scholarly journals Intra-operative extracorporeal radiation therapy for skeletally immature patients with malignant bone tumours

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Manish R Shah ◽  
Manisha Μ Shah ◽  
Aditya Κ Agrawal ◽  
Malkesh D Shah ◽  
Sarvang Μ Desai
Keyword(s):  
Radiation Therapy ◽  
Ewing’S Sarcoma ◽  
Ewing's Sarcoma ◽  
Chemotherapeutic Agents ◽  
Tumour Cells ◽  
The Body ◽  
Bone Tumours ◽  
Bony Union ◽  
Malignant Bone Tumours

ABSTRACT BACKGROUND: Management of malignant bone tumours has changed dramatically in recent years. Neoadjuvant chemotherapy, irradiation and conservative surgery have improved local control as well as functional outcome. Depending on the histology of the lesion, other modalities like chemotherapeutic agents or radiation can be selected in place of surgical intervention. Operative intervention is the main modality with wide marginal excision and fixation of bone graft from different sources or mega prosthesis to maintain congruity of the bone anatomy. Reconstruction, optimum fit and stability at the affected site are the major areas of concern with this modality. Radiation given outside the body to kill the tumour cells in the bone is called extracorporeal radiotherapy (ECRT). After resection of the bone, it is cleaned of all the surrounding soft tissue and marrow contents and placed in a container. It is then subjected to 50 Gy of radiation which kills all the tumour cells. METHODS: The study was conducted from June 2014 to May 2020, and included 15 patients (out of 18) diagnosed with either Ewing's sarcoma or osteosarcoma. They were followed up for an average of 4.44 years, up to May 2020. All 15 cases were analysed for bony union at the osteotomy sites. Cases reported with poorly differentiated sarcomas (total three) were subjected to immunohistochemistry and managed with other modalities of treatment. RESULTS: The average time for union of irradiated bone was 8.1 months (range 5-10; the metaphyseal end united faster than the diaphyseal end). At the final follow-up, the functional status was determined using the Musculoskeletal Tumour Society (MSTS) scoring system. Ninety-three per cent of patients had involvement of the lower limb (14 out of 15). All patients (except one who developed recurrence) did not have symptoms of the disease and no one had died at last follow-up. CONCLUSION: Biological limb salvage procedures are considered a successful treatment and a welcome alternative for patients who either cannot afford or be treated with an endoprosthesis. Early diagnosis and referral to specialised unit is of vital importance. This procedure can be used for selected patients with malignant bone tumours. Cost factors, and social and cultural considerations also play a role Level of evidence: Level 4. Keywords: ECRT, extracorporeal radiation therapy, malignant bone tumours, bone sarcoma, osteosarcoma, Ewing's sarcoma

Ewing’s Sarcoma of the Hand

2008 ◽  
Vol 34 (1) ◽  
pp. 35-39 ◽  
Author(s):  
O. A. ANAKWENZE ◽  
W. L. PARKER ◽  
L. E. WOLD ◽  
K. K AMRAMI ◽  
P. C. AMADIO
Keyword(s):  
Radiation Therapy ◽  
Ewing’S Sarcoma ◽  
Ewing's Sarcoma ◽  
Case Series ◽  
Surgical Excision ◽  
Case Review ◽  
Retrospective Case ◽  
Postoperative Radiation Therapy ◽  
Definitive Surgery

A retrospective case review was carried out to report the outcomes in a contemporary case series of Ewing’s sarcoma originating in the hand. We identified five patients treated since 1995. All five had wide surgical excision, one by ray amputation. All were treated with chemotherapy. Four patients also received radiation therapy, two to treat metastases and two as an adjunct to local excision. There were no local recurrences. Two patients developed metastases. Both died of their disease. Neither of these two patients had received local postoperative radiation therapy; one did not receive chemotherapy before definitive surgery. The other three patients were alive and free of disease at last follow-up, 4 to 12 years after initial presentation.

Malignant bone tumours

2011 ◽  
Author(s):  
Rej S. Bhumbra ◽  
Panagiotis D. Gikas ◽  
Sammy Hanna ◽  
Jakub Jagiello ◽  
Stephen R. Cannon
Keyword(s):  
Soft Tissue ◽  
Ewing’S Sarcoma ◽  
Ewing's Sarcoma ◽  
Bone Tumours ◽  
Malignant Bone Tumours

♦ Chondrosarcoma♦ Osteosarcoma♦ Ewing’s sarcoma♦ Myeloma of bone♦ Fibrosarcoma of bone or soft tissue♦ Lymphoma of bone♦ Malignant vascular tumours of bone.

Primary Bone Tumours of the Pelvis in Childhood—Ewing's Sarcoma of the Ilium, Pubis and Ischium. (Report of 30 cases) (Part I)

1989 ◽  
Vol 33 (4) ◽  
pp. 354-360 ◽  
Author(s):  
K. KOZLOWSKI ◽  
J. CAMPBELL ◽  
G. BELUFFI ◽  
J.C. HOEFFEL ◽  
L. MORRIS ◽  
...  
Keyword(s):  
Ewing’S Sarcoma ◽  
Ewing's Sarcoma ◽  
Bone Tumours ◽  
Primary Bone ◽  
Primary Bone Tumours

scholarly journals Precise single column resection and reconstruction with femoral head plus THR for malignant pelvic tumors

10.29007/nvsk ◽  
2018 ◽  
Author(s):  
Xiaohui Niu ◽  
Yongkun Yang ◽  
Qing Zhang ◽  
Yuan Li ◽  
Hairong Xu ◽  
...  
Keyword(s):  
Femoral Head ◽  
Ewing’S Sarcoma ◽  
Ewing's Sarcoma ◽  
Posterior Column ◽  
Surgical Margins ◽  
Wide Resection ◽  
Navigation Group ◽  
Single Column ◽  
And Function

Background Some malignant pelvic tumor may affect the anterior or posterior column at the acetabula area. The postoperative recurrenceand complication rate are high. Precise resection with safe surgical margin could cure the patients while saving healthier host bone for relative simple reconstruction.Questions/Purposes The purpose of this study is to evaluate the effect of precise single column resection and reconstruction with femoral head plus THR for malignant pelvic tumorswith respect to the (1) surgical safety, (2) oncological outcome and (3) prosthesis survivorship and function.Methods This is a clinical cases study. From 2007 to 2015, 19 patients with primary malignant tumors of the pelvis were enrolled in the study. The diagnosis included 16 cases of chondrosarcoma, 1 case of undifferentiated polymorphic sarcoma, 1 case of Ewing's sarcoma and 1 case of solitary plasmacytoma. All tumors were resected with safe surgical margins, which were proved by the postoperative specimen evaluation. Anterior column was involved in 17 cases and posterior column in 2 cases. Ten of 19 tumors were resected assisted by computer navigation. Femoral heads were used to reconstruct anterior or posterior column defects and fixed by screws; THR was used for the joint reconstruction. Oncologic outcome and function were evaluated by regular follow-up.Results The follow up time was more than 12 months in 14 cases with the average of 58.4 months (median 61, range 13-118) months. Surgical margins contained wide resection in 12 cases and marginal resection in 7 cases. The bony wide resection rate was 90% (9/10) in the navigation group and 77.8% (7/9) in free hand group respectively. One patient with Ewing's sarcoma died 14 months postoperative due to lung metastasis. There was only one case with chondrosarcoma was found recurrence in 61 months postoperatively, who was in the navigation group and having marginal margin resection. There was one prosthesis removed due to prosthesis infection (14 months postoperatively). There were another two patients with minor wound infection. The average MSTS function score was 24.8 (17-29).Conclusions The current treatment method is oncological safe and functional with less complications. The hardware is relatively cost effective and right on the shelf. However, this procedure is highly skill needed.

Multimodal therapy for the management of primary, nonmetastatic Ewing's sarcoma of bone: a long-term follow-up of the First Intergroup study.

1990 ◽  
Vol 8 (10) ◽  
pp. 1664-1674 ◽  
Author(s):  
M E Nesbit ◽  
E A Gehan ◽  
E O Burgert ◽  
T J Vietti ◽  
A Cangir ◽  
...  
Keyword(s):  
Overall Survival ◽  
Local Recurrence ◽  
Multimodal Therapy ◽  
Ewing’S Sarcoma ◽  
Ewing's Sarcoma ◽  
Patient Characteristics ◽  
Group I ◽  
Long Term Follow Up

A total of 342 previously untreated eligible children were entered into the first Intergroup Ewing's Sarcoma Study (IESS) between May 1973 and November 1978. In group I institutions, patients were randomized between treatment 1 (radiotherapy to primary lesion plus cyclophosphamide, vincristine, dactinomycin, and Adriamycin [doxorubicin; Adria Laboratories, Columbus, OH] [VAC plus ADR]) or treatment 2 (same as treatment 1 without ADR), and group II institutions randomized patients between treatment 2 or treatment 3 (same as treatment 2 plus bilateral pulmonary radiotherapy [VAC plus BPR]). The percentages of patients relapse-free and surviving (RFS) at 5 years for treatments 1, 2, and 3 were 60%, 24%, and 44%, respectively. There was strong statistical evidence of a significant advantage in RFS for treatment 1 (VAC plus ADR) versus 2 (VAC alone) (P less than .001) and 3 (P less than .05) and also of treatment 3 versus 2 (P less than .001). Similar significant results were observed with respect to overall survival. Patients with disease at pelvic sites have significantly poorer survival at 5 years than those with disease at nonpelvic sites (34% v 57%; P less than .001). Among pelvic cases, there was no evidence of differing survival by treatment (P = .81), but among nonpelvic cases, there was strong evidence of differing survival by treatment (P less than .001). The overall percentage of patients developing metastatic disease was 44%; the percentages by treatments 1, 2, and 3 were 30%, 72%, and 42%, respectively. The overall incidence of local recurrence was 15%, and there was no evidence that local recurrence rate differed by treatment. Patient characteristics related to prognosis, both with respect to RFS and overall survival experience, were primary site (nonpelvic patients were most favorable) and patient age (younger patients were more favorable).

Ewing's Sarcoma: An Approach to Radiological Diagnosis

1979 ◽  
Vol 65 (3) ◽  
pp. 389-399 ◽  
Author(s):  
Fabrizio Lombardi ◽  
Marco Gasparini ◽  
Cristina Gianni ◽  
Raffaele Petrillo ◽  
John David Tesoro-Tess ◽  
...  
Keyword(s):  
Ewing’S Sarcoma ◽  
Ewing's Sarcoma ◽  
Primary Site ◽  
Long Bones ◽  
Age Group ◽  
Pediatric Age Group ◽  
Localized Disease ◽  
The Mean ◽  
Small Bones

All the pertinent radiographs of 83 patients with histologically proven Ewing's sarcoma were reviewed. Forty-nine patients were in the pediatric age group, and 34 were adults. The mean age, the symptoms and time from symptoms to diagnosis were evaluated in the 2 groups. The site of primary involvement was in 54 % the long bones, 35 % the flat bones, 8 % the small bones and 3 % extraosseous. For the primary site we considered the diagnostic results of the standard radiographic investigations and in some cases the usefulness of angiography, xeroradiography and telethermography. At presentation we also evaluated the possible diffusion of the disease with standard radiographic surveys (chest and skeletal, including limbs) and with foot lymphography in selected cases. In this way, 57 patients (69 %) were considered to have localized disease. In this group, we also considered the value of the periodic radiographic follow-up, which enabled us to disclose the appearance of metastases (chest 64 %, bone 54 %, lymph nodes 11 %) in 28 cases (49 %). Finally, we made a comparison of the different radiologic and epidemiologic findings between children and adults.

Emergent radiation therapy to cardiac Ewing’s sarcoma with haemodynamic failure due to pulmonary artery compression

2019 ◽  
Vol 21 (2) ◽  
pp. 234-234
Author(s):  
Susumu Katsushika ◽  
Mikio Kishi ◽  
Takahiro Sato ◽  
Masashiro Matsushita ◽  
Masao Yamasaki
Keyword(s):  
Radiation Therapy ◽  
Pulmonary Artery ◽  
Ewing’S Sarcoma ◽  
Ewing's Sarcoma

Role of surgical resection in pelvic Ewing's sarcoma.

1995 ◽  
Vol 13 (9) ◽  
pp. 2336-2341 ◽  
Author(s):  
S P Scully ◽  
H T Temple ◽  
R J O'Keefe ◽  
M T Scarborough ◽  
H J Mankin ◽  
...  
Keyword(s):  
Overall Survival ◽  
Radiation Therapy ◽  
Disease Control ◽  
Surgical Resection ◽  
Ewing’S Sarcoma ◽  
Ewing's Sarcoma ◽  
Disease Free Survival ◽  
Local Disease ◽  
Local Disease Control

PURPOSE The improved survival in patients with Ewing's sarcoma over the past two decades has placed increased importance on achievement of local disease control. Ewing's sarcoma that arises in the pelvis has been recognized to have a worse prognosis than that in the appendicular skeleton, and the role of surgical resection in these cases remains controversial. The current study attempts to identify a benefit to surgical resection in these patients. METHODS We retrospectively examined 39 patients who presented with Ewing's sarcoma in a pelvic location, all of whom were treated systemically with chemotherapy. Twenty patients received radiation only as a means of local control, and 19 underwent resection with or without radiation therapy. The patients were evaluated with end points of disease-free survival and overall survival for a minimum of 24 months and a mean of 58 months. RESULTS There was an even distribution among patients who underwent surgical resection for local control as compared with those who received only radiation therapy with respect to age, site, date of treatment, and stage of disease. Despite uncontrolled biases including tumor size and response to chemotherapy that would be expected to favor patients who undergo resection, surgery in addition to or in substitution for radiation therapy did not result in a statistically significant increase in disease-free survival or overall survival. Local disease control was comparable between those who underwent resection and those who did not: three patients in each group developed a local recurrence. CONCLUSION Currently, morbidity of surgical resection should be weighed against the efficacy and secondary complications of radiation therapy in the decision-making process for local disease control. The issue of whether overall survival and local disease control is improved in patients who undergo surgical resection remains controversial and may require a prospective randomized trial to be answered definitively.

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