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Braaten M, Braaten J, Chaddha J, Hu R, Lanoue C, Silberstein P, Tauseef A, Asghar N, Mirza M. Survival and treatment in older patients with ewing sarcoma: an analysis of the national cancer database. Eur J Med Res 2024; 29:29. [PMID: 38183148 PMCID: PMC10768101 DOI: 10.1186/s40001-023-01599-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 12/15/2023] [Indexed: 01/07/2024] Open
Abstract
BACKGROUND Ewing sarcoma (EWS) is a malignancy which primarily arises in adolescence and has been studied extensively in this population. Much less is known about the rare patient cohort over the age of 40 at diagnosis. In this study, we describe the survival outcomes and clinical characteristics of this population. METHODS This retrospective cohort study utilized the National Cancer Database (NCDB) to identify 4600 patients diagnosed between 2004 through 2019. Of these patients, 4058 were under the age of 40 and 542 were over 40. Propensity score 1:1 matching was performed according to sex and race. Univariate and multivariate logistic regression was performed to generate odds ratios (OR) and a Multivariate Cox regression model was used to generate a hazard ratio (HR) for patients over 40. Kaplan-Meier curves were used to estimate survival from diagnosis to death between age groups. Chi-square tests were used to compare demographic and socioeconomic patient characteristics. IBM statistics version 27.0 was used. p < 0.05 was used to indicate statistical significance. RESULTS EWS patients older than 40 experienced worse survival outcomes compared to patients under the age of 40. 5-year survival was 44.6% for older patients vs. 61.8% for younger patients (p < 0.05). A multivariate Cox proportional hazards model showed that age was independently associated with inferior survival. (HR 1.96; p < 0.05). EWS patients over the age of 40 were more likely to have tumors originating from the vertebral column (16.1% vs 8.9%; p < 0.05) and cranium (5.3% vs. 2.9%; p < 0.05) and had a higher rate of axial tumors (31.6% vs. 18.5%; p < 0.05) compared to patients under 40. Additionally, patients older than 40 experienced a significantly longer delay between the date of diagnosis and initiation of systemic treatment (36.7 days vs. 24.8 days; p < 0.05) and were less likely to receive adjuvant chemotherapy (93.4% vs. 97.9%; p < 0.05). CONCLUSION An age over 40 is associated with decreased survival for patients with EWS. Due to the rarity of EWS in this cohort, the optimal role of systemic treatment remains unknown and has yet to be clearly elucidated. Consequently, our findings suggest that older patients receive disparities in treatment which may be contributing to decreased survival rates.
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Affiliation(s)
- Marco Braaten
- Creighton University School of Medicine, Omaha, NE, USA.
| | - Jacob Braaten
- University of Minnesota Medical School, Minneapolis, MN, USA
| | | | - Robert Hu
- Creighton University School of Medicine, Omaha, NE, USA
| | - Connor Lanoue
- Creighton University School of Medicine, Omaha, NE, USA
| | - Peter Silberstein
- Department of Hematology and Oncology, Creighton University Medical Center, Omaha, NE, USA
| | - Abubakar Tauseef
- Department of Internal Medicine, Creighton University Medical Center, Minneapolis, MN, USA
| | - Noureen Asghar
- Department of Internal Medicine, Creighton University Medical Center, Minneapolis, MN, USA
| | - Mohsin Mirza
- Department of Internal Medicine, Creighton University Medical Center, Minneapolis, MN, USA
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Aerospace Medicine Clinic. Aerosp Med Hum Perform 2024; 95:61-64. [PMID: 38158573 DOI: 10.3357/amhp.5814.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2024]
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3
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Gondim Teixeira PA, Lemore A, Vogt N, Oster J, Hossu G, Gillet R, Blum A. Initial Evaluation of Focal Bone Lesions: How Do We Do It? Semin Musculoskelet Radiol 2023; 27:471-479. [PMID: 37748471 DOI: 10.1055/s-0043-1769775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/27/2023]
Abstract
Focal bone lesions are frequent, and management greatly depends on the characteristics of their images. After briefly discussing the required work-up, we analyze the most relevant imaging signs for assessing potential aggressiveness. We also describe the imaging aspects of the various types of lesion matrices and their clinical implications.
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Affiliation(s)
- Pedro Augusto Gondim Teixeira
- Guilloz Imaging Department, University Hospital Center of Nancy, Central Hospital, Nancy Cedex, France
- Université de Lorraine, INSERM, Laboratoire d'Imagerie Diagnostic et Interventionnelle - IADI, Nancy, France
| | - Astrée Lemore
- Guilloz Imaging Department, University Hospital Center of Nancy, Central Hospital, Nancy Cedex, France
- Université de Lorraine, INSERM, Laboratoire d'Imagerie Diagnostic et Interventionnelle - IADI, Nancy, France
| | - Nora Vogt
- Université de Lorraine, INSERM, Laboratoire d'Imagerie Diagnostic et Interventionnelle - IADI, Nancy, France
| | - Julien Oster
- Université de Lorraine, INSERM, Laboratoire d'Imagerie Diagnostic et Interventionnelle - IADI, Nancy, France
| | - Gabriela Hossu
- Université de Lorraine, INSERM, Laboratoire d'Imagerie Diagnostic et Interventionnelle - IADI, Nancy, France
| | - Romain Gillet
- Guilloz Imaging Department, University Hospital Center of Nancy, Central Hospital, Nancy Cedex, France
- Université de Lorraine, INSERM, Laboratoire d'Imagerie Diagnostic et Interventionnelle - IADI, Nancy, France
| | - Alain Blum
- Guilloz Imaging Department, University Hospital Center of Nancy, Central Hospital, Nancy Cedex, France
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4
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Ye C, Wei W, Tang X, Li F, Xin B, Chen Q, Wei H, He S, Xiao J. Sacral Ewing sarcoma with rib, lung, and multifocal skull metastases: A rare case report and review of treatments. Front Oncol 2022; 12:933579. [PMID: 36172156 PMCID: PMC9511402 DOI: 10.3389/fonc.2022.933579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Accepted: 08/15/2022] [Indexed: 11/13/2022] Open
Abstract
Ewing sarcoma (ES) rarely derives from the sacrum or mobile spine. The discovery of primary ES with multimetastatic involvements is exceedingly less frequent in clinical practice. A 23-year-old man with initial primary sacral ES developed metastases of rib, lung, and multifocal skull after receiving surgical intervention and series of adjuvant therapies. We provide this very rare case consisting of its clinical features, imaging findings, treatments, and outcomes. Therapeutic modalities of ES are also reviewed in previous published articles. The prognosis of metastatic ES remains dismal; effective therapeutic modalities for ES require multidisciplinary collaboration, with more high-quality clinical trials to promote the optimal protocols.
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Affiliation(s)
- Chen Ye
- School of Health Science and Technology, University of Shanghai for Science and Technology, Shanghai, China
- Spinal Tumor Center, Department of Orthopaedic Oncology, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Wei Wei
- School of Health Science and Technology, University of Shanghai for Science and Technology, Shanghai, China
- Spinal Tumor Center, Department of Orthopaedic Oncology, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Xuebin Tang
- Department of Orthopaedics, The Second Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Feng Li
- Department of Orthopaedics, the 943rd Hospital of Joint Logistics Support Force of People's Liberation Army, Wuwei, China
| | - Baoquan Xin
- School of Health Science and Technology, University of Shanghai for Science and Technology, Shanghai, China
- Spinal Tumor Center, Department of Orthopaedic Oncology, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Qianqian Chen
- School of Health Science and Technology, University of Shanghai for Science and Technology, Shanghai, China
| | - Haifeng Wei
- School of Health Science and Technology, University of Shanghai for Science and Technology, Shanghai, China
- Spinal Tumor Center, Department of Orthopaedic Oncology, Changzheng Hospital, Second Military Medical University, Shanghai, China
- Department of Orthopaedics, No.905 Hospital of People's Liberation Army Navy, Second Military Medical University, Shanghai, China
- *Correspondence: Haifeng Wei, ; Shaohui He, ; Jianru Xiao,
| | - Shaohui He
- Spinal Tumor Center, Department of Orthopaedic Oncology, Changzheng Hospital, Second Military Medical University, Shanghai, China
- Department of Orthopaedics, No.905 Hospital of People's Liberation Army Navy, Second Military Medical University, Shanghai, China
- *Correspondence: Haifeng Wei, ; Shaohui He, ; Jianru Xiao,
| | - Jianru Xiao
- School of Health Science and Technology, University of Shanghai for Science and Technology, Shanghai, China
- Spinal Tumor Center, Department of Orthopaedic Oncology, Changzheng Hospital, Second Military Medical University, Shanghai, China
- Department of Orthopaedics, No.905 Hospital of People's Liberation Army Navy, Second Military Medical University, Shanghai, China
- *Correspondence: Haifeng Wei, ; Shaohui He, ; Jianru Xiao,
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Kamphorst B, Rooijakkers T, Veugen T, Cellamare M, Knoors D. Accurate training of the Cox proportional hazards model on vertically-partitioned data while preserving privacy. BMC Med Inform Decis Mak 2022; 22:49. [PMID: 35209883 PMCID: PMC8867891 DOI: 10.1186/s12911-022-01771-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 01/20/2022] [Indexed: 11/10/2022] Open
Abstract
Background Analysing distributed medical data is challenging because of data sensitivity and various regulations to access and combine data. Some privacy-preserving methods are known for analyzing horizontally-partitioned data, where different organisations have similar data on disjoint sets of people. Technically more challenging is the case of vertically-partitioned data, dealing with data on overlapping sets of people. We use an emerging technology based on cryptographic techniques called secure multi-party computation (MPC), and apply it to perform privacy-preserving survival analysis on vertically-distributed data by means of the Cox proportional hazards (CPH) model. Both MPC and CPH are explained. Methods We use a Newton-Raphson solver to securely train the CPH model with MPC, jointly with all data holders, without revealing any sensitive data. In order to securely compute the log-partial likelihood in each iteration, we run into several technical challenges to preserve the efficiency and security of our solution. To tackle these technical challenges, we generalize a cryptographic protocol for securely computing the inverse of the Hessian matrix and develop a new method for securely computing exponentiations. A theoretical complexity estimate is given to get insight into the computational and communication effort that is needed. Results Our secure solution is implemented in a setting with three different machines, each presenting a different data holder, which can communicate through the internet. The MPyC platform is used for implementing this privacy-preserving solution to obtain the CPH model. We test the accuracy and computation time of our methods on three standard benchmark survival datasets. We identify future work to make our solution more efficient. Conclusions Our secure solution is comparable with the standard, non-secure solver in terms of accuracy and convergence speed. The computation time is considerably larger, although the theoretical complexity is still cubic in the number of covariates and quadratic in the number of subjects. We conclude that this is a promising way of performing parametric survival analysis on vertically-distributed medical data, while realising high level of security and privacy.
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Affiliation(s)
- Bart Kamphorst
- Cyber Security and Robustness, Netherlands Organisation for Applied Scientific Research, The Hague, The Netherlands.
| | - Thomas Rooijakkers
- Cyber Security and Robustness, Netherlands Organisation for Applied Scientific Research, The Hague, The Netherlands
| | - Thijs Veugen
- Cyber Security and Robustness, Netherlands Organisation for Applied Scientific Research, The Hague, The Netherlands.,Cryptology, Centrum Wiskunde and Informatica, Amsterdam, The Netherlands
| | - Matteo Cellamare
- Research and Development, Netherlands Comprehensive Cancer Organisation, Eindhoven, The Netherlands
| | - Daan Knoors
- Research and Development, Netherlands Comprehensive Cancer Organisation, Eindhoven, The Netherlands
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Primary Ewing sarcoma/peripheral primitive neuroectodermal tumors in the cranial bone and mobile spine: what is the difference? BMC Surg 2022; 22:4. [PMID: 34996420 PMCID: PMC8742462 DOI: 10.1186/s12893-021-01452-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 12/23/2021] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Primary Ewing sarcoma (ES)/peripheral primitive neuroectodermal tumors (pPNETs) are aggressive bone tumors that rarely occur in the axial skeleton, including the cranial bone and mobile spine. The purpose of this study was to investigate whether there were any differences in patient characteristics, treatment strategies, and outcomes between patients with ES/pPNETs of the cranial bone and those with ES/pPNETs of the mobile spine. METHODS A retrospective study was performed on 33 patients with ES/pPNETs who had been surgically treated and pathologically confirmed at our institution between 2010 and 2020. Patient characteristics were compared using Fisher exact tests or independent t tests. Survival rates were estimated via Kaplan-Meier survival analysis and compared using log-rank tests. RESULTS Thirteen patients had ES/pPNETs of the cranial bone (39.4%), while 20 patients had ES/pPNETs of the mobile spine (60.6%). Patients with ES/pPNETs of the cranial bone had a younger mean age (14.8 vs 22.6 years; p = 0.047) and longer mean disease duration (2.5 vs 1.9 months; p = 0.008) compared with those of patients with ES/pPNETs of the mobile spine. Kaplan-Meier analysis showed that gross total resection (GTR) and radiotherapy resulted in a longer median survival time. The overall survival rates and progression-free survival rates of patients with ES/pPNETs of the cranial bone versus those of the mobile spine were not significantly different (p = 0.386 and p = 0.368, respectively). CONCLUSIONS Patients with ES/pPNETs of the cranial bone were younger compared to patients with ES/pPNETs of the mobile spine. There was no significant difference in the prognosis of patients with ES/pPNETs of the cranial bone versus those of the mobile spine. Taken together, our findings suggest that GTR and radiotherapy offer the best prognosis for improved long-term survival.
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Abbas A, Alaa MN. Ewing Sarcoma Family Tumors: Past, Present and Future Prospects. CURRENT CANCER THERAPY REVIEWS 2021. [DOI: 10.2174/1573394716999201125204643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Ewing’s sarcoma (ES), also known as mesenchymal primitive neuroectodermal tumor
(PNET), is a malignant round blue cell tumor (MRBCT) with a varying degree of neuronal differentiation.
PNET arises from the primitive nerve cells of the central nervous system (CNS) but may
also occur in the bones of the extremities, pelvis, vertebral column, and chest wall. Extraskeletal
ES/PNET may affect the various soft tissues, including those of the pelvis, paraspinal region, and
thoracopulmonary region.
Histopathological differentiation between ES, PNET, and other related sarcomas is often difficult.
On light microscopy, the same histopathological appearance of ES has been termed PNET, Askin-
Rosay (A-R) tumor, and malignant neuroepithelioma by various other authors. The immunohistochemical
distinction is also difficult due to poor tissue differentiation and low intake of the various
specific immunohistochemical markers. The most frequent translocation is t (11; 22) (q24; q12), resulting
in the EWSR1-FLI1 fusion gene detected in nearly 90% of cases and is considered the hallmark
of the diagnosis of ES, PNET, atypical ES, and A-R tumor. Therefore, ES, atypical ES,
PNET, and A-R tumor are currently regarded as one entity grouped together under the Ewing Family
Tumor (EFT) and are treated in an identical way. EFT represents only about 3% of all pediatric
malignancies. The annual incidence is between 2 and 5 cases per million children per year. The
peak prevalence of the tumor is between the ages of 10 and 15 years. The incidence is higher in
males than in females, with a ratio of 1.3:1.
Newer groups of MRBCT that have great similarities to EFT are being recently described. These tumors,
atypical EFT and Ewing’s like Sarcomas (ELS), bear similarities to EFT but have basic morphological
and molecular differences. Optimal treatment requires the use of adjuvant and new-adjuvant
chemotherapy (CTR), radical surgical resection and/or involves field radiotherapy (RT). The
reported disease-free survival (DFS) and overall survival (OS) range between 45-80% and 36-71%,
respectively. The overall prognosis for the metastatic and recurrent disease remains poor. The use
of newer conventional and targeted medications, improved RT delivery, and surgical techniques
may further improve the outcomes. The past few years have seen advances in genomics-based sarcoma
diagnosis and targeted therapies. In this comprehensive review article, we provide a detailed
report of EFT and discuss the various clinical aspects and the recent advances used in the diagnosis
and treatment.
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Affiliation(s)
- Adil Abbas
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, The Pediatric Hematology/Oncology Setion, Princess Nourah Oncology Centre, King Abdulaziz Medical City, Jeddah, Saudi Arabia
| | - Mohammed N.S. Alaa
- Department of Laboratory Medicine, King Saud Bin Abdulaziz University for Health Sciences, King Abdulaziz Medical City, Jeddah, Saudi Arabia
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8
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Eaton BR, Claude L, Indelicato DJ, Vatner R, Yeh B, Schwarz R, Laack N. Ewing sarcoma. Pediatr Blood Cancer 2021; 68 Suppl 2:e28355. [PMID: 33818887 DOI: 10.1002/pbc.28355] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 04/06/2020] [Accepted: 04/07/2020] [Indexed: 12/27/2022]
Abstract
Ewing sarcoma is a rare tumor that requires complex multidisciplinary management. This report describes the general management and standard radiotherapy guidelines in both North America (Children's Oncology Group) and Europe (International Society of Pediatric Oncology). Standard treatment involves multiagent induction chemotherapy followed by local treatment with surgery, definitive radiation, or a combination of surgery and radiation followed by additional chemotherapy and consolidation local treatment to metastatic sites. The data supporting the role of chemotherapy, surgery, and radiation and specific radiation therapy guidelines are presented.
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Affiliation(s)
- Bree R Eaton
- Radiation Oncology, Winship Cancer Institute of Emory University, Atlanta, Georgia
| | - Line Claude
- Radiation Oncology, Centre Léon Bérard, Lyon, France
| | - Daniel J Indelicato
- Radiation Oncology, University of Florida College of Medicine, Jacksonville, Florida
| | - Ralph Vatner
- Radiation Oncology, University of Cincinnati, Cincinnati, Ohio
| | - Brian Yeh
- Radiation Oncology, Mount Sinai Hospital, New York, New York
| | - Rudolf Schwarz
- Radiotherapy and Radiooncology, Outpatient Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Nadia Laack
- Radiation Oncology, Mayo Clinic, Rochester, Minnesota
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Laffranchi Z, Milella M, Lombardo P, Langer R, Lösch S. Co-occurrence of malignant neoplasm and Hyperostosis Frontalis Interna in an Iron Age individual from Münsingen-Rain (Switzerland): A multi-diagnostic study. INTERNATIONAL JOURNAL OF PALEOPATHOLOGY 2021; 32:1-8. [PMID: 33176226 DOI: 10.1016/j.ijpp.2020.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 10/28/2020] [Accepted: 10/28/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE To re-analyze one of the oldest cases of malignant bone neoplasm with different analytical techniques. MATERIAL The available skeletal remains of grave 138 (G138) from the Iron Age necropolis of Münsingen-Rain (Switzerland, 420-240 BC). METHODS The bones are analyzed by means of morphological, radiographic, histological, and biogeochemical methods. RESULTS The individual, a male aged between 35-50 years old, presents morphologically and radiographically a previously described coral-like bone neoformation on the proximal left humerus. The new analyses highlight previously undocumented coarse bone proliferation on the left scapula and lobular apposition on the endocranial surface of the frontal bone. The histological analysis of the humerus shows a 'lace-like' pattern of osteoid deposition without lamellation. CONCLUSIONS Our data support a diagnosis of osteoblastic malignant neoplasm, probably an osteosarcoma or, more likely, a dedifferentiated chondrosarcoma for the humerus and scapula, and of hyperostosis frontalis interna on the frontal. The co-presence of a malignant neoplasm and hyperostosis frontalis interna may be related to a hormonal imbalance, a possibility also suggested by atypical funerary treatment. SIGNIFICANCE This study confirms G138 as one of the oldest cases of malignant bone neoplasm, adds new paleopathological data on this individual, and demonstrates the advantages of a multidisciplinary approach. LIMITATIONS The discussion of the pathological changes is limited by the representation and preservation of the skeletal elements. SUGGESTION FOR FUTURE RESEARCH Biomolecular and protein biomarkers analyses may help to refine the diagnostic conclusions.
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Affiliation(s)
- Zita Laffranchi
- Department of Physical Anthropology, Institute of Forensic Medicine, University of Bern. Sulgenauweg 40, CH-3007, Bern Switzerland.
| | - Marco Milella
- Department of Physical Anthropology, Institute of Forensic Medicine, University of Bern. Sulgenauweg 40, CH-3007, Bern Switzerland.
| | - Paolo Lombardo
- Inselspital, Universitätsspital Bern, Universitätsinstitut für Diagnostische, Interventionelle und Pädiatrische Radiologie (DIPR). Freiburgstrasse 10, CH-3010, Bern Switzerland.
| | - Rupert Langer
- Institute of Pathology, University of Bern. Murtenstrasse 31, CH-3008, Bern Switzerland.
| | - Sandra Lösch
- Department of Physical Anthropology, Institute of Forensic Medicine, University of Bern. Sulgenauweg 40, CH-3007, Bern Switzerland.
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Guder WK, Hardes J, Nottrott M, Steffen AJ, Dirksen U, Streitbürger A. Pelvic Ewing sarcoma: a retrospective outcome analysis of 104 patients who underwent pelvic tumor resection at a single supra-regional center. J Orthop Surg Res 2020; 15:534. [PMID: 33198775 PMCID: PMC7667797 DOI: 10.1186/s13018-020-02028-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 10/20/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Local treatment in pelvic Ewing sarcoma (ES) consists of operation, radiation therapy, or a combination of both. Reported outcomes vary depending on the treatment modality performed. It is the objective of this study to analyze surgical outcome and complications as well as oncological outcome and complications of chemo- and radiation therapy in this patient cohort and evaluate prognostic factors. METHODS Retrospective review of 104 patients who underwent tumor resection for pelvic ES from 1988 to 2014. RESULTS All patients underwent pelvic resection and radiation therapy was administered in 77.9%. Margins were clear in 94.2%. The response to chemotherapy was good in 78.8%. Local recurrence occurred in 7.7%. The presence of distant metastases at the time of operation was the most important negative predictor for overall survival (p = 0.003). The cumulative 5- and 10-year survival rates were 82.7% and 80.1% for non-metastasized and 61.4% and 41.6% for metastasized pelvic ES at operation. In the presence of a single-distant metastatic site at operation compared to multiple metastatic sites, the cumulative survival rates were 64.3% versus 50% at five and 50.7% versus 16.7% at 10 years. CONCLUSIONS A combined treatment approach of tumor resection and radiation therapy leads to a local control and overall survival rates comparable with those of extremity locations in this study's patient cohort with localized pelvic ES. Therefore, surgical tumor resection (combined with (neo-)adjuvant radiation therapy) in non-metastatic pelvic ES seems feasible. In metastatic patients, however, the significance of tumor resection as a part of local treatment remains less certain and improved outcomes of combined local treatment approaches need to be weighed against these patients' prognosis and quality of life.
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Affiliation(s)
- Wiebke K Guder
- Department of Orthopedics and Tumor Orthopedics, University Hospital Muenster, Albert-Schweitzer-Campus 1, Building A1, 48149, Muenster, Germany. .,Department of Orthopedic Oncology, University Hospital Essen, Hufelandstrasse 55, 45147, Essen, Germany.
| | - Jendrik Hardes
- Department of Orthopedics and Tumor Orthopedics, University Hospital Muenster, Albert-Schweitzer-Campus 1, Building A1, 48149, Muenster, Germany.,Department of Orthopedic Oncology, University Hospital Essen, Hufelandstrasse 55, 45147, Essen, Germany
| | - Markus Nottrott
- Department of Orthopedics and Tumor Orthopedics, University Hospital Muenster, Albert-Schweitzer-Campus 1, Building A1, 48149, Muenster, Germany.,Department of Orthopedic Oncology, University Hospital Essen, Hufelandstrasse 55, 45147, Essen, Germany
| | - Anne Juliane Steffen
- Department of Orthopedics and Tumor Orthopedics, University Hospital Muenster, Albert-Schweitzer-Campus 1, Building A1, 48149, Muenster, Germany
| | - Uta Dirksen
- Department of Pediatric Hematology and Oncology (III), University Hospital Essen, Hufelandstrasse 55, 45147, Essen, Germany
| | - Arne Streitbürger
- Department of Orthopedics and Tumor Orthopedics, University Hospital Muenster, Albert-Schweitzer-Campus 1, Building A1, 48149, Muenster, Germany.,Department of Orthopedic Oncology, University Hospital Essen, Hufelandstrasse 55, 45147, Essen, Germany
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Molina ER, Chim LK, Salazar MC, Koons GL, Menegaz BA, Ruiz-Velasco A, Lamhamedi-Cherradi SE, Vetter AM, Satish T, Cuglievan B, Smoak MM, Scott DW, Ludwig JA, Mikos AG. 3D Tissue-Engineered Tumor Model for Ewing's Sarcoma That Incorporates Bone-like ECM and Mineralization. ACS Biomater Sci Eng 2019; 6:539-552. [PMID: 33463239 DOI: 10.1021/acsbiomaterials.9b01068] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
The tumor microenvironment harbors essential components required for cancer progression including biochemical signals and mechanical cues. To study the effects of microenvironmental elements on Ewing's sarcoma (ES) pathogenesis, we tissue-engineered an acellular three-dimensional (3D) bone tumor niche from electrospun poly(ε-caprolactone) (PCL) scaffolds that incorporate bone-like architecture, extracellular matrix (ECM), and mineralization. PCL-ECM constructs were generated by decellularizing PCL scaffolds harboring cultures of osteogenic human mesenchymal stem cells. The PCL-ECM constructs simulated in vivo-like tumor architecture and increased the proliferation of ES cells compared to PCL scaffolds alone. Compared to monolayer controls, 3D environments facilitated the downregulation of the canonical insulin-like growth factor 1 receptor (IGF-1R) signal cascade through mechanistic target of rapamycin (mTOR), both of which are targets of recent clinical trials. In addition to the downregulation of canonical IGF-1R signaling, 3D environments promoted a reduction in the clathrin-dependent nuclear localization and transcriptional activity of IGF-1R. In vitro drug testing revealed that 3D environments generated cell phenotypes that were resistant to mTOR inhibition and chemotherapy. Our versatile PCL-ECM constructs allow for the investigation of the roles of various microenvironmental elements in ES tumor growth, cancer cell morphology, and induction of resistant cell phenotypes.
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Affiliation(s)
| | | | | | | | - Brian A Menegaz
- Department of Sarcoma Medical Oncology, Division of Cancer Medicine, The University of Texas, MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, Texas 77030, United States
| | - Alejandra Ruiz-Velasco
- Department of Sarcoma Medical Oncology, Division of Cancer Medicine, The University of Texas, MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, Texas 77030, United States
| | - Salah-Eddine Lamhamedi-Cherradi
- Department of Sarcoma Medical Oncology, Division of Cancer Medicine, The University of Texas, MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, Texas 77030, United States
| | - Amelia M Vetter
- Department of Sarcoma Medical Oncology, Division of Cancer Medicine, The University of Texas, MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, Texas 77030, United States
| | | | - Branko Cuglievan
- Department of Sarcoma Medical Oncology, Division of Cancer Medicine, The University of Texas, MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, Texas 77030, United States
| | | | | | - Joseph A Ludwig
- Department of Sarcoma Medical Oncology, Division of Cancer Medicine, The University of Texas, MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, Texas 77030, United States
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12
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Kamal AF, Wahyudi M, Prabowo Y. Outcomes of pelvic resection from malignant pelvic tumors. A case series. INTERNATIONAL JOURNAL OF SURGERY OPEN 2019. [DOI: 10.1016/j.ijso.2018.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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13
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Chi WJ, Hanasono MM, Hofstede TM, Aponte-Wesson RA. Prosthodontic treatment of a patient with Ewing sarcoma of the left maxillary sinus: A clinical report. J Prosthet Dent 2018; 121:698-702. [PMID: 30503146 DOI: 10.1016/j.prosdent.2018.06.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Revised: 06/20/2018] [Accepted: 06/20/2018] [Indexed: 11/25/2022]
Abstract
This clinical report describes the prosthodontic rehabilitation of a 22-year-old woman with a substantial treatment history of Ewing sarcoma of the left maxillary sinus. The patient was diagnosed with Ewing sarcoma at the age of 7 years and went through chemotherapy, radiation, surgical resection, and free-flap reconstruction, initially without prosthodontic rehabilitation. The patient aged 22 years was referred to the oral oncology clinic at The University of Texas MD Anderson Cancer Center for prosthodontic treatment. The patient's prosthetic rehabilitation with dental implants and a definitive maxillary obturator prosthesis is presented in detail.
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Affiliation(s)
- Woo J Chi
- Fellow, Section of Oral Oncology and Maxillofacial Prosthodontics, Department of Head and Neck Surgery, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas.
| | - Matthew M Hanasono
- Professor, Department of Plastic Surgery, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Theresa M Hofstede
- Associate Professor, Section of Oral Oncology and Maxillofacial Prosthodontics, Department of Head and Neck Surgery, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Ruth A Aponte-Wesson
- Associate Professor, Section of Oral Oncology and Maxillofacial Prosthodontics, Department of Head and Neck Surgery, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
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14
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Arrieta MA, Mendonça OJ, Bordach MA. Differential diagnosis of a neoplastic condition in a prehistoric juvenile individual from La Falda site, Northwest Argentina. INTERNATIONAL JOURNAL OF PALEOPATHOLOGY 2018; 21:111-120. [PMID: 29776877 DOI: 10.1016/j.ijpp.2016.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Revised: 10/26/2016] [Accepted: 10/27/2016] [Indexed: 06/08/2023]
Abstract
Bone neoplasms or tumors are of great interest for paleopathological studies due to their close relationship with health and survivorship as well as for their epidemiologic and demographic relevance. However, the identification of these lesions in archaeological specimens is very uncommon. The aim of this paper is to report the case of skeleton R5 E#1 from the prehistoric cemetery La Falda, in the Northwest region of Argentina. During the osteopathological analysis of the skeletal series, proliferative lesions in several bones of the skeleton of a 7-10-year-old juvenile were observed (i.e., both scapulae; left clavicle, humerus, and ulna, both os coxae, femora, and fibulae, and right foot bones). Age-at-death estimation, location and distribution pattern, and morphological appearances of the lesions indicated that this juvenile suffered from a neoplastic condition. A comprehensive differential diagnosis was carried out, suggesting that these lesions were compatible with hereditary multiple osteochondromas. However, Ewing's sarcoma was not definitively ruled out as a probable diagnosis. Thus, this work adds new evidence to the existence of neoplastic conditions in the prehistoric populations of the Americas, and it contributes original data to perform a differential diagnosis for multiple proliferative lesions.
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Affiliation(s)
- Mario A Arrieta
- Laboratorio de Osteología y Anatomía Funcional Humana, Universidad Nacional de Río Cuarto-CONICET, Río Cuarto, Argentina.
| | - Osvaldo J Mendonça
- Laboratorio de Osteología y Anatomía Funcional Humana, Universidad Nacional de Río Cuarto-CONICET, Río Cuarto, Argentina
| | - María A Bordach
- Laboratorio de Osteología y Anatomía Funcional Humana, Universidad Nacional de Río Cuarto, Río Cuarto, Argentina
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15
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Longhi A, Barbieri E, Fabbri N, Macchiagodena M, Favale L, Lippo C, Salducca N, Bacci G. Radiation-Induced Osteosarcoma Arising 20 years after the Treatment of Ewing's Sarcoma. TUMORI JOURNAL 2018; 89:569-72. [PMID: 14870790 DOI: 10.1177/030089160308900526] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We report the case of a 17 years old female with a Ewing's sarcoma of the left femur treated with limb sparing surgery followed by local radiotherapy of 45 Gy and adjuvant chemotherapy with vincristine, doxorubicine, cyclophosphamide, actinomycin D. The patient received neoadjuvant chemotherapy for osteosarcoma and a left femur resection with endoprosthesis replacement. The patient is alive and free of disease 4 years after the treatment of this second malignant neoplasm (SMN). This case shows that radioinduced SMN can occurr with relatively low doses of RT («50Gy) and that it may occurr very late.
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Affiliation(s)
- Alessandra Longhi
- Department of Musculoskeletal Oncology, Rizzoli Orthopedic Institute, Bologna, Italy.
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16
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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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Abstract
PURPOSE OF REVIEW Agriculture remains a major economic sector globally, and workers experience high rates of chronic inflammatory lung and musculoskeletal diseases. Whereas obstructive pulmonary diseases are known risk factors for bone loss, the underlying relationship between lung inflammation and bone health is not well known. RECENT FINDINGS An agriculture organic dust extract inhalation animal model has recently linked lung injury-induced inflammation to systemic bone loss. This process is dependent upon lipopolysaccharide and the toll-like receptor 4 (TLR4) signaling pathway. Downstream systemic interleukin-6 is a key mediator that subsequently activates osteoclastogenesis. Age is a host factor that impacted bone disease with younger mice demonstrating increased susceptibility to bone loss following inhalant exposures as compared to older mice. Supplemental dietary vitamin D was shown to prevent organic dust-induced bone loss, but not lung disease, in animals. Recent animal studies provide new mechanistic insight into the lung-bone inflammatory axis. Host factors, diet, and lipopolysaccharide/TLR4 signaling pathways play a significant role in explaining how inhalant organic dust exposures impact bone health. These investigations might lead to specific targeted therapeutic approaches.
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18
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Pretz JL, Barysauskas CM, George S, Hornick JL, Raut CP, Chen YLE, Marcus KJ, Choy E, Hornicek F, Ready JE, DeLaney TF, Baldini EH. Localized Adult Ewing Sarcoma: Favorable Outcomes with Alternating Vincristine, Doxorubicin, Cyclophosphamide, and Ifosfamide, Etoposide (VDC/IE)-Based Multimodality Therapy. Oncologist 2017; 22:1265-1270. [PMID: 28550026 PMCID: PMC5634761 DOI: 10.1634/theoncologist.2016-0463] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Accepted: 03/10/2017] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND In children with localized Ewing sarcoma (ES), addition of ifosfamide and etoposide to cyclophosphamide, doxorubicin, and vincristine (VDC/IE) improved 5-year overall survival (OS) to 70%-80%. Prior to delivery of VDC/IE in adults, 5-year OS was <50%. We reviewed our institutional outcomes for adults with ES who received VDC/IE-based treatment. MATERIALS AND METHODS Between 1997-2013, 67 adults with localized ES were treated with curative intent. Local recurrence-free survival (LRFS), progression-free survival (PFS), and OS were determined using Kaplan-Meier method; comparisons were assessed with log-rank. Proportional hazard models were used to determine predictive factors. RESULTS All patients received VDC/IE (median 14 cycles.) Local therapy was surgery for 33, radiation therapy for 17, or both for 17. Median follow-up for living patients was 5.2 years. Six patients had disease progression on therapy. Site of first failure was local for three, local and distant for two, and distant for ten. Five-year LRFS was 91%; 5-year LRFS was 96% for nonpelvic disease and 64% for pelvic disease (p = .003). Five-year PFS was 66%, and 5-year OS was 79%. On multivariate analysis, pelvic site had a 3.3 times increased risk of progression (p = .01). CONCLUSION Survival for adults with localized ES treated with VDC/IE-based multimodality therapy appears to be better than historical data and similar to excellent outcomes in children. Pelvic site of disease remains a predictor of worse outcome. Given the paucity of literature for adult ES, these data help validate VDC/IE-based therapy as an appropriate treatment approach for this rare disease in adults. IMPLICATIONS FOR PRACTICE Ewing sarcoma (ES) is rare in adults. Treatment approaches for adults have been extrapolated from the pediatric experience, and there is a sense that adults fare less well than children. We reviewed treatment outcomes in adults with localized ES treated with cyclophosphamide, doxorubicin, and vincristine in alternation with ifosfamide and etoposide (VDC/IE) as part of multimodality therapy. Survival outcomes appear to be better than historical data for adults and similar to the excellent outcomes for children. These data help validate VDC/IE-based therapy as an appropriate treatment approach for this rare disease in adults.
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Affiliation(s)
- Jennifer L Pretz
- Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham & Women's Hospital, Boston, Massachusetts, USA
| | - Constance M Barysauskas
- Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Suzanne George
- Center for Sarcoma and Bone Oncology, Dana-Farber Cancer Institute and Brigham & Women's Hospital, Boston, Massachusetts, USA
| | - Jason L Hornick
- Department of Pathology, Dana-Farber Cancer Institute and Brigham & Women's Hospital, Boston, Massachusetts, USA
| | - Chandrajit P Raut
- Department of Surgical Oncology, Dana-Farber Cancer Institute and Brigham & Women's Hospital, Boston, Massachusetts, USA
- Center for Sarcoma and Bone Oncology, Dana-Farber Cancer Institute and Brigham & Women's Hospital, Boston, Massachusetts, USA
| | - Yen-Lin E Chen
- Center for Sarcoma and Connective Tissue Oncology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Karen J Marcus
- Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham & Women's Hospital, Boston, Massachusetts, USA
- Center for Sarcoma and Bone Oncology, Dana-Farber Cancer Institute and Brigham & Women's Hospital, Boston, Massachusetts, USA
| | - Edwin Choy
- Center for Sarcoma and Connective Tissue Oncology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Francis Hornicek
- Center for Sarcoma and Connective Tissue Oncology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - John E Ready
- Center for Sarcoma and Bone Oncology, Dana-Farber Cancer Institute and Brigham & Women's Hospital, Boston, Massachusetts, USA
| | - Thomas F DeLaney
- Department of Surgical Oncology, Dana-Farber Cancer Institute and Brigham & Women's Hospital, Boston, Massachusetts, USA
- Center for Sarcoma and Connective Tissue Oncology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Elizabeth H Baldini
- Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham & Women's Hospital, Boston, Massachusetts, USA
- Center for Sarcoma and Bone Oncology, Dana-Farber Cancer Institute and Brigham & Women's Hospital, Boston, Massachusetts, USA
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19
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Elomaa I, Blomqvist C, Saeter G, Nilbert M, Monge OR, Wiebe T, Alvegård TA. Chemotherapy in Ewing's sarcoma. ACTA ACUST UNITED AC 2016. [DOI: 10.1080/17453674.1999.11744827] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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20
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Ravindra VM, Eli IM, Schmidt MH, Brockmeyer DL. Primary osseous tumors of the pediatric spinal column: review of pathology and surgical decision making. Neurosurg Focus 2016; 41:E3. [DOI: 10.3171/2016.5.focus16155] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Spinal column tumors are rare in children and young adults, accounting for only 1% of all spine and spinal cord tumors combined. They often present diagnostic and therapeutic challenges. In this article, the authors review the current management of primary osseous tumors of the pediatric spinal column and highlight diagnosis, management, and surgical decision making.
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Affiliation(s)
- Vijay M. Ravindra
- 1Department of Neurosurgery, Clinical Neurosciences Center and Huntsman Cancer Institute, University of Utah; and
| | - Ilyas M. Eli
- 1Department of Neurosurgery, Clinical Neurosciences Center and Huntsman Cancer Institute, University of Utah; and
| | - Meic H. Schmidt
- 1Department of Neurosurgery, Clinical Neurosciences Center and Huntsman Cancer Institute, University of Utah; and
| | - Douglas L. Brockmeyer
- 1Department of Neurosurgery, Clinical Neurosciences Center and Huntsman Cancer Institute, University of Utah; and
- 2Division of Pediatric Neurosurgery, Primary Children's Hospital, Salt Lake City, Utah
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21
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Sewell MD, Tan KA, Quraishi NA, Preda C, Varga PP, Williams R. Systematic Review of En Bloc Resection in the Management of Ewing's Sarcoma of the Mobile Spine with Respect to Local Control and Disease-Free Survival. Medicine (Baltimore) 2015; 94:e1019. [PMID: 26166072 PMCID: PMC4504586 DOI: 10.1097/md.0000000000001019] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
There is no consensus on the optimal method of local control in Ewing's sarcoma (ES) of the mobile spine. Recent reports have suggested that en bloc resection may improve local control and survival. The authors therefore performed a systematic review to answer the following questions: (1) What is the outcome of en bloc resection for ES of the mobile spine with respect to local control and disease-free survival (DFS)? (2) How should residual ES of the mobile spine be treated?Inclusion criteria were articles published between the years 1960 and 2014 in English that contained more than five patients. This yielded 204 articles, from which 4 were selected for detailed analysis. The literature was graded for quality, summarized, and presented to a group of spinal oncology experts with consensus recommendations made.All 4 studies were retrospective case series graded as very low quality evidence. Local control strategies included radiotherapy (RT) alone, surgery and RT, or surgery alone. There was no standardized outcome reported across studies with respect to the type of surgical procedure, margins, and outcomes of interest such as local recurrence (LR) and DFS. When the en bloc procedures were pooled together, 2 of the 21 patients with available LR data developed LR (9.5%), and 5 of the 7 patients with available DFS data were disease free at a mean of 76 months. The remaining 2 died at 10 and 29 months, respectively. No studies were identified detailing the treatment of residual ES of the mobile spine.There is no consensus on the optimal method of local control for spinal ES or the treatment of residual disease. A weak recommendation supports that when the en bloc resection is technically possible, in combination with RT, this appears to provide superior local control than RT alone, or incomplete excision and RT. The effect on survival is indeterminate.
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Affiliation(s)
- Mathew David Sewell
- From the Princess Alexandra Hospital, Brisbane, Australia (MDS, CP, RW); University of New South Wales, Faculty of Medicine, Sydney, Australia (K-AT); Centre for Spine Studies and Surgery, Queens Medical Centre, Nottingham, UK (NAQ); and The National Centre for Spinal Disorders, Budapest, Hungary (PPV)
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22
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Zang J, Guo W, Yang R, Tang X, Li D. Is total en bloc sacrectomy using a posterior-only approach feasible and safe for patients with malignant sacral tumors? J Neurosurg Spine 2015; 22:563-70. [PMID: 25815809 DOI: 10.3171/2015.1.spine14237] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT In this study the authors' aim was to describe their experience with total en bloc sacrectomy using a posterioronly approach and to assess the outcome of patients with malignant sacral tumors who underwent this procedure at their center. METHODS The authors identified and retrospectively reviewed the records of 10 patients with malignant sacral tumors who underwent a total en bloc sacrectomy via a single posterior approach at their center. The pathological diagnosis was chordoma in 4 patients, chondrosarcoma in 1, osteosarcoma in 1, malignant schwannoma in 1, malignant giant cell tumor in 1, and Ewing's sarcoma in 2. Radiological examination revealed that the tumor involved S1-5 in 7 patients, S1-4 in 1, S1-3 in 1, and S1-2 in 1. RESULTS All 10 patients were stable during the perioperative period. The mean surgery duration was 282 minutes (range 250-310 minutes). The median estimated blood loss was 2595 ml (range 1500-3200 ml). All patients were followed up for 13-29 months (mean 22 months). Two patients had a local recurrence. Two patients died of disease, 1 patient was alive with disease, and 7 patients were alive without evidence of disease. Among the 8 surviving patients, 6 were able to walk without assistive devices, and 2 were able to walk with crutches. The total complication rate was 40% (4 of 10). Wound complications (deep infection and wound healing problems) occurred in 3 patients, and a distal deep vein thrombosis occurred in 1 patient. CONCLUSIONS Total en bloc sacrectomy using a posterior-only approach is feasible and safe in selected patients and is an important procedure for the treatment of primary malignant tumor involving the entire sacrum or only the top portion.
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Affiliation(s)
- Jie Zang
- Musculoskeletal Tumor Center, People's Hospital, Peking University, Beijing, China
| | - Wei Guo
- Musculoskeletal Tumor Center, People's Hospital, Peking University, Beijing, China
| | - Rongli Yang
- Musculoskeletal Tumor Center, People's Hospital, Peking University, Beijing, China
| | - Xiaodong Tang
- Musculoskeletal Tumor Center, People's Hospital, Peking University, Beijing, China
| | - Dasen Li
- Musculoskeletal Tumor Center, People's Hospital, Peking University, Beijing, China
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23
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Abstract
Ewing sarcoma (ES) is rare in Japanese people, and only 30-40 patients develop the disease annually. To diagnose ES, molecular techniques that aim to detect characteristic fusion genes are commonly used in combination with conventional histological and immunohistochemical examinations. The treatment strategy for ES is characterized by multi-disciplinary collaboration between pediatric oncologists, medical oncologists, radiation oncologists, and orthopedic surgeons. In recent years, numerous large-scale national or international multi-institutional studies of ES have been performed. Pre- and postoperative intensive systemic chemotherapy with multiple anticancer drugs is the standard treatment method for ES. Depending on the obtained surgical margin, postoperative radiation might also be performed. If preoperative radiological examinations indicate that surgical excision would be difficult, preoperative radiation can be administered. As the treatment outcomes of ES have improved, late complications and secondary malignancies have become a problem. After treatment, patients with ES require very long-term follow-up in order to detect secondary malignancies and growth-related musculoskeletal complications.
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Affiliation(s)
- Toshifumi Ozaki
- Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry, Pharmaceutical Sciences, Shikata-cho 2-5-1, Kita-ku, Okayama, 700-8558, Japan,
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24
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Primitive neuroectodermal tumor/ewing sarcoma presenting with pulmonary nodular lesions. Case Rep Oncol Med 2015; 2015:957239. [PMID: 25705534 PMCID: PMC4325222 DOI: 10.1155/2015/957239] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2014] [Accepted: 01/03/2015] [Indexed: 11/17/2022] Open
Abstract
Primitive neuroectodermal tumors (PNETs) and Ewing sarcoma (EWS) belong to the same family of malignant, small, round cell neoplasms of soft tissue or bone origin. EWS-PNETs that arise in the lung parenchyma involvement are extremely rare in adults. A case of a 32-year-old male presenting with chest pain and diffuse pulmonary nodules on chest X-ray and diagnosed with Ewing sarcoma-PNETs will be presented here.
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25
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Abstract
Malignant bone tumors (osteosarcoma, Ewing sarcoma) and soft-tissue sarcomas (rhabdomyosarcoma, nonrhabdomyosarcoma) account for approximately 14% of childhood malignancies. Successful treatment of patients with sarcoma depends on a multidisciplinary approach to therapy, including oncology, surgery, radiation oncology, radiology, pathology, and physiatry. By combining systemic treatment with chemotherapy and primary tumor control using surgery and/or radiation, survival rates for localized disease range from 70% to 75%. However, children with metastatic or recurrent disease continue to have dismal outcomes. A better understanding of the biology underlying both bone and soft-tissue sarcomas is required to further improve outcomes for children with these tumors.
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Affiliation(s)
- Josephine H HaDuong
- Division of Hematology, Oncology, and Blood & Marrow Transplantation, Department of Pediatrics, Children's Center for Cancer and Blood Diseases, Children's Hospital Los Angeles, University of Southern California Keck School of Medicine, 4650 Sunset Boulevard, MS 54, Los Angeles, CA 90027, USA
| | - Andrew A Martin
- Division of Hematology/Oncology, Department of Pediatrics, Pauline Allen Gill Center for Cancer and Blood Disorders, Children's Medical Center, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, MC 9063, Dallas, TX 75390, USA
| | - Stephen X Skapek
- Division of Hematology/Oncology, Department of Pediatrics, Pauline Allen Gill Center for Cancer and Blood Disorders, Children's Medical Center, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, MC 9063, Dallas, TX 75390, USA
| | - Leo Mascarenhas
- Division of Hematology, Oncology, and Blood & Marrow Transplantation, Department of Pediatrics, Children's Center for Cancer and Blood Diseases, Children's Hospital Los Angeles, University of Southern California Keck School of Medicine, 4650 Sunset Boulevard, MS 54, Los Angeles, CA 90027, USA.
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26
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Duchman KR, Gao Y, Miller BJ. Prognostic factors for survival in patients with Ewing's sarcoma using the surveillance, epidemiology, and end results (SEER) program database. Cancer Epidemiol 2015; 39:189-95. [PMID: 25595632 DOI: 10.1016/j.canep.2014.12.012] [Citation(s) in RCA: 87] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2014] [Revised: 12/22/2014] [Accepted: 12/26/2014] [Indexed: 02/06/2023]
Abstract
BACKGROUND The current study aims to determine cause-specific survival in patients with Ewing's sarcoma while reporting clinical risk factors for survival. METHODS The Surveillance, Epidemiology, and End Results (SEER) Program database was used to identify patients with osseous Ewing's sarcoma from 1991 to 2010. Patient, tumor, and socioeconomic variables were analyzed to determine prognostic factors for survival. RESULTS There were 1163 patients with Ewing's sarcoma identified in the SEER Program database. The 10-year cause-specific survival for patients with non-metastatic disease at diagnosis was 66.8% and 28.1% for patients with metastatic disease. Black patients demonstrated reduced survival at 10 years with an increased frequency of metastatic disease at diagnosis as compared to patients of other race, while Hispanic patients more frequently presented with tumor size>10cm. Univariate analysis revealed that metastatic disease at presentation, tumor size>10cm, axial tumor location, patient age≥20 years, black race, and male sex were associated with decreased cause-specific survival at 10 years. Metastatic disease at presentation, axial tumor location, tumor size>10cm, and age≥20 years remained significant in the multivariate analysis. CONCLUSIONS Patients with Ewing's sarcoma have decreased cause-specific survival at 10 years when metastatic at presentation, axial tumor location, tumor size>10cm, and patient age≥20 years.
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Affiliation(s)
- Kyle R Duchman
- Department of Orthopaedics and Rehabilitation, University of Iowa, 200 Hawkins Drive, 01015 JPP, Iowa City, IA 52242, USA.
| | - Yubo Gao
- Department of Orthopaedics and Rehabilitation, University of Iowa, 200 Hawkins Drive, 01015 JPP, Iowa City, IA 52242, USA.
| | - Benjamin J Miller
- Department of Orthopaedics and Rehabilitation, University of Iowa, 200 Hawkins Drive, 01015 JPP, Iowa City, IA 52242, USA.
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27
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Tosso PN, Kong Y, Scher L, Cummins R, Schneider J, Rahim S, Holman KT, Toretsky J, Wang K, Üren A, Brown ML. Synthesis and structure-activity relationship studies of small molecule disruptors of EWS-FLI1 interactions in Ewing's sarcoma. J Med Chem 2014; 57:10290-303. [PMID: 25432018 PMCID: PMC4281097 DOI: 10.1021/jm501372p] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
EWS-FLI1 is an oncogenic fusion protein implicated in the development of Ewing's sarcoma family tumors (ESFT). Using our previously reported lead compound 2 (YK-4-279), we designed and synthesized a focused library of analogues. The functional inhibition of the analogues was measured by an EWS-FLI1/NR0B1 reporter luciferase assay and a paired cell screening approach measuring effects on growth inhibition for human cells containing EWS-FLI1 (TC32 and TC71) and control PANC1 cell lines devoid of the oncoprotein. Our data revealed that substitution of electron donating groups at the para-position on the phenyl ring was the most favorable for inhibition of EWS-FLI1 by analogs of 2. Compound 9u (with a dimethylamino substitution) was the most active inhibitor with GI50 = 0.26 ± 0.1 μM. Further, a correlation of growth inhibition (EWS-FLI1 expressing TC32 cells) and the luciferase reporter activity was established (R(2) = 0.84). Finally, we designed and synthesized a biotinylated analogue and determined the binding affinity for recombinant EWS-FLI1 (Kd = 4.8 ± 2.6 μM).
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Affiliation(s)
- Perrer N Tosso
- Center for Drug Discovery, Georgetown University Medical Center , New Research Building EP07, 3970 Reservoir Road, NW, Washington, D.C. 20057, United States
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Casey DL, Meyers PA, Alektiar KM, Magnan H, Healey JH, Boland PJ, Wolden SL. Ewing sarcoma in adults treated with modern radiotherapy techniques. Radiother Oncol 2014; 113:248-53. [PMID: 25613397 DOI: 10.1016/j.radonc.2014.11.023] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2014] [Revised: 11/12/2014] [Accepted: 11/13/2014] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE To evaluate local control and survival outcomes in adults with Ewing sarcoma (ES) treated with radiotherapy (RT). MATERIAL AND METHODS Retrospective review of all 109 patients age ⩾18 treated for ES with RT to the primary site at Memorial Sloan Kettering Cancer Center between 1990 and 2011. RT was used as the definitive local control modality in 44% of patients, preoperatively for 6%, and postoperatively for 50%. RESULTS Median age at diagnosis was 27years (range, 18-67). The 5-year local failure (LF) was 18%. Differences in LF were not identified when evaluated by modality of local control (RT versus combined surgery and RT), RT dose, fractionation, and RT technique. However, margin status at time of resection significantly predicted LF. The 5-year event-free survival and overall survival rates were 44% and 66% for patients with localized disease, compared with 16% and 26% for metastatic disease (p=0.0005 and 0.0002). Tumor size, histopathologic response to chemotherapy, and treatment on or according to a protocol were also significantly associated with survival. CONCLUSIONS This series of adults treated with modern chemotherapy and RT had prognostic factors and outcomes similar to adolescents with ES. All adults with ES should be treated with an aggressive, multidisciplinary approach.
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Affiliation(s)
- Dana L Casey
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, USA
| | - Paul A Meyers
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, USA
| | - Kaled M Alektiar
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, USA
| | - Heather Magnan
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, USA
| | - John H Healey
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, USA
| | - Patrick J Boland
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, USA
| | - Suzanne L Wolden
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, USA.
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Davis CM, Choong AM, Sharp D, Taheri T, Senewiratne S, Hinckley V. Peripheral primitive neuroectodermal tumour – a rare cause of a popliteal fossa mass: A case report and review of the literature. Plast Surg (Oakv) 2014. [DOI: 10.1177/229255031402200309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Colin M Davis
- Department of Plastic Surgery; Herston, Queensland, Australia
| | - Andrew Mtl Choong
- Department of Vascular Surgery, Royal Brisbane and Women's Hospital; Herston, Queensland, Australia
- Department of Surgery, University of Queensland; Herston, Queensland, Australia
| | - David Sharp
- Department of Plastic Surgery; Herston, Queensland, Australia
| | - Touraj Taheri
- Department of Anatomical Pathology, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
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Proton radiotherapy for pediatric sarcoma. Cancers (Basel) 2014; 6:112-27. [PMID: 24424260 PMCID: PMC3980591 DOI: 10.3390/cancers6010112] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2013] [Revised: 12/17/2013] [Accepted: 12/18/2013] [Indexed: 11/16/2022] Open
Abstract
Pediatric sarcomas represent a distinct group of pathologies, with approximately 900 new cases per year in the United States alone. Radiotherapy plays an integral role in the local control of these tumors, which often arise adjacent to critical structures and growing organs. The physical properties of proton beam radiotherapy provide a distinct advantage over standard photon radiation by eliminating excess dose deposited beyond the target volume, thereby reducing both the dose of radiation delivered to non-target structures as well as the total radiation dose delivered to a patient. Dosimetric studies comparing proton plans to IMRT and 3D conformal radiation have demonstrated the superiority of protons in numerous pediatric malignancies and data on long-term clinical outcomes and toxicity is emerging. In this article, we review the existing clinical and dosimetric data regarding the use of proton beam radiation in malignant bone and soft tissue sarcomas.
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Khoury JD. Ewing sarcoma family of tumors: a model for the new era of integrated laboratory diagnostics. Expert Rev Mol Diagn 2014; 8:97-105. [DOI: 10.1586/14737159.8.1.97] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Okpokowuruk FS, Oloyede I. Congenital Ewing's Sarcoma in a neonate in Uyo--a case report. Pan Afr Med J 2013; 15:90. [PMID: 24198886 PMCID: PMC3810286 DOI: 10.11604/pamj.2013.15.90.2219] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2012] [Accepted: 05/28/2013] [Indexed: 11/11/2022] Open
Abstract
Congenital Ewing's sarcoma is a very rare occurrence indeed with only one case involving the humerus and none involving the ulna that has been noted in the literature to our knowledge. It is one of those tumours that not only do they rarely occur in the neonatal period, but is also very uncommon in black people. We present a case report of Congenital Ewing's Sarcoma in a black female infant involving the ulna bone and surrounding soft tissues which was diagnosed by histology and immnohistochemistry.
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Affiliation(s)
- Frances Sam Okpokowuruk
- Lecturer/Consultant Paediatrician, University Of Uyo Teaching Hospital, Uyo, Akwa Ibom State, Nigeria
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Tamura M, Kogo K, Masuo O, Oura Y, Matsumoto H, Fujita K, Nakao N, Uematsu Y, Itakura T, Chernov M, Hayashi M, Muragaki Y, Iseki H. Formation and Rupture of the Internal Carotid Artery Aneurysm after Multiple Courses of Intensity-Modulated Radiation Therapy for Management of the Skull Base Ewing Sarcoma/PNET: Case Report. J Neurol Surg Rep 2013; 74:111-7. [PMID: 24303346 PMCID: PMC3836956 DOI: 10.1055/s-0033-1358379] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2012] [Accepted: 07/08/2013] [Indexed: 11/08/2022] Open
Abstract
Background Aneurysm formation after stereotactic irradiation of skull base tumors is rare. The formation and rupture of an internal carotid artery (ICA) aneurysm in a patient with skull base Ewing sarcoma/primitive neuroectodermal tumor (PNET), who underwent surgery followed by multiple courses of intensity-modulated radiation therapy (IMRT) and chemotherapy, is described. Case Description A 25-year-old man presented with a sinonasal tumor with intraorbital and intracranial growth. At that time cerebral angiography did not reveal any vascular abnormalities. The lesion was resected subtotally. Histopathologic diagnosis was Ewing sarcoma/PNET. The patient underwent multiple courses of chemotherapy and three courses of IMRT at 3, 28, and 42 months after initial surgery. The total biologically effective dose delivered to the right ICA was 220.2 Gy. Seven months after the third IMRT, the patient experienced profound nasal bleeding that resulted in hypovolemic shock. Angiography revealed a ruptured right C4–C5 aneurysm and irregular stenotic changes of the ICA. Lifesaving endovascular trapping of the right ICA was done. The patient recovered well after surgery but died due to tumor recurrence 6 months later. Conclusion Excessive irradiation of the ICA may occasionally result in aneurysm formation, which should be borne in mind during stereotactic irradiation of malignant skull base tumors.
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Affiliation(s)
- Manabu Tamura
- Faculty of Advanced Techno-Surgery, Institute of Advanced Biomedical Engineering and Science, Tokyo Women's Medical University, Tokyo, Japan
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Zhu L, McManus MM, Hughes DPM. Understanding the Biology of Bone Sarcoma from Early Initiating Events through Late Events in Metastasis and Disease Progression. Front Oncol 2013; 3:230. [PMID: 24062983 PMCID: PMC3775316 DOI: 10.3389/fonc.2013.00230] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2013] [Accepted: 08/21/2013] [Indexed: 12/27/2022] Open
Abstract
The two most common primary bone malignancies, osteosarcoma (OS), and Ewing sarcoma (ES), are both aggressive, highly metastatic cancers that most often strike teens, though both can be found in younger children and adults. Despite distinct origins and pathogenesis, both diseases share several mechanisms of progression and metastasis, including neovascularization, invasion, anoikis resistance, chemoresistance, and evasion of the immune response. Some of these processes are well-studies in more common carcinoma models, and the observation from adult diseases may be readily applied to pediatric bone sarcomas. Neovascularization, which includes angiogenesis and vasculogenesis, is a clear example of a process that is likely to be similar between carcinomas and sarcomas, since the responding cells are the same in each case. Chemoresistance mechanisms also may be similar between other cancers and the bone sarcomas. Since OS and ES are mesenchymal in origin, the process of epithelial-to-mesenchymal transition is largely absent in bone sarcomas, necessitating different approaches to study progression and metastasis in these diseases. One process that is less well-studied in bone sarcomas is dormancy, which allows micrometastatic disease to remain viable but not growing in distant sites – typically the lungs – for months or years before renewing growth to become overt metastatic disease. By understanding the basic biology of these processes, novel therapeutic strategies may be developed that could improve survival in children with OS or ES.
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Affiliation(s)
- Limin Zhu
- Department of Pediatrics - Research, UT MD Anderson Cancer Center , Houston, TX , USA
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Ewing sarcoma versus osteomyelitis: differential diagnosis with magnetic resonance imaging. Skeletal Radiol 2013; 42:1097-104. [PMID: 23685708 DOI: 10.1007/s00256-013-1632-5] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2012] [Revised: 04/04/2013] [Accepted: 04/21/2013] [Indexed: 02/08/2023]
Abstract
OBJECTIVE To find and evaluate characteristic magnetic resonance imaging (MRI) patterns for the differentiation between Ewing sarcoma and osteomyelitis. MATERIALS AND METHODS We identified 28 consecutive patients referred to our department for MRI (1.5 T) of an unclear bone lesion with clinical symptoms suggestive of Ewing sarcoma or osteomyelitis. MRI scans were re-evaluated by two experienced radiologists, typical MR imaging features were documented and a diagnostic decision between Ewing sarcoma and osteomyelitis was made. Statistical significance of the association between MRI features and the biopsy-based diagnosis was assessed using Fisher's exact test. RESULTS The most clear-cut pattern for determining the correct diagnosis was the presence of a sharp and defined margin of the bone lesion, which was found in all patients with Ewing sarcoma, but in none of the patients with osteomyelitis (P < 0.0001). Contrast enhancing soft tissue was present in all cases with Ewing sarcoma and absent in 4 patients with osteomyelitis (P = 0.0103). Cortical destruction was found in all patients with Ewing sarcoma, 4 patients with osteomyelitis did not present any cortical reaction (P = 0.0103). Cystic or necrotic areas were identified in 13 patients with Ewing sarcoma and in 1 patient with osteomyelitis (P = 0.004). Interobserver reliability was very good (kappa = 1) in Ewing sarcoma and moderate (kappa = 0.6) in patients with osteomyelitis. CONCLUSIONS A sharp and defined margin, optimally visualized on T1-weighted images in comparison to short tau inversion recovery (STIR) images, is the most significant feature of Ewing sarcoma in differentiating from osteomyelitis.
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Adult ewing sarcoma: survival and local control outcomes in 102 patients with localized disease. Sarcoma 2013; 2013:681425. [PMID: 23840168 PMCID: PMC3693164 DOI: 10.1155/2013/681425] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2013] [Revised: 05/21/2013] [Accepted: 05/22/2013] [Indexed: 11/24/2022] Open
Abstract
Objectives. To assess the clinical features and local control (LC) outcomes in adult patients with localized Ewing Sarcoma (ES). Methods. The records of 102 ES patients with localized disease ≥18 years of age seen from 1977 to 2007 were reviewed. Factors relevant to prognosis, survival, and LC were analyzed.
Results. The 5-year overall survival (OS) and event-free survival (EFS) were 60% and 52%, respectively, for the entire cohort. Treatment era (1977–1992 versus 1993–2007) remained an independent prognostic factor for OS on multivariate analysis, with improved outcomes observed in the 1993–2007 era (P = 0.02). The 5-year OS and EFS for the 1993–2007 era were 73% and 60%, respectively. Ifosfamide and etoposide based chemotherapy and surgery were more routinely used in the 1993–2007 era (P < 0.01). The 5-year local failure rate (LFR) was 14%, with a 5-year LFR of 18% for surgery, 33% for radiation, and 0% for combined surgery and radiation in the 1993–2007 era (P = 0.17). Conclusion. Modern survival outcomes for adults with localized ES are similar to multi-institutional results in children. This improvement over time is associated with treatment intensification with chemotherapy and increased use of surgery. Aggressive LC (combined surgery and radiation) may improve outcomes in poor prognosis patients.
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38
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Peotter J, Neiderer KM, Walters JL, Dancho JF. Ewing sarcoma in a diabetic male with history of foot ulceration. J Foot Ankle Surg 2013; 52:533-6. [PMID: 23643668 DOI: 10.1053/j.jfas.2013.03.029] [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: 07/23/2012] [Indexed: 02/03/2023]
Abstract
Ewing sarcoma is a rare diagnosis, with as few as 225 new cases diagnosed in North America annually, and only 3% occurring in the foot. They generally present in the second decade of life and are very infrequently found in patients older than 40 years. The diagnosis of Ewing sarcoma can be difficult, especially in older patients with diabetes and a history of ulceration, because it can have an appearance on radiography similar to that of osteomyelitis. We present a case of Ewing sarcoma of the foot in a patient with type 2 diabetes in his sixth decade of life.
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Affiliation(s)
- Jill Peotter
- Southern Arizona Veterans Affairs Medical Center, Tucson, AZ 85723, USA
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Murphey MD, Senchak LT, Mambalam PK, Logie CI, Klassen-Fischer MK, Kransdorf MJ. From the Radiologic Pathology Archives: Ewing Sarcoma Family of Tumors: Radiologic-Pathologic Correlation. Radiographics 2013; 33:803-31. [DOI: 10.1148/rg.333135005] [Citation(s) in RCA: 170] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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40
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Morris P, Dickman PS, Seidel MJ. Ewing's sarcoma/primitive neuroectodermal tumor of the proximal humeral epiphysis. Orthopedics 2013; 36:e113-6. [PMID: 23276342 DOI: 10.3928/01477447-20121217-29] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Ewing's sarcoma/primitive neuroectodermal tumor (ES/PNET) of bone is a rare childhood tumor most commonly located in the metadiaphysis. In skeletally immature patients, lesions of the epiphysis are rarely malignant, with the most common diagnosis being chondroblastoma. This article presents a case of ES/PNET of the proximal humeral epiphysis in a 12-year-old boy. To the authors' knowledge, this is the first reported case of epiphyseal ES/PNET confirmed with molecular testing. Radiographs of the patient's painful shoulder showed a well-defined lytic lesion within the humeral epiphysis. Magnetic resonance imaging suggested a chondroid tumor with surrounding edema. Based on the imaging characteristics, the patient's age, and the lesion's location, a preliminary diagnosis of chondroblastoma was made. A trochar biopsy of the lesion demonstrated a small, round, blue cell tumor on frozen section. Subsequently, immunohistochemical staining was uniformly positive in a membrane pattern for CD99, and molecular diagnostic testing demonstrated a EWSR1/FLI1 fusion transcript, confirming the pathologic diagnosis of ES/PNET. Although metadiaphyseal locations for ES/PNET are most common, this case adds to previously reported cases of epiphyseal ES/PNET, suggesting that the diagnosis be considered for pediatric epiphyseal tumors. This case also demonstrates why following rigorous oncologic treatment algorithms by obtaining a limited trochar biopsy, even in the case of a confident radiographic diagnosis, is critically important; the biopsy results can lead to a major change in treatment and avoid contamination of a larger area of soft tissue and bone.
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Affiliation(s)
- Parisa Morris
- Department of Orthopaedic Surgery, University of Arizona, Tucson, USA
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Rombi B, DeLaney TF, MacDonald SM, Huang MS, Ebb DH, Liebsch NJ, Raskin KA, Yeap BY, Marcus KJ, Tarbell NJ, Yock TI. Proton Radiotherapy for Pediatric Ewing's Sarcoma: Initial Clinical Outcomes. Int J Radiat Oncol Biol Phys 2012; 82:1142-8. [DOI: 10.1016/j.ijrobp.2011.03.038] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2010] [Revised: 03/17/2011] [Accepted: 03/23/2011] [Indexed: 01/28/2023]
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Jalal H, Belhadj Z, Enneddam H, Madhar M, Fikry T, Essadki O, Ousehal A. Contribution of magnetic resonance imaging in the diagnosis of talus skip metastases of Ewing's sarcoma of the calcaneus in a child: a case report. J Med Case Rep 2011; 5:451. [PMID: 21910875 PMCID: PMC3183038 DOI: 10.1186/1752-1947-5-451] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2011] [Accepted: 09/12/2011] [Indexed: 11/10/2022] Open
Abstract
Introduction Ewing's sarcoma of the calcaneus is rare. About thirty cases with calcaneus involvement have been reported in the literature. Talus skip metastases have rarely been described in the available literature Case presentation We report a case of a 14-year-old Moroccan boy, who presented with Ewing's sarcoma of his right calcaneus, diagnosed by swelling of the calcaneus evolving over a year. Radiography, computed tomography and magnetic resonance imaging showed an important tumoral process of the calcaneus and talus skip metastases. The diagnosis was confirmed with histology after a biopsy. In spite of amputation and postoperative chemotherapy, our patient died six months later due to secondary respiratory distress after lung metastasis. Conclusion Imaging, especially magnetic resonance, is important in the diagnosis of Ewing sarcoma and skeletal skip metastases. Treatment of Ewing's sarcoma consists of chemotherapy, radiation therapy and surgical resection depending on the stage and extent of the disease. With the exception of lesions in the calcaneus, the prognosis for disease-free survival of Ewing's sarcoma of the foot is excellent.
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Affiliation(s)
- Hicham Jalal
- Department of Radiology, Ibn Tofail Hospital, Gueliz, Marrakesh, 40000, Morocco.
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Yang Y, Liu Y, Yin Z. Primary orbital Ewing sarcoma. J Pediatr Ophthalmol Strabismus 2011; 48 Online:e43-8. [PMID: 21766739 DOI: 10.3928/01913913-20110712-05] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2011] [Accepted: 06/01/2011] [Indexed: 11/20/2022]
Abstract
The authors report the clinical manifestations, pathologic character, management, and prognosis of primary orbital Ewing sarcoma, and review pertinent literature. A 6-year-old boy presented with the complaint of abruptly decreasing visual acuity and right proptosis. Computed tomography scan revealed a mass in the region of the right infratemporal orbit with extension into the infratemporal fossa and masseteric space, and there was erosion of the right lateral orbital wall. An anterior orbitotomy eyelid crease was performed to remove the tumor. The tumor cells were positive in membranous pattern for CD99 immunostaining; all other reactions were negative. The EWS-FLI-1 fusion gene was not detected by reverse-transcription polymerase chain reaction. Combined radiotherapy was applied. Primary orbital Ewing sarcoma is an extremely rare malignant tumor that shows a predilection for males (ratio: 1.4 to 1). Appropriate treatment consists of local resection, radiotherapy, and adjunctive chemotherapy.
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Affiliation(s)
- Yuli Yang
- Southwest Hospital, Southwest Eye Hospital, Third Military Medical University, No. 30 Gaotanyan Main Street, Shapingba District, Chongqing 400038, China.
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Kollender Y, Shabat S, Nirkin A, Issakov J, Flusser G, Merimsky O, Meller I. Periosteal Ewing's Sarcoma: Report of Two New Cases and Review of the Literature. Sarcoma 2011; 3:85-8. [PMID: 18521268 PMCID: PMC2395413 DOI: 10.1080/13577149977695] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
Background. The origin of Ewing's sarcoma in a periosteal location is rare and not clearly documented. Other malignant bone tumors appear to have a somewhat better prognosis when confined between periosteum and bone. Is it the same for periosteal Ewing's sarcoma?Methods. We describe two new cases and comprehensively review the literature consisting of 18 documented cases since the condition was first described in 1986 (S.M. Bator.Cancer 58:1781- 4).Results. Periosteal Ewing's sarcoma differs from the other forms of Ewing's sarcoma in terms of sex predominance, location of tumor, surgical stage at presentation and typical imaging studies. Eighteen out of the 20 patients were reported to be alive with no evidence of disease.Conclusions. It seems that the prognosis of this rare variant of Ewing's sarcoma family of tumors might be better but the small number of cases precludes such a firm conclusion.
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Affiliation(s)
- Y Kollender
- The National Unit of Orthopedic Oncology The Tel-Aviv Sourasky Medical Center Tel Aviv Israel
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Pradhan A, Grimer RJ, Spooner D, Peake D, Carter SR, Tillman RM, Abudu A, Jeys L. Oncological outcomes of patients with Ewing's sarcoma: is there a difference between skeletal and extra-skeletal Ewing's sarcoma? ACTA ACUST UNITED AC 2011; 93:531-6. [PMID: 21464495 DOI: 10.1302/0301-620x.93b4.25510] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
The aim of this study was to identify whether there was any difference in patient, tumour, treatment or outcome characteristics between patients with skeletal or extra-skeletal Ewing's sarcoma. We identified 300 patients with new primary Ewing's sarcoma diagnosed between 1980 and 2005 from the centres' local database. There were 253 (84%) with skeletal and 47 (16%) with extra-skeletal Ewing's sarcomas. Although patients with skeletal Ewing's were younger (mean age 16.8 years) than those with extra-skeletal Ewing's sarcoma (mean age 27.5 years), there was little difference between the groups in terms of tumour stage or treatment. Nearly all the patients were treated with chemotherapy and most had surgery. There was no difference in the overall survival of patients with skeletal (64%) and extra-skeletal Ewing's sarcoma (61%) (p = 0.85), and this was also the case when both groups were split by whether they had metastases or not. This large series has shown that the oncological outcomes of Ewing's sarcoma are related to tumour characteristics and patient age, and not determined by whether they arise in bone or soft tissue.
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Affiliation(s)
- A Pradhan
- Royal Orthopaedic Hospital Oncology Service, Birmingham, UK
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Indelicato DJ, Keole SR, Shahlaee AH, Morris CG, Gibbs CP, Scarborough MT, Pincus DW, Marcus RB. Spinal and Paraspinal Ewing Tumors. Int J Radiat Oncol Biol Phys 2010; 76:1463-71. [DOI: 10.1016/j.ijrobp.2009.03.042] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2008] [Revised: 03/11/2009] [Accepted: 03/19/2009] [Indexed: 10/20/2022]
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Abstract
BACKGROUND Results of surgical treatment in Indian patients of Ewing's sarcoma managed with multimodality treatment with chemotherapy and/or radiotherapy are insufficient. We report a retrospective evaluation of a series of cases of Ewing's sarcoma managed with chemotherapy, surgery with or without radiotherapy. MATERIALS AND METHODS 54 patients of biopsy-proven Ewing's sarcoma of the bone, except craniofacial and vertebral bones were included. The patients having recurrence or having previous treatment were excluded from the study. Local and systemic extent of the sarcoma was defined, staged, and patients were subjected to the chemotherapy, surgery, and in some cases radiotherapy. Patients were evaluated for results of surgery with respect to complications, recurrence, and metastases at 3, 6, 9, 12, 18 and 24 months of follow-up RESULTS Average age of patients was 15.6 years (range 7-26 years); average delay in treatment was 4.1 months (1-7 months); follow-up ranged from 2 to 5 years (median 3.1 years); 14 patients (25.9%) had pulmonary metastases at their initial presentation. Twenty-one patients (38.9%) underwent resection and intercalary reconstruction with bone grafting, fixed with locking plates. Allograft was also used in 11 of these. Sixteen patients underwent resection and reconstruction with endoprosthesis, while seven patients (13.0%) underwent resection and arthrodesis. An above-knee amputation was required in 7.4% (four patients). Mesh was used for containing the graft longitudinally in five patients (femoral and tibial intercalary reconstructions) and for soft tissue attachment in two patients (hip and shoulder endoprostheses). Two patients had deep wound infection. One patient presented 1 year later with implant failure. The disease-free survival at 2 years from the time of diagnosis was 57.5% (23 out of 40) for patients without preoperative metastases and 42.9% (6 out of 14) for those with preoperative metastases. Overall, the disease-free survival at 2 years was 53.7% (29 out of 54 patients). Overall survival rate at 2 years was 61.1% (33 out of 54 patients). CONCLUSION Results of surgical treatment in this study are comparable with the current literature in spite of involvement of long bony segment and large soft tissue component. Intramedullary fibular autograft with morcellized cancellous autograft and allograft contained longitudinally in a mesh appears to be a good alternative with such large bone tumors.
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Affiliation(s)
- Shishir Rastogi
- Department of Orthopaedics, All India Institute of Medical Sciences, Dr. B. R. A. Institute Rotary Cancer Hospital, Delhi, India,Address for correspondence: Dr. Shishir Rastogi, Department of Orthopaedics and Medical Oncology, All India Institute of Medical Sciences, Delhi 29, India. E-mail:
| | - Ashok Kumar
- Department of Orthopaedics, All India Institute of Medical Sciences, Dr. B. R. A. Institute Rotary Cancer Hospital, Delhi, India
| | - Himanshu Gupta
- Department of Orthopaedics, All India Institute of Medical Sciences, Dr. B. R. A. Institute Rotary Cancer Hospital, Delhi, India
| | - Shah Alam Khan
- Department of Orthopaedics, All India Institute of Medical Sciences, Dr. B. R. A. Institute Rotary Cancer Hospital, Delhi, India
| | - Sameer Bakhshi
- Department of Medical Oncology, All India Institute of Medical Sciences, Dr. B. R. A. Institute Rotary Cancer Hospital, Delhi, India
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48
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Abstract
BACKGROUND Despite advances in adjuvant therapy, Ewing's sarcoma of the pelvis remains an anatomic site with a poor prognosis due to its relative inaccessibility, complex anatomy, and limited reconstructive options available. This study evaluates the role of surgery in the management of patients with pelvic Ewing's sarcoma who also have received conventional radiation therapy and chemotherapy. MATERIALS AND METHODS From July 1990 to July 2006, we received 10 patients with Ewing's sarcoma of pelvis at our center. Nine patients were in stage II B and one in Stage III at the time of presentation to us. All patients underwent surgical resection after preoperative chemotherapy with or without radiotherapy, which was given at the discretion of the referral center. Reconstruction was attempted using plate osteosynthesis in four patients, SS wires and screws in three patients, free fibular strut graft in one patient, and none was done in two patients. RESULTS Functional outcome assessed by Enneking's criteria revealed excellent outcome in two patients, good outcome in five patients, and poor outcome in two patients. At a mean followup of 10.3 years, seven patients remained free from the disease, and three patients died. The 5- and 10-year cumulative survival (Kaplan Meier method) was 63% and 34%, respectively. CONCLUSION This study demonstrates that surgery plus chemotherapy and radiation therapy is helpful for treating patients with pelvic Ewing's sarcoma, particularly in achieving local control.
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Affiliation(s)
- Mayil Vahanan Natarajan
- Department of Orthopaedic Surgery and Traumatology, Madras Medical College and Government General Hospital, Chennai - 600 003, India,Address for correspondence: Dr. Mayil Vahanan Natarajan, 4, Lakshmi Street, Kilpauk, Chennai - 600 010, India. E-mail:
| | - M Mohamed Sameer
- Department of Orthopaedic Surgery and Traumatology, Madras Medical College and Government General Hospital, Chennai - 600 003, India
| | - Jagdish Chandra Bose
- Department of Orthopaedic Surgery and Traumatology, Madras Medical College and Government General Hospital, Chennai - 600 003, India
| | - Kunal Dheep
- Department of Orthopaedic Surgery and Traumatology, Madras Medical College and Government General Hospital, Chennai - 600 003, India
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49
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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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50
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Kano T, Sasaki A, Tomizawa S, Shibasaki T, Tamura M, Ohye C. Primary Ewing’s sarcoma of the orbit: case report. Brain Tumor Pathol 2009; 26:95-100. [DOI: 10.1007/s10014-009-0256-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2009] [Accepted: 05/22/2009] [Indexed: 12/27/2022]
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