Document Type : Original Article
Authors
1 Associate Professor, Bone and Joint Diseases Research Center, Department of Orthopaedic, School of medicine, Shiraz University of Medical Sciences, Shiraz, Iran.
2 Assistant Professor, School of Rehabilitation, Hamadan University of Medical Sciences, Hamadan, Iran.
3 Bone and Joint Diseases Research Center, Department of Orthopedic, School of medicine, Shiraz University of Medical Sciences, Shiraz, Iran.
4 Bone and Joint Diseases Research Center, Department of Orthopaedic, School of medicine, Shiraz University of Medical Sciences, Shiraz, Iran.
Abstract
Background: Ewing's sarcoma is a primitive and malignant bone tumor that is a serious medical challenge in preserving the patient's life and choosing the appropriate treatment. The aim of this study was to consider the metastasis and survival rate after preoperative chemotherapy, surgery and postoperative chemotherapy as a treatment protocol.
Methods: In this study, 42 patients with Ewing's Sarcoma admitted to Chamran and Namazi Hospitals during 2005 to 2016 were enrolled. After considering inclusion and exclusion criteria, 27 patients were finally entered the study. Neo adjuvant chemotherapy and again restaging with MRI and chest CT scan was done. After restaging, treatment was selected. Treatments included amputation; only wide resection; wide resection and allograft; wide resection and prosthesis and only chemotherapy. After surgical treatments, patient had adjuvant chemotherapy.
Results: In this study, 42 patients were investigated of whom 29 (%69) were male and 13 (%31) female respectively. The age mean and standard deviation were 21.45± 7.69 and 16.23± 4.9 in the male and female in respect. Femur (%30) and tibia (%23.8), respectively, were the more commonly involved sites. The treatments of 27 cases in the study group were amputation (5 subjects), only wide resection (6 subjects), wide resection and allograft (8 subjects) and wide resection and prosthesis (3 subjects). Patients with pelvis involvement received only chemotherapy (5 subjects). %46.2 of subjects had a 5-year survival period.
Conclusion: Early diagnosis of Ewing's sarcoma and appropriate treatment using preoperative chemotherapy followed by, surgery through proper margin removal and then postoperative chemotherapy is highly recommended for this condition. Our study confirmed the above-mentioned points on preoperative chemotherapy followed by surgery and post operative chemotherapy.
Keywords
References:
- Petca RC, Gavriliu S, Burnei Gh. Clinical and therapeutical aspect of ewing sarcoma in children and adolescents- A single center experience. Revista Medicala Romana. 2016;63(1):39-44.
- Robert K, Heck JR. Malignant bone tumor. In: Terry Canale S, James H. Campbells Operative Orthopedics. New York: Mosby; 2013.
- Balamuth NJ, Warner RB. Ewing's sarcoma. lancet Oncol. 2010;11:184-92.
- Choi EY, Gardner JM, Lucas DR, McHugh JB, Patel RM. Ewing sarcoma. Semin Diagn Pathol. 2014;31(1):39-47.
- Durer S, Shaikh H. Ewing Sarcoma. [Updated 2021 Jul 26]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK559183/; 2021.
- Tu J, Huo Z, Gingold J, Zhao R, Shen J, Lee DF. The Histogenesis of Ewing Sarcoma. Cancer reports and reviews. 2017;1(2).
- Zollner SK, Amatruda JF, Bauer S, Collaud S, de Alava E, DuBois SG, et al. Ewing Sarcoma-Diagnosis, Treatment, Clinical Challenges and Future Perspectives. Journal of clinical medicine. 2021;10(8).
- Srivastava S, Arora J, Parakh A, Goel RK. Primary extraskeletal Ewing's sarcoma/primitive neuroectodermal tumor of breast. The Indian journal of radiology & imaging. 2016;26(2):226-30.
- Karkhur Y, Maini L, Tiwari A, Verma T. Ewings sarcoma of ilium: Resection and reconstruction with femoral head allograft. J Clin Orthop Trauma. 2017;8(Suppl 1):S53-S7.
- Ozaki T. Diagnosis and treatment of Ewing sarcoma of the bone: a review article. J Orthop Sci. 2015;20(2):250-63.
- Kai-Ling H, Cheng-fong Ch, etal. Clinical outcomes and prognostic factors of Ewing sarcoma. Journal of Chinese Medical Association. 2012;75:16-20.
- Biswas B, Bakhshi S. Management of Ewing sarcoma family of tumors: Current scenario and unmet need. World journal of orthopedics. 2016;7(9):527-38.
- Zhang J, Huang Y, Sun Y, He A, Zhou Y, Hu H, et al. Impact of chemotherapy cycles and intervals on outcomes of nonspinal Ewing sarcoma in adults: a real-world experience. BMC Cancer. 2019;19(1):1168.
- Iwamoto Y. Diagnosis and Treatment of Ewing's Sarcoma. Jpn J Clin Oncol. 2007;37(2):79-89.
- De Ioris MA, Prete A, Cozza R, Podda M, Manzitti C, Pession A, et al. Ewing sarcoma of the bone in children under 6 years of age. PLoS One. 2013;8(1):e53223.
- de Alava E, Gerald WL. Molecular biology of the Ewing's sarcoma/primitive neuroectodermal tumor family. J Clin Oncol. 2000;18:204-13.
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