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Xu M, Tu J, Huang Y, Wang B, Zhao Z, Lin T, Huang G, Yin J, Xie X, Shen J, Zou C. Comparison of oncological and functional outcomes in Lower-limb osteosarcoma pediatric patients: a large single-center retrospective cohort study. Int J Surg 2024; 110:4208-4220. [PMID: 38471042 PMCID: PMC11254188 DOI: 10.1097/js9.0000000000001340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Accepted: 03/04/2024] [Indexed: 03/14/2024]
Abstract
OBJECTIVE Treating pediatric osteosarcoma in long bones is challenging due to skeletal immaturity, which restricts the generalizability of insights derived from adult patients. Are there disparities in outcomes? How should surgical protocols be tailored for children of varying ages? What are the specific postoperative complications? A large single-center retrospective cohort study of 345 patients under 14 years old with lower-limb osteosarcoma treated in our department since 2000 was conducted to address these inquiries. METHODS A retrospective analysis of 345 pediatric patients with lower-limb osteosarcoma admitted to our department between 2000 and 2019 was conducted. Clinical and functional outcomes were compared based on age groups, surgical methods, type of prosthesis, and primary tumor location. Patients were divided into the low-age group (≤10 y old) and the high-age group (>10 y old). Overall survival rate (OS), progressionfree survival rate (PFS), and prosthesis survival rate were assessed using Kaplan-Meier curves, nonparametric survival analysis (log-rank test), and Univariate cox regression were used for comparison. The incidence of complications, local relapse rate (LRR), metastasis rate, final limb-salvage, and amputation rate, and Musculoskeletal Tumor Society (MSTS) score of different independent groups were further evaluated using χ2 test or Fisher's exact test, and t -test was employed to evaluate the measurement data. RESULTS The average age of the patients was 11.10±2.32 years ranging from 4 to 14 y, with an average follow-up duration of 48.17 months. The 5, 10, and 15-year OS rates were 50.3%, 43.8%, and 37.9%, respectively. The progression-free survival rate was 44.8% at 5 years and 41.1% at 10 years. The final limb salvage rate was 61.45%, while the final amputation rate was 38.55%. The low-age group had a higher amputation rate compared with the high-age group (48.00% vs. 33.18%, P =0.009). The overall LRR was 9.28%, and the incidence of metastasis was 28.99%. The LRR of the limb-salvage group was higher than the amputation group ( P =0.004). The low-age group experienced more prosthesis-related complications than the high-age group ( P =0.001). The most common prosthesis-related complication in the low-age group was soft-tissue failure, while the periprosthetic infection was most frequent in the high-age group. The high-age group had a higher cumulative prosthesis survival compared with the low-age group ( P =0.0097). Modular prosthesis showed better MSTS scores and higher cumulative prosthetic survival than expandable prosthesis in pediatric patients ( P <0.05). CONCLUSION Limb preservation in pediatric patients becomes increasingly efficacious with advancing age, while consideration of amputation is warranted for younger patients. The prevailing postoperative complications associated with prosthesis encompass soft tissue failure and periprosthetic infection. Younger patients diagnosed with lower limb osteosarcoma exhibit a heightened amputation rate and a greater incidence of prosthesis-related complications.
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Affiliation(s)
- Mingxian Xu
- Department of Musculoskeletal Oncology, The First Affiliated Hospital, Sun Yat-sen University
- Guangdong Provincial Key Laboratory of Orthopedics and Traumatology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Jian Tu
- Department of Musculoskeletal Oncology, The First Affiliated Hospital, Sun Yat-sen University
- Guangdong Provincial Key Laboratory of Orthopedics and Traumatology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yongfu Huang
- Department of Musculoskeletal Oncology, The First Affiliated Hospital, Sun Yat-sen University
- Guangdong Provincial Key Laboratory of Orthopedics and Traumatology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Bo Wang
- Department of Musculoskeletal Oncology, The First Affiliated Hospital, Sun Yat-sen University
- Guangdong Provincial Key Laboratory of Orthopedics and Traumatology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Zhiqiang Zhao
- Department of Musculoskeletal Oncology, The First Affiliated Hospital, Sun Yat-sen University
- Guangdong Provincial Key Laboratory of Orthopedics and Traumatology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Tiao Lin
- Department of Musculoskeletal Oncology, The First Affiliated Hospital, Sun Yat-sen University
- Guangdong Provincial Key Laboratory of Orthopedics and Traumatology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Gang Huang
- Department of Musculoskeletal Oncology, The First Affiliated Hospital, Sun Yat-sen University
- Guangdong Provincial Key Laboratory of Orthopedics and Traumatology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Junqiang Yin
- Department of Musculoskeletal Oncology, The First Affiliated Hospital, Sun Yat-sen University
- Guangdong Provincial Key Laboratory of Orthopedics and Traumatology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Xianbiao Xie
- Department of Musculoskeletal Oncology, The First Affiliated Hospital, Sun Yat-sen University
- Guangdong Provincial Key Laboratory of Orthopedics and Traumatology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Jingnan Shen
- Department of Musculoskeletal Oncology, The First Affiliated Hospital, Sun Yat-sen University
- Guangdong Provincial Key Laboratory of Orthopedics and Traumatology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Changye Zou
- Department of Musculoskeletal Oncology, The First Affiliated Hospital, Sun Yat-sen University
- Guangdong Provincial Key Laboratory of Orthopedics and Traumatology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
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Papakonstantinou E, Athanasiadou KI, Markozannes G, Tzotzola V, Bouka E, Baka M, Moschovi M, Polychronopoulou S, Hatzipantelis E, Galani V, Stefanaki K, Strantzia K, Vousvouki M, Kourou P, Magkou E, Nikita M, Zambakides C, Michelarakis J, Alexopoulou A, Gavra M, Malama A, Ntzani EE, Petridou ET. Prognostic factors in high-grade pediatric osteosarcoma among children and young adults: Greek Nationwide Registry for Childhood Hematological Malignancies and Solid Tumors (NARECHEM-ST) data along with a systematic review and meta-analysis. Cancer Epidemiol 2024; 90:102551. [PMID: 38447251 DOI: 10.1016/j.canep.2024.102551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Revised: 02/28/2024] [Accepted: 02/29/2024] [Indexed: 03/08/2024]
Abstract
The 5-year overall survival of children and adolescents with osteosarcoma has been in plateau during the last 30 years. The present systematic review (1976-2023) and meta-analysis aimed to explore factors implicated in the prognosis of children and young adults with high-grade osteosarcoma. Original studies including patients ≤30 years and the Nationwide Registry for Childhood Hematological Malignancies and Solid Tumors (NARECHEM-ST) data (2010-2021) referred to children ≤14 years were analysed. Individual participant data (IPD) and summary estimates were used to assess the n-year survival rates, as well as the association of risk factors with overall survival (OS) and event-free survival (EFS). IPD and the n-year survival rates were pooled using Kaplan-Meier and Cox regression models, and random effects models, respectively. Data from 8412 patients, including 46 publications, NARECHEM-ST data, and 277 IPD from 10 studies were analysed. The summary 5-year OS rate was 64% [95% confidence interval (95%CI): 62%-66%, 37 studies, 6661 patients] and the EFS was 52% (95%CI: 49%-56%, 30 studies, 5010 patients). The survival rates generally differed in the pre-specified subgroups. Limb-salvage surgery showed a higher 5-year OS rate (69%) versus amputation (47%). Good responders had higher OS rates at 3 years (94%) and 5 years (81%), compared to poor responders at 3 years (66%), and 5 years (56%). Patients with metastatic disease had a higher risk of death [Hazard Ratio (HR): 3.60, 95%CI: 2.52, 5.15, 11 studies]. Sex did not have an impact on EFS (HR females/males: 0.90, 95%CI: 0.54, 1.48, 3 studies), whereas age>18 years seems to adversely affect EFS (HR 18+/<10 years: 1.36, 95%CI: 1.09, 1.86, 3 studies). Our results summarize the collective experience on prognostic factors of high-grade osteosarcoma among children and young adults. Poor response to neoadjuvant chemotherapy and metastatic disease at diagnosis were confirmed as primary risk factors of poor outcome. International collaboration of osteosarcoma study groups is essential to improve survival.
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Affiliation(s)
- Evgenia Papakonstantinou
- Department of Pediatric Oncology, Ippokratio General Hospital, 49 Konstantinoupoleos Street, Thessaloniki 54642, Greece.
| | - Kleoniki I Athanasiadou
- Endocrine Unit and Diabetes Centre, Department of Clinical Therapeutics, Alexandra Hospital, School of Medicine, National and Kapodistrian University of Athens, 80 Vasilisis Sophias Avenue, Athens 11528, Greece.
| | - Georgios Markozannes
- Department of Hygiene and Epidemiology, School of Medicine, University of Ioannina, Ioannina, Greece
| | - Vassiliki Tzotzola
- Department of Pediatric Hematology-Oncology (TAO), Aghia Sophia Children's Hospital, Thivon and Livadias, Goudi, Athens 11527, Greece
| | - Evdoxia Bouka
- Hellenic Society for Social Pediatrics and Health Promotion, Athens, Greece
| | - Margarita Baka
- Department of Oncology, "Pan. & Agl. Kyriakou", Thivon and Papadiamantopoulou Str, Athens 11527, Greece
| | - Maria Moschovi
- Haematology-Oncology Unit, First Department of Pediatrics, Athens University Medical School, Aghia Sophia Children's Hospital, Thivon and Levadias, Goudi, Athens 11527, Greece.
| | - Sophia Polychronopoulou
- Department of Pediatric Hematology-Oncology (TAO), Aghia Sophia Children's Hospital, Thivon and Livadias, Goudi, Athens 11527, Greece.
| | - Emmanuel Hatzipantelis
- Children's & Adolescents Hematology-Oncology Unit, 2nd Paediatric Department, School of Medicine, Aristotle University of Thessaloniki, Greece.
| | - Vasiliki Galani
- Paediatric and Adolescent Oncology Clinic, Children's Hospital "MITERA", Athens, Greece
| | - Kalliopi Stefanaki
- Histopathology Department, Aghia Sophia Children's Hospital, Thivon and Levadias, Goudi, Athens 11527, Greece.
| | - Katerina Strantzia
- Histopathology Department, "Pan. & Agl. Kyriakou" Children's Hospital, Thivon and Papadiamantopoulou Str, Athens 11527, Greece
| | - Maria Vousvouki
- Childhood & Adolescent Hematology Oncology Unit, 2nd Pediatric Department, Faculty of Health Sciences, Aristotle University of Thessaloniki, AHEPA Hospital, Greece
| | - Panagiota Kourou
- Pediatric Hematology-Oncology Unit, First Department of Pediatrics, Thivon and Levadias, Goudi, Athens 11527, Greece
| | - Evgenia Magkou
- Department of Pediatric Hematology-Oncology, "Pan. & Agl. Kyriakou" Children's Hospital, Thivon and Papadiamantopoulou Str, Athens 11527, Greece
| | - Maria Nikita
- Department of Pediatric Hematology-Oncology, "Pan. & Agl. Kyriakou" Children's Hospital, Thivon and Papadiamantopoulou Str, Athens 11527, Greece
| | - Christos Zambakides
- 1st Orthopedic Clinic, "Pan. & Agl. Kyriakou" Children's Hospital, Thivon and Papadiamantopoulou Str, Athens 11527, Greece.
| | - John Michelarakis
- 2nd Orthopedic Clinic, "Pan. & Agl. Kyriakou" Children's Hospital, Thivon and Papadiamantopoulou Str, Athens 11527, Greece
| | - Aikaterini Alexopoulou
- Children's & Adolescents Radiotherapy Department, "Pan. & Agl. Kyriakou" Children's Hospital, Thivon and Papadiamantopoulou Str, Athens 11527, Greece
| | - Maro Gavra
- Department of Medical Imaging and Interventional Radiology, Aghia Sofia Children's Hospital, Thivon and Levadias, Goudi, Athens 11527, Greece
| | - Astero Malama
- Department of Medical Imaging and Interventional Radiology, Aghia Sofia Children's Hospital, Thivon and Levadias, Goudi, Athens 11527, Greece
| | - Evangelia E Ntzani
- Department of Hygiene and Epidemiology, School of Medicine, University of Ioannina, Ioannina 45110, Greece; Center for Evidence Synthesis in Health, Brown University School of Public Health, Providence, RI 02903, USA.
| | - Eleni Th Petridou
- Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, 75 Mikras Asias Str, Athens 11527, Greece.
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Zou C, Huang R, Lin T, Wang Y, Tu J, Zhang L, Wang B, Huang J, Zhao Z, Xie X, Huang G, Wang K, Yin J, Shen J. Age-dependent molecular variations in osteosarcoma: implications for precision oncology across pediatric, adolescent, and adult patients. Front Oncol 2024; 14:1382276. [PMID: 38841159 PMCID: PMC11150704 DOI: 10.3389/fonc.2024.1382276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Accepted: 04/19/2024] [Indexed: 06/07/2024] Open
Abstract
Background Osteosarcoma is a leading subtype of bone tumor affecting adolescents and adults. Comparative molecular characterization among different age groups, especially in pediatric, adolescents and adults, is scarce. Methods We collected samples from 194 osteosarcoma patients, encompassing pediatric, adolescent, and adult cohorts. Genomic analyses were conducted to reveal prevalent mutations and compare molecular features in pediatric, adolescent, and adult patients. Results Samples from 194 osteosarcoma patients across pediatric to adult ages were analyzed, revealing key mutations such as TP53, FLCN, NCOR1, and others. Children and adolescents showed more gene amplifications and HRD mutations, while adults had a greater Tumor Mutational Burden (TMB). Mutations in those over 15 were mainly in cell cycle and PI3K/mTOR pathways, while under 15s had more in cell cycle and angiogenesis with higher VEGFA, CCND3, TFEB mutations. CNV patterns varied with age: VEGFA and XPO5 amplifications more in under 25s, and CDKN2A/B deletions in over 25s. Genetic alterations in genes like MCL1 and MYC were associated with poor prognosis, with VEGFA mutations also indicating worse outcomes. 58% of patients had actionable mutations, suggesting opportunities for targeted therapies. Age-specific patterns were observed, with Multi-TKI mutations more common in younger patients and CDK4/6 inhibitor mutations in adults, highlighting the need for personalized treatment approaches in osteosarcoma. In a small group of patients with VEGFR amplification, postoperative treatment with multi-kinase inhibitors resulted in a PR in 3 of 13 cases, especially in patients under 15. A significant case involved a 13-year-old with a notable tumor size reduction achieving PR, even with other genetic alterations present in some patients with PD. Conclusion This study delineates the molecular differences among pediatric, adolescent, and adult osteosarcoma patients at the genomic level, emphasizing the necessity for precision diagnostics and treatment strategies, and may offer novel prognostic biomarkers for patients with osteosarcoma. These findings provide a significant scientific foundation for the development of individualized treatment approaches tailored to patients of different age groups.
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Affiliation(s)
- Changye Zou
- Department of Musculoskeletal Oncology Center, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Renxuan Huang
- Department of Musculoskeletal Oncology Center, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Tiao Lin
- Department of Musculoskeletal Oncology Center, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | | | - Jian Tu
- Department of Musculoskeletal Oncology Center, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | | | - Bo Wang
- Department of Musculoskeletal Oncology Center, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | | | - Zhiqiang Zhao
- Department of Musculoskeletal Oncology Center, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Xianbiao Xie
- Department of Musculoskeletal Oncology Center, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Gang Huang
- Department of Musculoskeletal Oncology Center, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | | | - Junqiang Yin
- Department of Musculoskeletal Oncology Center, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Jingnan Shen
- Department of Musculoskeletal Oncology Center, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
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Kaneuchi Y, Yoshida S, Fujiwara T, Evans S, Abudu A. Limb salvage surgery has a higher complication rate than amputation but is still beneficial for patients younger than 10 years old with osteosarcoma of an extremity. J Pediatr Surg 2022; 57:702-709. [PMID: 35490054 DOI: 10.1016/j.jpedsurg.2022.04.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Revised: 02/19/2022] [Accepted: 04/03/2022] [Indexed: 11/17/2022]
Abstract
BACKGROUND/PURPOSE Limb preserving surgery for the treatment of patients with osteosarcoma younger than 10 years old is challenging and some authors have advocated amputation to reduce the risk of complications. The aim of this study was to compare the clinical outcomes and surgical complications of patients with osteosarcoma of the extremity aged <10 years old who were treated with limb salvage and amputation. PATIENTS AND METHODS Retrospective review of patients aged <10 years old who were treated for primary osteosarcoma of bone between 2000 and 2018. RESULTS We analyzed 82 consecutive patients (32 males, 50 females; median age 8, range 3-9 yrs). Limb-salvage surgery (LSS; n = 65, 79%) and amputation (n = 17, 21%) were performed. Fourteen patients had metastasis at surgery. In patients without metastasis at surgery, the metastasis-free and overall survival rates at 5 years following LSS vs. amputation were 75% vs. 58% (p = 0.162) and 71% vs. 55% (p = 0.516), respectively. The 2-year and 5-year OS rates of the LSS and amputation groups of patients with metastasis at surgery were 88% versus 83% and 50% versus 0%, respectively (p = 0.180). The overall complication rates were 46% post-LSS with 31% requiring re-operation versus 12% post-amputation, with 6% requiring re-operation (p = 0.010). CONCLUSION The prognosis of patients with localized osteosarcoma aged <10 years undergoing LSS is similar to those treated with amputation, but LSS is associated with a higher risk of complications and subsequent re-operation. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Yoichi Kaneuchi
- Department of Oncology, The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK; Department of Orthopaedic Surgery, Fukushima Medical University School of Medicine, Fukushima, Japan.
| | - Shinichirou Yoshida
- Department of Oncology, The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK
| | - Tomohiro Fujiwara
- Department of Oncology, The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK
| | - Scott Evans
- Department of Oncology, The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK
| | - Adesegun Abudu
- Department of Oncology, The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK
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Cole S, Gianferante DM, Zhu B, Mirabello L. Osteosarcoma: a Surveillance, Epidemiology, and End Results program-based analysis from 1975 to 2017. Cancer 2022; 128:2107-2118. [PMID: 35226758 DOI: 10.1002/cncr.34163] [Citation(s) in RCA: 64] [Impact Index Per Article: 32.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 01/29/2022] [Accepted: 02/10/2022] [Indexed: 11/10/2022]
Abstract
BACKGROUND Osteosarcoma is the most common primary bone malignancy. As a rare cancer, population-based studies remain small with limited information on finer demographic categories. Recent studies have reported important genetic differences based on age and ethnicity, and more detailed studies are needed to better understand potentially important osteosarcoma risk groups. METHODS Incidence and survival rates for 5016 patients with osteosarcoma from the Surveillance, Epidemiology, and End Results (SEER) program (1975-2017) were analyzed by age (0-9, 10-24, 25-59, and >60 years old), race/ethnicity, histologic subtype, stage, and tumor location using SEER*Stat software. RESULTS For cases 0 to 9 years old, incidence of primary osteosarcoma was similar between the sexes, increased significantly throughout the study period (P < .05), and the 5-year relative survival has steadily increased over time. Blacks had the highest incidence in all aged cases combined and a significant increase in incidence throughout the study period (P < .05). Overall, survival rates for all cases have remained relatively unchanged over recent decades, with worse survival observed in males, American Indian/Alaska Native cases, older patients, metastatic disease, axial tumors, and subsequent osteosarcoma cases. For cases 0 to 24 years old, the incidence of subsequent osteosarcoma increased 3-fold since the 2000s. CONCLUSION Important differences in osteosarcoma incidence and survival, particularly for the youngest children, ethnic minorities, and subsequent osteosarcoma, are identified. A genetic risk factor may be associated with observed ancestry-specific incidence differences and illustrates the importance of analyzing osteosarcoma by specific age groups and ethnicities to better understand their unique epidemiology and underlying biology. LAY SUMMARY Osteosarcoma is the most common bone cancer, but still a relatively rare disease, and previous studies have had limited information on finer demographics. Using a large database, osteosarcoma incidence and survival patterns are thoroughly evaluated and important differences, especially for the youngest children, ethnic minorities, and subsequent osteosarcoma cases, are identified.
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Affiliation(s)
- Sarah Cole
- Clinical Genetics Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, Maryland.,Walter Reed National Military Medical Center, Bethesda, Maryland
| | - D Matthew Gianferante
- Clinical Genetics Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, Maryland
| | - Bin Zhu
- Biostatistics Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, Maryland
| | - Lisa Mirabello
- Clinical Genetics Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, Maryland
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Li J, Zhang L, Wang M, Xie Y, Wu C. Purely lytic telangiectatic osteosarcoma: A rare case of a 3-year-old female patient. Pediatr Neonatol 2022; 63:101-102. [PMID: 34593345 DOI: 10.1016/j.pedneo.2021.05.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 05/13/2021] [Accepted: 05/24/2021] [Indexed: 11/28/2022] Open
Affiliation(s)
- Jiwei Li
- Department of Pathology, Kunming Children's Hospital, Yunnan Key Laboratory of Children's Major Disease Research, Kunming, Yunnan Province, China
| | - Liping Zhang
- Department of Dentistry, Yunnan Provincial Hospital of Traditional Chinese Medicine, Yunnan Province, China
| | - Meifen Wang
- Department of Gastroenterology, Kunming Children's Hospital, Yunnan Key Laboratory of Children's Major Disease Research, Kunming, Yunnan Province, China
| | - Yucheng Xie
- Department of Pathology, Kunming Children's Hospital, Yunnan Key Laboratory of Children's Major Disease Research, Kunming, Yunnan Province, China
| | - Changsha Wu
- Department of Orthopaedics, Zhenxiong People's Hospital, Zhaotong, Yunnan Province, China.
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Erwin US, Cahyadi SD. Cryosurgery and vascularized fibular graft reconstruction in proximal tibia osteosarcoma in young children: A case report. Int J Surg Case Rep 2021; 89:106568. [PMID: 34826746 PMCID: PMC8632832 DOI: 10.1016/j.ijscr.2021.106568] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 10/31/2021] [Accepted: 10/31/2021] [Indexed: 11/20/2022] Open
Abstract
Introduction Osteosarcoma epidemiology in children younger than 5-year-old is very rare. Currently, limb salvage surgery becomes the preferred treatment in osteosarcoma. Wide excision using cryosurgery has been reported as an effective and safe procedure for malignant bone tumors. Case report A 5-year-old girl was presented with pain and a lump on her right knee. Physical examination showed a solid circumferential mass in the proximal tibia, with limited range of motion due to mass and pain. Osteoblastic lesion with a discrete margin and narrow transition zone on the proximal tibia from plain radiograph and magnetic resonance imaging (MRI) examination. Histopathological examination suggested osteosarcoma with a giant cell rich osteosarcoma subtype. Three cycles of neoadjuvant chemotherapy was conducted with cisplatin, ifosfamide, and adriamycin. We performed limb salvage surgery by wide excision with cryosurgery and vascularized fibular graft reconstruction. Wide excision was performed with the respect to preserve the epiphyseal plate. The proximal tibia segment was recycled using liquid nitrogen and re-implanted, fixed with a locking 2.7 mm T-plate and a straight reconstruction 2.7 mm reconstruction plate. Vascularized fibular graft was used to fill the bone defect on the medial side. Post-operative radiograph showed the plate and screws are well-fixated and the post-operative histopathological examination confirmed the diagnosis of conventional osteosarcoma HUVOS I. There was no post-operative complication observed, and the functional outcome was good. Conclusions Cryosurgery and vascularized fibular graft is a viable reconstructive option for proximal tibia osteosarcoma in very young children. Osteosarcoma in a very young child is rare. Few cases of osteosarcoma in very young child treated with cryosurgery Wide excision with cryosurgery and vascularized fibular graft reconstruction showed excellent functional outcome.
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Affiliation(s)
- Uno Surgery Erwin
- Department of Orthopaedic and Traumatology, Faculty of Medicine Universitas Indonesia, Dr. Cipto Mangunkusumo Hospital, Indonesia.
| | - Sigit Daru Cahyadi
- Department of Orthopaedic and Traumatology, Faculty of Medicine Universitas Indonesia, Persahabatan General Hospital, Indonesia
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Guimarães GM, Tesser-Gamba F, Petrilli AS, Donato-Macedo CRP, Alves MTS, de Lima FT, Garcia-Filho RJ, Oliveira R, Toledo SRC. Molecular profiling of osteosarcoma in children and adolescents from different age groups using a next-generation sequencing panel. Cancer Genet 2021; 258-259:85-92. [PMID: 34666222 DOI: 10.1016/j.cancergen.2021.10.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 08/30/2021] [Accepted: 10/03/2021] [Indexed: 10/20/2022]
Abstract
Osteosarcoma (OS) is a malignant bone tumor, with a peak of incidence in the second decade of life and possibly associated with the presence of germline mutations. Besides, clinicians have pointed to a second, rarer group of patients that develops OS before 10 years old. Here we access, through next-generation sequencing (NGS) strategy, the genetic alterations present in OS and blood samples from patients diagnosed before and during the second decade of life. A custom NGS panel, designed for the main alterations described in childhood and adolescence neoplasms, named Oncomine Childhood Cancer Research Assay (OCCRA©), was used. Of all 84 OS samples investigated, 42 (50%) presented some somatic variant, with TP53, MYC, CDK4, RB1 and PDGFRA genes harboring the most observed genetic variants. MYC CNVs were more frequent in tumors from patients diagnosed before 10 years old (X21= 5.18, p = 0.023). Additionally, patients diagnosed during the second decade of life presented a higher percentage of somatic and germline variants. Germline variants in TP53 and RB1 were found in 5 of the 11 (45.5%) patients analyzed. Clinical variables and tumor histopathological characteristics were also collected and correlated with our molecular findings.
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Affiliation(s)
- G M Guimarães
- Pediatrics Department, Pediatric Oncology Institute/GRAACC (Grupo de Apoio ao Adolescente e à Criança com Câncer), Federal University of Sao Paulo, Sao Paulo, SP, Brazil; Morphology and Genetics Department, Genetics Discipline, Federal University of São Paulo, Sao Paulo, SP, Brazil
| | - F Tesser-Gamba
- Pediatrics Department, Pediatric Oncology Institute/GRAACC (Grupo de Apoio ao Adolescente e à Criança com Câncer), Federal University of Sao Paulo, Sao Paulo, SP, Brazil
| | - A S Petrilli
- Pediatrics Department, Pediatric Oncology Institute/GRAACC (Grupo de Apoio ao Adolescente e à Criança com Câncer), Federal University of Sao Paulo, Sao Paulo, SP, Brazil
| | - C R P Donato-Macedo
- Pediatrics Department, Pediatric Oncology Institute/GRAACC (Grupo de Apoio ao Adolescente e à Criança com Câncer), Federal University of Sao Paulo, Sao Paulo, SP, Brazil
| | - M T S Alves
- Pathology Department, Federal University of Sao Paulo, Sao Paulo, SP, Brazil
| | - F T de Lima
- Pediatrics Department, Pediatric Oncology Institute/GRAACC (Grupo de Apoio ao Adolescente e à Criança com Câncer), Federal University of Sao Paulo, Sao Paulo, SP, Brazil; Gynecology Department, Federal University of Sao Paulo, Sao Paulo, SP, Brazil
| | - R J Garcia-Filho
- Pediatrics Department, Pediatric Oncology Institute/GRAACC (Grupo de Apoio ao Adolescente e à Criança com Câncer), Federal University of Sao Paulo, Sao Paulo, SP, Brazil; Orthopedics and Traumatology Department, Oncology Orthopedics Group, Federal University of São Paulo, Sao Paulo, SP, Brazil
| | - R Oliveira
- Pediatrics Department, Pediatric Oncology Institute/GRAACC (Grupo de Apoio ao Adolescente e à Criança com Câncer), Federal University of Sao Paulo, Sao Paulo, SP, Brazil; Surgery Department, Federal University of Sao Paulo, São Paulo, SP, Brazil
| | - S R C Toledo
- Pediatrics Department, Pediatric Oncology Institute/GRAACC (Grupo de Apoio ao Adolescente e à Criança com Câncer), Federal University of Sao Paulo, Sao Paulo, SP, Brazil; Morphology and Genetics Department, Genetics Discipline, Federal University of São Paulo, Sao Paulo, SP, Brazil.
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Selective Activation of ZAK β Expression by 3-Hydroxy-2-Phenylchromone Inhibits Human Osteosarcoma Cells and Triggers Apoptosis via JNK Activation. Int J Mol Sci 2020; 21:ijms21093366. [PMID: 32397561 PMCID: PMC7247666 DOI: 10.3390/ijms21093366] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 04/20/2020] [Accepted: 04/21/2020] [Indexed: 11/17/2022] Open
Abstract
Although various advancements in radical surgery and neoadjuvant chemotherapy have been developed in treating osteosarcoma (OS), their clinical prognosis remains poor. A synthetic chemical compound, 3-hydroxylflavone, that is reported to regulate ROS production is known to inhibit human bone osteosarcoma cells. However, its role and mechanism in human OS cells remains unclear. In this study, we have determined the potential of 3-Hydroxy-2-phenylchromone (3-HF) against OS using human osteosarcoma (HOS) cells. Our previous studies showed that Zipper sterile-alpha-motif kinase (ZAK), a kinase member of the MAP3K family, was involved in various cellular events such as cell proliferation and cell apoptosis, and encoded two transcriptional variants, ZAKα and β. In this study, we show that 3-HF induces the expression of ZAK and thereby enhances cellular apoptosis. Using gain of function and loss of function studies, we have demonstrated that ZAK activation by 3-HF in OS cells is confined to a ZAKβ form that presumably plays a leading role in triggering ZAKα expression, resulting in an aggravated cancer apoptosis. Our results also validate ZAKβ as the predominant form of ZAK to drive the anticancer mechanism in HOS cells.
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Abstract
AIM The aims of this study were to assess survival outcome of pediatric patients with localized osteosarcoma of the extremities in Upper Egypt, identify factors of prognostic significance for survival, and to determine factors predictive of surgical methods used in these patients, as well as developing a clinical model for risk prediction. PATIENTS AND METHODS A retrospective analysis of data assembled from medical records of 30 pediatric patients with a histologically verified nonmetastatic osteosarcoma of the extremities treated at South Egypt Cancer Institute with a unified chemotherapy protocol between January 2001 and December 2015 was carried out. Prognostic factors were determined using univariable and multivariable methods. A model for surgical outcomes in these patients based on the baseline clinical factors, and the parameters predictive of their tumor response to chemotherapy, was developed. RESULTS With a median follow-up of 63 months for the study population, the estimates for event-free survival and overall survival (OS) at 3 and 5 years were 69.5% and 79% and 65.2% and 65.3%, respectively. Age 16 years or above was independently associated with both worse metastasis-free survival (hazard ratio [HR]=6.05, 95% confidence interval [CI]: 1.43-25.6, P=0.015) and OS (HR=7.9, 95% CI: 1.71-36.2, P=0.008). In the multivariable analysis, a proximal location within the limb gained a statistical significance to be independently associated with worse OS (HR=2.4, 95% CI: 1.13-22.1, P=0.003). Poor response to chemotherapy was marginally associated with worse metastasis-free survival (HR=4.9, 95% CI: 1.02-23.8, P=0.047) only in the univariable analysis. The patients found to be more likely to undergo an amputation surgery (odds ratio=14.1, 95% CI: 1.34-149.4, P=0.028) were those in whom a tumor was poorly responding to chemotherapy. CONCLUSION In Upper Egypt, despite the reasonable survival outcomes in nonmetastatic osteosarcoma, a relatively high limb amputation rate has been encountered. The development of a clinical prediction model for future planning of possible outcome improvement in these patients, however, is still feasible.
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Wang Z, Wu B, Zhou Y, Huang X, Pan W, Liu M, Yan X, Lin N, Ye Z. Predictors of the Survival of Primary and Secondary Older Osteosarcoma Patients. J Cancer 2019; 10:4614-4622. [PMID: 31528225 PMCID: PMC6746122 DOI: 10.7150/jca.32627] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Accepted: 06/07/2019] [Indexed: 01/23/2023] Open
Abstract
Purpose: Older osteosarcoma patients have a very poor prognosis and treatment for them remains a challenge. The outcomes and potential prognostic factors of primary or secondary older osteosarcoma patients are rarely documented. Therefore, we examined the prognosis of the two special cohorts to identify possible prognostic factors, and provide optimal treatment strategy for them. Methods: The Surveillance, Epidemiology, and End Results (SEER) program database was used to identify osteosarcoma patients aged over 40 years from 1973 to 2015. The prognostic analysis was performed using the Kaplan-Meier method and a Cox proportional hazards regression model. Results: In total, 1162 primary older osteosarcoma patients and 444 secondary older osteosarcoma patients were eligible for this study. The OS and CSS rates of the primary older osteosarcoma patients at 5-year were 38.5% and 37.1%, respectively. The 3- and 5-year OS rates of the secondary older osteosarcoma patients were 22.8% and 14.6%, respectively. On multivariate analysis of the primary older osteosarcoma patients, age > 60, male, axial site, high grade, metastasis, tumor size>10 cm, no surgery, and radiation treatment were negatively associated with OS. In terms of CSS, age, gender, decade of diagnosis, tumor site, tumor grade, tumor stage, tumor size, and surgery were independent prognostic factors. A multivariate Cox regression model showed that secondary older osteosarcoma patients of high grade, metastasis, tumor size > 10 cm, no surgery, and no chemotherapy were independent predictors of decreased OS. Conclusions: Surgery in combination with chemotherapy should be recommended for the treatment of the secondary older osteosarcoma patients, while for the primary older osteosarcoma patients, only surgery should be recommended.
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Affiliation(s)
- Zhan Wang
- Department of Orthopaedics, Centre for Orthopaedic Research, Orthopedics Research Institute of Zhejiang University, The Second Affiliated Hospital, Zhejiang University School of Medicine, 88 Jiefang Road, Hangzhou, Zhejiang 310000, P.R. China
| | - Bo Wu
- Department of Orthopaedics, Centre for Orthopaedic Research, Orthopedics Research Institute of Zhejiang University, The Second Affiliated Hospital, Zhejiang University School of Medicine, 88 Jiefang Road, Hangzhou, Zhejiang 310000, P.R. China
| | - Yuanxi Zhou
- Department of Orthopaedics, Centre for Orthopaedic Research, Orthopedics Research Institute of Zhejiang University, The Second Affiliated Hospital, Zhejiang University School of Medicine, 88 Jiefang Road, Hangzhou, Zhejiang 310000, P.R. China
| | - Xin Huang
- Department of Orthopaedics, Centre for Orthopaedic Research, Orthopedics Research Institute of Zhejiang University, The Second Affiliated Hospital, Zhejiang University School of Medicine, 88 Jiefang Road, Hangzhou, Zhejiang 310000, P.R. China
| | - Weibo Pan
- Department of Orthopaedics, Centre for Orthopaedic Research, Orthopedics Research Institute of Zhejiang University, The Second Affiliated Hospital, Zhejiang University School of Medicine, 88 Jiefang Road, Hangzhou, Zhejiang 310000, P.R. China
| | - Meng Liu
- Department of Orthopaedics, Centre for Orthopaedic Research, Orthopedics Research Institute of Zhejiang University, The Second Affiliated Hospital, Zhejiang University School of Medicine, 88 Jiefang Road, Hangzhou, Zhejiang 310000, P.R. China
| | - Xiaobo Yan
- Department of Orthopaedics, Centre for Orthopaedic Research, Orthopedics Research Institute of Zhejiang University, The Second Affiliated Hospital, Zhejiang University School of Medicine, 88 Jiefang Road, Hangzhou, Zhejiang 310000, P.R. China
| | - Nong Lin
- Department of Orthopaedics, Centre for Orthopaedic Research, Orthopedics Research Institute of Zhejiang University, The Second Affiliated Hospital, Zhejiang University School of Medicine, 88 Jiefang Road, Hangzhou, Zhejiang 310000, P.R. China
| | - Zhaoming Ye
- Department of Orthopaedics, Centre for Orthopaedic Research, Orthopedics Research Institute of Zhejiang University, The Second Affiliated Hospital, Zhejiang University School of Medicine, 88 Jiefang Road, Hangzhou, Zhejiang 310000, P.R. China
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12
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Osteosarcoma in a Child Below 2 Years of Age: Case Report and Review of the Literature. J Pediatr Hematol Oncol 2019; 41:410-412. [PMID: 30303869 DOI: 10.1097/mph.0000000000001315] [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] [Indexed: 11/26/2022]
Abstract
BACKGROUND Osteosarcoma in children below the age of 5 is extremely rare. OBSERVATION We report on a previously well 14-month-old male infant, who presented with a reluctance to weight-bear on his right leg and had an associated limp. Plain imaging and a magnetic resonance imaging scan demonstrated a lytic lesion in the right distal femur. An open surgical biopsy confirmed the diagnosis of osteosarcoma. There was no significant family history of cancer and genetic screening for Li-Fraumeni syndrome was negative. CONCLUSIONS This case highlights the importance of timely consideration of osteosarcoma in an infant, when the clinical presentation and medical imaging are consistent with that diagnosis.
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13
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Nie Z, Peng H. Osteosarcoma in patients below 25 years of age: An observational study of incidence, metastasis, treatment and outcomes. Oncol Lett 2018; 16:6502-6514. [PMID: 30405789 PMCID: PMC6202522 DOI: 10.3892/ol.2018.9453] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Accepted: 08/06/2018] [Indexed: 12/19/2022] Open
Abstract
Only few systematic and comprehensive studies have focused on osteosarcoma in children and adolescents. In the present study, 3,085 patients with osteosarcoma were identified in the Surveillance, Epidemiology and End Results Program database. The patients were <25 years of age and diagnosed between 1973 to 2012. A retrospective study was performed to investigate the factors associated with tumor incidence, metastasis, treatment and survival. The results indicated that the incidence of osteosarcoma was higher in male patients compared with female patients. In addition, the incidence rate of osteosarcoma was higher among male and female patients between the ages of 10 and 19. Osteosarcoma located in the chest and pelvic bones was associated with metastatic disease; however, metastasis in two histological types, parosteal and periosteal, was infrequent. Survival analysis revealed the following were associated with poor outcomes: Sex, patients diagnosed between 1973 and 1982, distant metastasis, treatment without surgery or with radiation, a tumor with a poorly differentiated or undifferentiated grade, tumor size ≥100 mm, and a tumor in the pelvic bones. Patient's whose histologic type was parosteal osteosarcoma and whose tumor was located in one of the limbs, or who underwent local or radical excision, exhibited a good survival outcome. Survival outcomes were ranked according to the type of surgery, from best to worst, as follows: Local excision, radical excision, amputation and no surgery. In summary, the incidence of osteosarcoma is higher in male patients compared with female patients. Furthermore, individuals between the ages of 10 and 19 have a higher risk of osteosarcoma. Osteosarcoma located in the chest and pelvic bones has a high risk of metastasis. Limb-salvage surgery may be the optimal treatment approach for non-metastatic osteosarcoma.
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Affiliation(s)
- Zhigang Nie
- Department of Orthopedics, Renmin Hospital of Wuhan University, Wuhan, Hubei 430060, P.R. China
| | - Hao Peng
- Department of Orthopedics, Renmin Hospital of Wuhan University, Wuhan, Hubei 430060, P.R. China
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14
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Groundland JS, Ambler SB, Houskamp LDJ, Orriola JJ, Binitie OT, Letson GD. Surgical and Functional Outcomes After Limb-Preservation Surgery for Tumor in Pediatric Patients: A Systematic Review. JBJS Rev 2018; 4:01874474-201602000-00002. [PMID: 27490132 DOI: 10.2106/jbjs.rvw.o.00013] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Limb-salvage surgery and segmental reconstruction for the treatment of lower extremity osseous tumors in the pediatric population have been described in the literature, but there is little consensus regarding the optimal surgical treatment for this patient population. METHODS A systematic review of the literature was performed to identify studies focusing on limb-salvage procedures in pediatric patients who were managed with one of three reconstructions with use of a metallic endoprosthesis, allograft, or allograft-prosthesis composite. Data were segregated according to the excised and reconstructed anatomical location (proximal part of the femur, total femur, distal part of the femur, proximal part of the tibia) and were collated to assess modes of failure and functional outcomes of each reconstruction type for each anatomic location. RESULTS Sixty articles met the inclusion criteria; all were Level-IV evidence, primarily consisting of small, retrospective case series. Infection was a primary mode of failure across all reconstruction types and locations, whereas allograft reconstructions were susceptible to structural failure as well. The rate of failure in the pediatric population correlated well with previously published results for adults. The incidence of subsequent amputation was lower in the pediatric population (5.2%) than has been reported in adults (9.5%) (p = 0.013). Meaningful growth of expandable metallic endoprostheses was reported in the literature, with an overall rate of leg-length discrepancy of 13.4% being noted at the time of the latest follow-up. The Musculoskeletal Tumor Society (MSTS) questionnaire was the most consistently used outcome measure in the literature, with average scores ranging from 71.0% to 86.8%, depending on reconstruction type and anatomic location. CONCLUSIONS The current state of the literature detailing the surgical and functional outcomes of segmental reconstruction for the treatment of pediatric bone tumors is limited to Level-IV evidence and is complicated by under-segregation of the data by age and anatomical location of the reconstruction. Despite these limitations, pediatric limb-salvage surgery demonstrates satisfactory initial surgical and functional outcomes. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- John S Groundland
- Department of Orthopedics and Sports Medicine (J.S.G.), School of Physical Therapy & Rehabilitation Sciences (S.B.A), Shimberg Health Sciences Library (J.J.O.), USF Health Morsani College of Medicine, University of South Florida, 13330 USF Laurel Drive, MDC 90, Tampa, FL 33612
| | - Steven B Ambler
- Department of Orthopedics and Sports Medicine (J.S.G.), School of Physical Therapy & Rehabilitation Sciences (S.B.A), Shimberg Health Sciences Library (J.J.O.), USF Health Morsani College of Medicine, University of South Florida, 13330 USF Laurel Drive, MDC 90, Tampa, FL 33612
| | - Lt Daniel J Houskamp
- Department of Orthopaedic Surgery, Naval Medical Center San Diego, 34800 Bob Wilson Drive, San Diego, CA 92134
| | - John J Orriola
- Department of Orthopedics and Sports Medicine (J.S.G.), School of Physical Therapy & Rehabilitation Sciences (S.B.A), Shimberg Health Sciences Library (J.J.O.), USF Health Morsani College of Medicine, University of South Florida, 13330 USF Laurel Drive, MDC 90, Tampa, FL 33612
| | - Odion T Binitie
- Sarcoma Department (O.T.B.) and Executive Vice President of Clinical Affairs (G.D.L.), H. Lee Moffitt Cancer Center, 12902 Magnolia Drive, Tampa, FL 33612
| | - G Douglas Letson
- Sarcoma Department (O.T.B.) and Executive Vice President of Clinical Affairs (G.D.L.), H. Lee Moffitt Cancer Center, 12902 Magnolia Drive, Tampa, FL 33612
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15
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Huh WW, Daw NC, Herzog CE, Munsell MF, McAleer MF, Lewis VO. Ewing sarcoma family of tumors in children younger than 10 years of age. Pediatr Blood Cancer 2017; 64. [PMID: 27696711 DOI: 10.1002/pbc.26275] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Revised: 08/26/2016] [Accepted: 08/30/2016] [Indexed: 11/11/2022]
Abstract
AIM Few data exist regarding the clinical characteristics and outcome of young children with Ewing sarcoma family of tumors (ESFT). METHODS We reviewed the records of ESFT patients at our institution younger than 10 years of age at diagnosis. RESULTS Forty-two patients were identified. Median age was 6.4 years (range 0.6-9.5 years). Most patients had T2 (>5 cm) tumors (n = 31; 74%). Most common primary site was the extremity (n = 17; 41%). Seven patients (17%) had metastasis at diagnosis. For local tumor control, 20 patients had surgery only, 13 had radiation therapy only, and 6 had surgery plus radiation. Surgical margin status was negative in 19 patients (73%). Median follow-up was 4.7 years (range 0.7-29.7 years), and 5-year relapse-free survival (RFS) and overall survival (OS) estimates were 67% (95% CI: 53-84%) and 82% (95% CI: 71-95%), respectively. Metastasis at presentation was the only significant predictor for decreased RFS (P = 0.008) and OS (P = 0.01). A trend was seen for T2 tumors with worse OS (P = 0.09). CONCLUSION Patients younger than 10 years of age with ESFT may have a better OS than older patients, but further study of a homogeneously treated larger cohort is needed.
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Affiliation(s)
- Winston W Huh
- Division of Pediatrics, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Najat C Daw
- Division of Pediatrics, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Cynthia E Herzog
- Division of Pediatrics, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Mark F Munsell
- Department of Biostatistics, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Mary Frances McAleer
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Valerae O Lewis
- Division of Orthopedic Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas
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16
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Cepeda MDLÁ, Sosa AJ, Mora G. [Telangiectatic osteosarcoma in an infant]. BOLETIN MEDICO DEL HOSPITAL INFANTIL DE MEXICO 2017; 74:60-64. [PMID: 29364816 DOI: 10.1016/j.bmhimx.2016.11.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2016] [Revised: 11/16/2016] [Accepted: 11/25/2016] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Osteosarcoma is one of the most common types of cancer in childhood and adolescence and it is the most common malignant bone tumor in this group of age. Osteosarcoma is frequently found in long bones of the extremities. There are very few cases described in children under 5 years of age, and according to this review, none in infants. The telangiectatic variant is uncommon, and there are no reported cases before preschool age. CASE REPORT A 10-month-old female infant with a lithic tumor of the ninth right rib, which was classified after resection as a telangiectatic osteosarcoma, is presented. CONCLUSIONS Telangiectatic osteosarcoma in the pediatric age is very uncommon. To date, the patient has presented good response to treatment, although the prognosis and survival of this condition is unknown.
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Affiliation(s)
| | | | - Glenda Mora
- Hospital Roberto Gilbert, Guayaquil, Ecuador
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17
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Abstract
Limb preservation surgery has gained acceptance as a viable alternative to amputation for the treatment of extremity bone tumors in the growing child. There are several options for reconstructing the potential loss of a physis and the defect created by tumor excision. Metallic endoprosthesis, massive allograft, and allograft-prosthesis composites have been described in the skeletally immature population. With the development of expandable prostheses, even those far from skeletal maturity may be candidates for limb salvage. However, improvements in the literature are needed, including reporting surgical and functional outcomes in a rigorous manner, specific to age, anatomic location, and reconstruction.
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Affiliation(s)
- John S Groundland
- Department of Orthopedics and Sports Medicine, University of South Florida, 13220 USF Laurel Drive, Tampa, FL 33612, USA
| | - Odion Binitie
- Department of Orthopedics and Sports Medicine, University of South Florida, 13220 USF Laurel Drive, Tampa, FL 33612, USA; Department of Sarcoma, H. Lee Moffitt Cancer Center, 12902 Magnolia Drive, Tampa, FL 33612, USA.
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18
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De Ioris MA, Prete A, Cozza R, Podda M, Manzitti C, Pession A, Schiavello E, Contoli B, Balter R, Fagioli F, Bisogno G, Amoroso L, Locatelli F, Luksch R. Ewing sarcoma of the bone in children under 6 years of age. PLoS One 2013; 8:e53223. [PMID: 23382839 PMCID: PMC3561359 DOI: 10.1371/journal.pone.0053223] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2012] [Accepted: 11/26/2012] [Indexed: 11/23/2022] Open
Abstract
Background Ewing Sarcoma Family Tumours (ESFT) are rare in early childhood. The aim of this study was to report the clinical characteristics and outcome of children under 6 years of age affected by ESFT of the bone in Italy. Methods The records of all the children diagnosed with osseous ESFT in centres members of the Associazione Italiana di Ematologia ed Oncologia Pediatrica (AIEOP) from 1990 to 2008 were reviewed. The Kaplan–Meier method was used for estimating overall and progression-free survival (OS, PFS) curves; multivariate analyses were performed using Cox proportional hazards regression model. Results This study includes 62 patients. An axial primary localization was present in 66% of patients, with the primary site in the chest wall in 34%. Fourteen (23%) patients presented metastatic disease. The 5-year OS and PFS were 73% (95% confidence interval, CI, 58–83%) and 72% (95% CI 57–83%) for patients with localized disease and 38% (95% CI 17–60%) and 21% (95% CI 5–45%) for patients with metastatic disease. Metastatic spread, skull/pelvis/spine primary localization, progression during treatment and no surgery predicted worse survival (P<0.01), while patients treated in the last decade had better survival (P = 0.002). In fact, the 5-year OS and PFS for patients diagnosed in the period 2000–2008 were 89% (95% CI 71–96%) and 86% (95% CI 66–94%), respectively. Conclusion The axial localization is the most common site of ESFT in pre-scholar children. Patients treated in the most recent period have an excellent outcome.
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Affiliation(s)
| | - Arcangelo Prete
- Paediatric Haematology-Oncology Department, University of Bologna, Bologna, Italy
| | - Raffaele Cozza
- Haematology-Oncology Department, Ospedale Pediatrico Bambino Gesù-IRCCS, Rome, Italy
| | - Marta Podda
- Paediatrics, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Carla Manzitti
- Paediatric Haematology-Oncology Department, Istituto Giannina Gaslini-IRCCS, Genoa, Italy
| | - Andrea Pession
- Paediatric Haematology-Oncology Department, University of Bologna, Bologna, Italy
| | | | - Benedetta Contoli
- Epidemiology Unit, Ospedale Pediatrico Bambino Gesù-IRCCS, Rome, Italy
| | - Rita Balter
- Paediatric Haematology-Oncology Department, University of Verona, Verona, Italy
| | - Franca Fagioli
- Paediatric Haematology-Oncology Department, Regina Margherita Hospital, Turin, Italy
| | - Gianni Bisogno
- Paediatric Haematology-Oncology Department, University of Padua, Padua, Italy
| | - Loredana Amoroso
- Paediatric Haematology-Oncology Department, Istituto Giannina Gaslini-IRCCS, Genoa, Italy
| | - Franco Locatelli
- Haematology-Oncology Department, Ospedale Pediatrico Bambino Gesù-IRCCS, Rome, Italy
- Pediatrics, University of Pavia, Pavia, Italy
| | - Roberto Luksch
- Paediatrics, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
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Guillon MAM, Mary PMJ, Brugière L, Marec-Bérard P, Pacquement HD, Schmitt C, Guinebretière JM, Tabone MDP. Clinical characteristics and prognosis of osteosarcoma in young children: a retrospective series of 15 cases. BMC Cancer 2011; 11:407. [PMID: 21942935 PMCID: PMC3188515 DOI: 10.1186/1471-2407-11-407] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2011] [Accepted: 09/24/2011] [Indexed: 11/26/2022] Open
Abstract
Background Osteosarcoma is the most common primary bone malignancy in childhood and adolescence. However, it is very rare in children under 5 years of age. Although studies in young children are limited in number, they all underline the high rate of amputation in this population, with conflicting results being recently reported regarding their prognosis. Methods To enhance knowledge on the clinical characteristics and prognosis of osteosarcoma in young children, we reviewed the medical records and histology of all children diagnosed with osteosarcoma before the age of five years and treated in SFCE (Société Française des Cancers et leucémies de l'Enfant) centers between 1980 and 2007. Results Fifteen patients from 7 centers were studied. Long bones were involved in 14 cases. Metastases were present at diagnosis in 40% of cases. The histologic type was osteoblastic in 74% of cases. Two patients had a relevant history. One child developed a second malignancy 13 years after osteosarcoma diagnosis. Thirteen children received preoperative chemotherapy including high-dose methotrexate, but only 36% had a good histologic response. Chemotherapy was well tolerated, apart from a case of severe late convulsive encephalopathy in a one-year-old infant. Limb salvage surgery was performed in six cases, with frequent mechanical and infectious complications and variable functional outcomes. Complete remission was obtained in 12 children, six of whom relapsed. With a median follow-up of 5 years, six patients were alive in remission, seven died of their disease (45%), in a broad range of 2 months to 8 years after diagnosis, two were lost to follow-up. Conclusions Osteosarcoma seems to be more aggressive in children under five years of age, and surgical management remains a challange.
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Affiliation(s)
- Maud A M Guillon
- 1Department of Pediatric Oncology, Institut Curie, Paris, France
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20
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Israelsen RB, Illum BE, Crabtree S, Randall RL, Jones KB. Extremity sarcoma surgery in younger children: ten years of patients ten years and under. THE IOWA ORTHOPAEDIC JOURNAL 2011; 31:145-53. [PMID: 22096434 PMCID: PMC3215128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Sarcoma surgeons face unique challenges in younger patients with significant skeletal growth remaining. The heightened concerns regarding radiation in the very young and the drastic changes expected in the lengths and cross-sectional areas of bones affect the decision-making for both soft-tissue and bone sarcomas in this population. Nonetheless, there is sparse literature focused on sarcoma surgery in this age group. The records of one tertiary regional sarcoma treatment program were reviewed to identify all patients ten years old or younger at the time of local control surgery for limb or limb-girdle sarcomas. Demographic information, diagnosis, surgery performed, complications, and general outcomes were gleaned from the medical records. 43 patients were identified, including 15 with osteosarcomas, 11 Ewing's sarcoma family tumors, five rhabdomyosarcomas, and two synovial sarcomas, among others. Location of tumors varied widely, but demonstrated a predilection for the upper extremity more than is typical in adolescents with the same tumor types. Survival was favorable overall, with only five patients dying from disease. Most patients continued to function well at latest follow-up, but 16 experienced additional surgical interventions following the index procedure. Sarcoma surgery in the younger growing child presents challenges for the surgeon, patient, and parents, but is usually successful in the long-term.
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Affiliation(s)
- Ryan B Israelsen
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, USA
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