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Salimbene O, Viggiano D, Muratori F, Lo Piccolo R, Facchini F, Tamburini A, Campanacci DA, Voltolini L, Gonfiotti A. Primary Chest Wall Ewing Sarcoma: Treatment and Long-Term Results. Life (Basel) 2024; 14:766. [PMID: 38929749 PMCID: PMC11204814 DOI: 10.3390/life14060766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Revised: 05/21/2024] [Accepted: 06/03/2024] [Indexed: 06/28/2024] Open
Abstract
OBJECTIVE The aim of the study is to evaluate early and long-term results of chest wall primary Ewing's sarcoma patients treated in the time period February 2000-February 2023 by a multidisciplinary approach. METHODS We retrospectively reviewed the medical records of patients who underwent chest wall resection for a primary tumor. Treatment approach, extent of resection, 30-day mortality, overall survival (OS), local recurrence-free survival (LRFS), and metastasis-free survival (MFS) were analyzed. RESULTS Overall, n = 15 consecutive patients were treated for chest wall primary Ewing's sarcoma. A median of n = 3 ribs was resected with a median of n = 2 ribs adjacent to the lesion. Resections were extended to the adjacent structures in n = 5 patients (33.3%). In all cases, we performed a prosthetic reconstruction, associated with muscle flap (n = 10, 66.6%) or with rigid titanium bars and muscle flap (n = 6, 40%). A radical resection was accomplished in n = 13 patients (84.6%). The median surgical time was 310 ± 120 min; median hospitalization was 7.8 ± 1.9 days. Post-operative mortality was zero. We recorded n = 4 (30.7%) post-operative complication. The median follow-up (FU) was 26 months. Moreover, 5-year overall and event-free survival were 52% and 48%, respectively. CONCLUSIONS This case series confirms the benefit of the multidisciplinary approach for Ewing sarcomas in early and long-term results.
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Affiliation(s)
- Ottavia Salimbene
- Division of Thoracic Surgery, Careggi University Hospital, 50134 Florence, Italy (D.V.); (L.V.)
| | - Domenico Viggiano
- Division of Thoracic Surgery, Careggi University Hospital, 50134 Florence, Italy (D.V.); (L.V.)
| | - Francesco Muratori
- Division of Oncological Orthopedics, Careggi University Hospital, 50134 Florence, Italy; (F.M.); (D.A.C.)
| | - Roberto Lo Piccolo
- Division of Pediatric Surgery, Meyer University Hospital, 50139 Florence, Italy; (R.L.P.); (F.F.)
| | - Flavio Facchini
- Division of Pediatric Surgery, Meyer University Hospital, 50139 Florence, Italy; (R.L.P.); (F.F.)
| | - Angela Tamburini
- Division of Pediatric Oncology, Meyer University Hospital, 50139 Florence, Italy;
| | - Domenico Andrea Campanacci
- Division of Oncological Orthopedics, Careggi University Hospital, 50134 Florence, Italy; (F.M.); (D.A.C.)
| | - Luca Voltolini
- Division of Thoracic Surgery, Careggi University Hospital, 50134 Florence, Italy (D.V.); (L.V.)
| | - Alessandro Gonfiotti
- Division of Thoracic Surgery, Careggi University Hospital, 50134 Florence, Italy (D.V.); (L.V.)
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Lin D, Zhu X, Tian L, Qin C, Dong J, Zhou Q. A huge Ewing's sarcoma of the rib presenting with superior vena cava syndrome and dysphagia. Thorac Cancer 2022; 13:1726-1730. [PMID: 35445539 PMCID: PMC9161347 DOI: 10.1111/1759-7714.14430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 04/01/2022] [Accepted: 04/02/2022] [Indexed: 02/05/2023] Open
Abstract
A 24-year-old male patient was admitted to our center complaining of dizziness (superior vena cava syndrome [SVCS]), dysphagia and pain in the right chest wall. At the initial diagnosis, the patient had been found to have an irregular shaped 35 × 30 × 27 cm mass in the right side of his chest. On November 12, 2019, this patient received surgery in our center. The right sixth rib and the tumor were completely removed (R0), while preserving all the lung tissue and other organs in the chest. The patient recovered well after surgery, and his right lung was fully expanded.
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Affiliation(s)
- Dan Lin
- Lung Cancer Center, West China Hospital of Sichuan University, Chengdu, China
| | - Xiaomu Zhu
- Department of Pharmacy, West China Hospital of Sichuan University, Chengdu, China
| | - Long Tian
- Lung Cancer Center, West China Hospital of Sichuan University, Chengdu, China
| | - Changlong Qin
- Lung Cancer Center, West China Hospital of Sichuan University, Chengdu, China
| | - Jingsi Dong
- Lung Cancer Center, West China Hospital of Sichuan University, Chengdu, China
| | - Qinghua Zhou
- Lung Cancer Center, West China Hospital of Sichuan University, Chengdu, China
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Saltsman JA, Danzer E, Hammond WJ, Rhee D, Berhe S, Monteagudo J, Price AP, Heaton TE, Jones DR, LaQuaglia MP. Survival and Scoliosis Following Resection of Chest Wall Tumors in Children and Adolescents: A Single-center Retrospective Analysis. Ann Surg 2021; 274:e167-e173. [PMID: 31356260 PMCID: PMC7147950 DOI: 10.1097/sla.0000000000003495] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE We reviewed our experience with pediatric chest wall tumors (CWTs) to identify variables associated with survival, scoliosis development, and need for corrective scoliosis surgery. BACKGROUND Chest wall neoplasms in children or adolescents are rare. Consequently, there are few large series that detail survival or quality of life indicators, like scoliosis. METHODS Medical records were reviewed for all chest wall resections for primary and metastatic CWT performed from October 1, 1986 to September 30, 2016 on patients 21 years or younger at diagnosis. Kaplan-Meier distributions were compared using the log-rank test. Variables correlated with survival, scoliosis development, or need for corrective surgeries were analyzed using competing-risk analysis. RESULTS Seventy-six cases [57 (75%) primary, 19 (25%) metastatic] were identified. Median age at diagnosis was 15.6 years (range: 0.5-21 years). Tumor types were Ewing sarcoma family tumors (54%), other soft tissue sarcomas (21%), osteosarcoma (11%), rhabdomyosarcoma (7%), and other (8%). A median of 3 (range: 1-5) contiguous ribs were resected. Surgical reconstruction included composite Marlex mesh and methyl-methacrylate, Gore-Tex, or primary closure in 57%, 28%, and 14% of procedures, respectively. Overall 5-year survival was 61% (95% confidence interval: 50%-75%). Scoliosis developed in 19 (25%) patients; 6 patients required corrective surgery. Variables associated with overall survival were the presence of metastatic disease at diagnosis, and whether the chest tumor itself was a primary or metastatic lesion. Younger age at chest wall resection was associated with the need for corrective surgery in patients who developed scoliosis. CONCLUSIONS Among pediatric and adolescent patients with CWTs, survival depends primarily on the presence of metastases. Age, type of chest wall reconstruction, and tumor size are not associated with scoliosis development. Among patients who develop scoliosis, younger patients are more likely to require corrective surgery.
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Affiliation(s)
- James A. Saltsman
- Pediatric Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Enrico Danzer
- Pediatric Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - William J. Hammond
- Pediatric Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Daniel Rhee
- Pediatric Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Simon Berhe
- Pediatric Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Julie Monteagudo
- Pediatric Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Anita P. Price
- Department of Radiology, Memorial Sloan Kettering Cancer Center New York, NY
| | - Todd E. Heaton
- Pediatric Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - David R. Jones
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Michael P. LaQuaglia
- Pediatric Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
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Ewing Sarcoma of the Chest Wall: Prognostic Factors of Multimodal Therapy Including En Bloc Resection. Ann Thorac Surg 2018; 106:207-213. [DOI: 10.1016/j.athoracsur.2018.02.031] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Revised: 12/30/2017] [Accepted: 02/12/2018] [Indexed: 01/11/2023]
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Girotti A, Rosa F, Ferrotto M, Girotti P, Pastorino U. Mechanical behavior of a total chest wall prosthesis with rib-like features. Comput Methods Biomech Biomed Engin 2017; 20:1581-1588. [PMID: 29131656 DOI: 10.1080/10255842.2017.1391952] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
The Department of Thoracic Surgery of the National Institute of Cancer in Milan developed a new rib-cage prosthesis which tries to combine flexibility, protection and bio-compatibility. This new replacement concept has been implanted in many patients, showing cheering results in term of reconstructions simplicity, postoperative complications reduction and patients comfort. This paper investigates and discusses in detail the mechanical behavior of the innovative rib cage prosthesis. Mechanical strength and stiffness are numerically evaluated in order to asses its limits and if it is fully compatible with patients 'normal' life.
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Affiliation(s)
- A Girotti
- a Dipartimento di Meccanica , Politecnico di Milano , Milano , Italy
| | - F Rosa
- a Dipartimento di Meccanica , Politecnico di Milano , Milano , Italy
| | | | - P Girotti
- c S.C. Chirurgia Toracica, Fondazione IRCCS , Istituto Nazionale dei Tumori , Milano , Italy
| | - U Pastorino
- c S.C. Chirurgia Toracica, Fondazione IRCCS , Istituto Nazionale dei Tumori , Milano , Italy
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Lucas JT, Fernandez-Pineda I, Tinkle CL, Bishop MW, Kaste SC, Heda R, Davidoff AM, Krasin MJ. Late toxicity and outcomes following radiation therapy for chest wall sarcomas in pediatric patients. Pract Radiat Oncol 2017; 7:411-417. [PMID: 28676226 DOI: 10.1016/j.prro.2017.04.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Revised: 04/06/2017] [Accepted: 04/21/2017] [Indexed: 10/19/2022]
Abstract
PURPOSE To investigate the contribution of radiation therapy to acute and late toxicity in pediatric chest wall sarcoma patients and evaluate dosimetric correlates of higher incidence toxicities such as scoliosis and pneumonitis. METHODS AND MATERIALS The data from 23 consecutively treated pediatric patients with chest wall sarcomas of various histologies (desmoid, Ewing, rhabdomyosarcoma, nonrhabdomyosarcoma-soft tissue sarcomas) were reviewed to evaluate the relationship between end-organ radiation dose, clinical factors, and the risk of subsequent late effects (scoliosis, pneumonitis). Cobb angles were used to quantify the extent of scoliosis. Doses to the spine and lung were calculated from the radiation treatment plan. RESULTS The range of scoliosis identified on follow-up imaging ranged from -47.6 to 64° (median, 2.95°). No relationship was identified between either radiation dose to the ipsilateral or contralateral vertebral body or tumor size and the degree or direction of scoliosis. The extent of surgical resection and number and location of resected ribs affected the extent of scoliosis. The dominant predictor of extent of scoliosis at long-term follow-up was the extent of scoliosis following surgical resection. Radiation pneumonitis was uncommon and was not correlated with mean dose or volume of lung receiving 24 Gy; however, 1 of 3 surviving patients who received whole pleural surface radiation therapy developed significant restrictive lung disease. CONCLUSIONS Acute and late radiation therapy-associated toxicities in pediatric chest wall sarcoma patients are modest. The degree of scoliosis following resection is a function of the extent of resection and of the number and location of ribs resected, and the degree of scoliosis at the last follow-up visit is a function of the extent of scoliosis following surgery. Differential radiation therapy dose across the vertebral body does not increase the degree of scoliosis. Severe restrictive pulmonary disease is a late complication of survivors after whole pleural surface radiation therapy.
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Affiliation(s)
- John T Lucas
- Department of Radiation Oncology, St. Jude Children's Research Hospital Memphis, Tennessee.
| | | | - Christopher L Tinkle
- Department of Radiation Oncology, St. Jude Children's Research Hospital Memphis, Tennessee
| | - Michael W Bishop
- Department of Oncology, St. Jude Children's Research Hospital Memphis, Tennessee
| | - Sue C Kaste
- Department of Diagnostic Imaging, St. Jude Children's Research Hospital Memphis, Tennessee; Department of Radiology, University of Tennessee Health Sciences, Memphis, Tennessee
| | | | - Andrew M Davidoff
- Department of Surgery, St. Jude Children's Research Hospital Memphis, Tennessee
| | - Matthew J Krasin
- Department of Radiation Oncology, St. Jude Children's Research Hospital Memphis, Tennessee
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Guillén G, García L, Marhuenda C, Pellisé F, Molino JA, Fontecha CG, López S, Lloret J. Thoracic wall reconstruction with bioabsorbable plates in pediatric malignant thoracic wall tumors. J Pediatr Surg 2017; 52:377-381. [PMID: 27653461 DOI: 10.1016/j.jpedsurg.2016.08.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Revised: 08/22/2016] [Accepted: 08/24/2016] [Indexed: 12/19/2022]
Abstract
AIM Childhood malignant chest wall tumors may require extensive surgical resection and reconstruction with musculoskeletal flaps or non-resorbable prosthetic materials. Implant-related complications and scoliosis often occur. This study analyzes the outcomes of chest wall reconstruction using resorbable plates as an alternative approach. METHODS Retrospective review (2007-2015) of patients who underwent resection of malignant primary chest wall tumors in 2 tertiary pediatric centers. Reconstruction was performed using copolymer (l-lactic and glycolic acid) plates, fixed to the ribs and surrounding structures with copolymer screws and/or polyglactin sutures. RESULTS Eight patients aged 10.6+2.6years were treated. There were no operative complications, and implant removal was not required in any case. Six patients received postoperative radiotherapy. Over follow-up (39.6months, range 9.4-78), chest wall shape was maintained in all, and there were no radiological artifacts. Three patients developed scoliosis (Cobb 17°-33°), but treatment was needed only in one, who had undergone hemivertebrectomy. There were no cases of local tumor relapse. One patient died because of metastatic spread. CONCLUSIONS Implantation of bioabsorbable l-lactic and glycolic acid copolymer plates with a relatively simple technique provided a rigid, stable reconstruction with only mild mid-/long-term complications. Resorbable plates may be a good alternative for pediatric chest wall reconstruction. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- G Guillén
- Pediatric Surgery Department, Hospital Vall d'Hebron, Barcelona, Spain.
| | - L García
- Pediatric Surgery Department, Hospital Vall d'Hebron, Barcelona, Spain
| | - C Marhuenda
- Pediatric Surgery Department, Hospital Son Espases, Palma de Mallorca, Spain
| | - F Pellisé
- Orthopedics Department, Hospital Vall d'Hebron, Barcelona, Spain
| | - J A Molino
- Pediatric Surgery Department, Hospital Vall d'Hebron, Barcelona, Spain
| | - C G Fontecha
- Orthopedics Department, Hospital Vall d'Hebron, Barcelona, Spain
| | - S López
- Pediatric Surgery Department, Hospital Vall d'Hebron, Barcelona, Spain
| | - J Lloret
- Pediatric Surgery Department, Hospital Vall d'Hebron, Barcelona, Spain
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