarcomas of the head and neck are rarely seen; approximately 6% to 13% these tumors occur in the head and neck, and less than 2% occur in the cranium. Not only eradication of the tumor but reconstruction to achieve satisfactory esthetic and functional results are the main issues regarding these tumors. In this report, a case of osteogenic sarcoma that invaded the infratemporal area, fronto-orbital region, and sphenoid wing is presented. The surgical results of eradication and reconstruction are also presented.
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Affiliation(s)
- Orhan Sen
- Department of Neurosurgery, Faculty of Medicine, Bashkent University, Adana, Turkey.
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11
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Abe K, Kosuda S, Kusano S, Shima K. Detection of Recurrent Skull Osteosarcoma by Skull Single Photon Emission Computed Tomography Using Tc-99m Methylene Diphosphonate. Clin Nucl Med 2004; 29:72-3. [PMID: 14688610 DOI: 10.1097/01.rlu.0000102766.99886.e9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Katsumi Abe
- Department of Radiology, National Defense Medical College, Tokorozawa, Japan
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12
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Patel SG, Meyers P, Huvos AG, Wolden S, Singh B, Shaha AR, Boyle JO, Pfister D, Shah JP, Kraus DH. Improved outcomes in patients with osteogenic sarcoma of the head and neck. Cancer 2002; 95:1495-503. [PMID: 12237918 DOI: 10.1002/cncr.10849] [Citation(s) in RCA: 98] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND The current study reviews the authors' recent institutional experience in the treatment of osteosarcoma of the head and neck (OSHN). METHODS The clinical records of 44 patients who were treated between 1981 and 1998 for OSHN were reviewed retrospectively. Archived histologic material was reviewed and data were analyzed to identify factors predictive of disease control and survival. Outcomes were compared with a previously reported historic cohort treated at the study institution. RESULTS Patients ranged in age from 6 to 64 years (median, 31 years). The mandible was the primary site in 18 patients (41%), the maxilla in 20 patients (45%), and the skull in 6 patients (14%). Surgery was employed in all 44 patients, neoadjuvant chemotherapy was administered in 30 patients (68%), and postoperative radiation therapy was given to 7 patients (16%). The surgical excision margins were positive in 13 patients (30%). High-grade lesions were reported in 50% patients and low-grade lesions were noted in 18% of patients (grade was not assessable in 32%). Histologic response was "unfavorable" in 22 of 30 patients (73%) who were treated with neoadjuvant chemotherapy. The 3-year overall, disease-specific, and recurrence-free survival rates were approximately 81%, 81%, and 73%, respectively (median follow-up of 41 months). Positive surgical margins were found to be the only significant predictor of worse disease-specific survival. Compared with the historical cohort, the current experience demonstrated an obvious improvement in the 5-year local control (35% vs. 78%), distant metastases (37% vs. 13%), and overall survival (23% vs. 70%). CONCLUSIONS Negative surgical margins were found to be the only significant predictor of overall and disease-specific survival. The results of the current study represent a considerable improvement over the authors' previously published experience and compare favorably with the results reported in the literature.
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Affiliation(s)
- Snehal G Patel
- Head and Neck Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York 10021, USA
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13
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Abstract
BACKGROUND An osteogenic sarcoma of the skull is rare, particularly as a primary tumor. The incidence of primary osteogenic sarcomas of the skull is about 1 to 2% of all skull tumors. CASE DESCRIPTION A 21-year-old male was initially evaluated because of a large mass that had been growing for 7 months. The patient had been experiencing frequent headaches and tenderness at the site of the lump for about a month before being seen by the neurosurgeon. A computed tomography scan revealed a large mass, 12 cm x 7 cm, involving the scalp extending from the right temporal region to the vertex. A magnetic resonance imaging (MRI) scan showed a large mass arising from the posterolateral aspect that was 90% extracranial and 10% intracranial on the right side of the skull. The MRI showed marked vascularity and neovascularity of the tumor. An angiogram was performed, which demonstrated that the mass was fed by the branches from the right external carotid artery. The patient subsequently underwent surgery for embolization of the right occipital and superficial temporal arteries and removal of the mass. Pathology evaluation of a specimen revealed a high-grade osteoblastic osteosarcoma. CONCLUSION We review the literature of reported cases of primary osteogenic sarcomas of the skull to discuss the common clinical presentation, evaluation methods, and recommended treatment plans.
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Affiliation(s)
- Bikash Bose
- Department of Neurosurgery, Christiana Care Health Care System, Newark, Delaware, USA
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14
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15
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Setzer M, Lang J, Turowski B, Marquardt G. Primary Meningeal Osteosarcoma: Case Report and Review of the Literature. Neurosurgery 2002. [DOI: 10.1227/00006123-200208000-00034] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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16
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Colarinha P, Fonseca AT, Salgado L, Vieira MR. Diagnosis of malignant change in Paget's disease by Tl-201. Clin Nucl Med 1996; 21:299-301. [PMID: 8925612 DOI: 10.1097/00003072-199604000-00008] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Scintigraphy using Tc-99m MDP and Tl-201 was performed in a patient with polyostotic Paget's disease and sarcomatous degeneration in the right iliac bone. Tc-99m MDP imaging showed abnormal uptake in both types of lesions. Tl-201 imaging showed increased uptake in the sarcomatous lesion and absent uptake in pagetic lesions. This result supports the idea that Tl-201 scintigraphy may have a potential role to play in the differentiation of Paget's disease from malignancy. To the authors' knowledge, Tl-201 has never been reported for the detection of sarcomatous change of pagetic bone.
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Affiliation(s)
- P Colarinha
- Department of Nuclear Medicine, Portuguese Institute of Oncology, Lisbon, Portugal
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17
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Salvati M, Ciappetta P, Capoccia G, Capone R, Raco A. Osteosarcoma of the skull. Report of a post-Paget and post-radiation case in an elderly woman. Neurosurg Rev 1994; 17:73-6. [PMID: 8078612 DOI: 10.1007/bf00309991] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Osteosarcomas rarely affect the skull, preferring the long bones. As at other sites, osteosarcomas of the skull may be classified chiefly as de novo, post-radiation and post-Paget cases. Plain films of the skull and, even more, CT and MRI are the key diagnostic procedures for this disease. The treatment is surgery plus chemotherapy, in some cases radiotherapy. We report an odd case of post-radiation and post-Paget osteosarcoma in an elderly woman whose sister had been similarly affected.
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Affiliation(s)
- M Salvati
- University of Rome La Sapienza, Department of Neurological Sciences-Neurosurgery, Italy
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18
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Carpentier AF, Chantelard JV, Henin D, Poisson M. Osteosarcoma following radiation treatment for meningioma: report of a case and effective treatment with chemotherapy. J Neurooncol 1994; 21:249-53. [PMID: 7535347 DOI: 10.1007/bf01063774] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
A case of effective chemotherapy in postirradiation sarcoma is reported. A 30-year-old woman underwent a subtotal resection of a benign mixed meningioma followed by a course of radiotherapy. Five years later she developed a skull tumor which was resected. Histological study showed sarcomatous change corresponding most likely to a postirradiation osteosarcoma. Adjuvant chemotherapy (methotrexate, carboplatin, and VP16) was given. A progression occurred 8 months later and the patient was treated unsuccessfully with tamoxifen, LHRH, and later with high dose methotrexate and carboplatin. Six months later a lung metastasis was discovered and she received four cycles of IVP (ifosfamide, vepeside, cisplatin) alternating with IVA (ifosfamide, vepeside, adriamycin). Within 4 months the primary and lung tumours had decreased substantially without evidence of progression at follow-up 5 months later. We conclude that IVP/IVA regimen is a potentially useful therapy when an osteosarcoma of the skull is in progression.
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Affiliation(s)
- A F Carpentier
- Clinique Neurologique (Pr Brunet), Hôpital de la Salpetriere, Paris, France
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19
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Salvati M, Ciappetta P, Capone R, Santoro A, Raguso M, Raco A. Osteosarcoma of the skull in a child: case report and review of the literature. Childs Nerv Syst 1993; 9:437-9. [PMID: 8306364 DOI: 10.1007/bf00306202] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Osteosarcoma does not often affect the bones of the skull, occurring preferentially in the appendicular skeleton. The patient's age at onset seems to be later when the tumor is in the skull than in other sites. CT and MRI are at present the best means of establishing the extent of the tumor. Surgical removal of the lesion combined with polychemotherapy is the basis of treatment. We report a case of osteosarcoma of the skull in a child and review relevant publications.
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Affiliation(s)
- M Salvati
- Department of Neurological Sciences--Neurosurgery, La Sapienza University of Rome, Italy
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20
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Shinoda J, Kimura T, Funakoshi T, Iwata H, Tange K, Kasai C, Miyata Y. Primary osteosarcoma of the skull--a case report and review of the literature. J Neurooncol 1993; 17:81-8. [PMID: 8120575 DOI: 10.1007/bf01054277] [Citation(s) in RCA: 25] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Primary osteosarcoma of the skull (POS) in a young man with intracranial involvement is reported. After an initial transient remission by surgical intervention and chemotherapy, he began to deteriorate due to tumor recurrence and intracranial hemorrhage, and died 15 months following the time of diagnosis. The rarity and poor prognosis of POS are emphasized together with the review of the clinical and therapeutic aspects in the previously reported 98 cases in the literature.
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Affiliation(s)
- J Shinoda
- Department of Neurosurgery, Daiyukai General Hospital, Ichinomiya City, Japan
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21
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Abstract
BACKGROUND Osteosarcomas are typically long bone tumors and rarely affect the skull, with most articles reporting single cases. As elsewhere in the body, these lesions may be classified as primary or secondary, chiefly post-Paget and post-radiation therapy. METHODS The authors reviewed the osteosarcomas of the skull diagnosed at the Division of Neurosurgery of "La Sapienza" University of Rome. The patients were placed into two groups, according to the treatment received (prechemotherapeutic era and chemotherapeutic era). In the last five patients, a diagnostic-therapeutic protocol was adopted. RESULTS The most effective investigations are plain radiographs, computed tomography (CT) with bone windows, and magnetic resonance imaging (MRI), with the latter two allowing assessment of the extraosseous extent of the disease. Chemotherapy has changed the prognosis dramatically, achieving cure in some cases (especially in de novo osteosarcomas). Before the age of chemotherapy, the median survival length was 16 months, but since its introduction, five of nine patients in this study are alive 2 years after diagnosis. The onset of metastases, chiefly to the lung, does not necessarily imply a poor prognosis. The authors propose a schedule for the diagnosis and treatment of new cases of osteosarcoma of the skull. CONCLUSIONS Plain radiographs, CT targeted on the bone, and MRI are the most important diagnostic tools. Aggressive chemotherapy together with surgery (eventually including local radiation therapy in nontotal macroscopic surgical removal of the lesions) can drastically modify the prognosis of de novo and post-radiation therapy osteosarcomas.
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Affiliation(s)
- M Salvati
- Department of Neurological Sciences-Neurosurgery, La Sapienza University of Rome, Italy
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Abstract
A bone tumour of intermediate grade malignancy in the skull is described. These tumours are extremely rare and share several histological features with the benign osteoblastomas and low grade osteosarcomas. They may be associated with local invasion and pulmonary metastases. Treatment of this tumour in the skull poses several problems in view of its proximity to the cerebral cortex.
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Affiliation(s)
- T Z Aziz
- Department of Cell and Structural Biology, Medical School, Manchester
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23
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Kellie SJ, Pratt CB, Parham DM, Fleming ID, Meyer WH, Rao BN. Sarcomas (other than Ewing's) of flat bones in children and adolescents. A clinicopathologic study. Cancer 1990; 65:1011-6. [PMID: 2297650 DOI: 10.1002/1097-0142(19900215)65:4<1011::aid-cncr2820650428>3.0.co;2-#] [Citation(s) in RCA: 28] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The clinicopathologic features and response to therapy of 28 patients with non-Ewing's flat bone sarcoma treated at St. Jude Children's Research Hospital, Memphis, Tennessee, over a 25-year period were reviewed. Twenty-two patients had osteosarcoma, four malignant fibrous histiocytoma, one chondrosarcoma, and one fibrosarcoma. Ages at diagnosis ranged from 3 to 24 years (median, 15 years). Primary sites were craniofacial bones in ten patients, pelvis eight, scapula four, ribs two, metatarsal bones two, clavicle one, and vertebra one. All primary tumors were associated with soft tissue extension; none of the patients had metastatic disease at presentation. Six cases represented second malignancies that arose 5 to 16 years after irradiation for an unrelated tumor. Complete excision was possible in ten patients, eight of whom received postoperative chemotherapy. Five of these patients remain free of disease 1.8+ to 13+ years (median, 8.1 years) from diagnosis. Prolonged remissions after adjuvant chemotherapy were achieved in only two of 18 patients after incomplete surgical resection or biopsy. The median survival time in this group was 1 year (range, 0.2-7.7+ years). The remaining 16 patients had progressive local disease, but only two developed concurrent metastases. Thus, complete surgical resection appears to maximize disease-free survival in patients with non-Ewing's flat bone sarcoma. For the large percentage of patients in whom total resection is not possible, because of soft tissue extension and local invasion of bulky tumors, preoperative chemotherapy may increase the likelihood of complete excision and improve long-term survival.
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Affiliation(s)
- S J Kellie
- Department of Hematology/Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee
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