Curettage, phenolization, and cementation in paediatric Ewing’s sarcoma with a complete radiological response to neoadjuvant chemotherapy
- 82 Downloads
Although wide resection is the standard treatment for Ewing’s sarcoma (ES), it has complications especially in children. In this study, we compared the oncologic and functional outcomes of wide resection with extended curettage and local adjuvant therapy (phenolization and cementation), as a less extensive surgery for paediatric ES with a complete radiologic response to neoadjuvant chemotherapy.
Children aged ≤ ten years, with ES of non-expendable long-bones and complete radiologic response to neoadjuvant chemotherapy, were included in this case-control study. Twenty-six patients were treated with extended curettage and local adjuvant therapy (case group) and 17 were managed with wide resection (control group). The average follow-up period was 60.1 ± 28.7 months (range 30–168 months). Functional outcome was assessed with the Musculoskeletal Tumor Society (MSTS) scoring system.
Three local recurrences (11.5%) and three distant metastases (11.5%) were observed in the case group. Two local recurrences (11.7%) and two metastases (11.7%) were recorded in the control group. The rate of local recurrence was not statistically different between the two study groups (p = 0.668). The rate of metastasis was not statistically different between the two study groups as well (p = 0.668). The complication rates were 15% in the case group and 53% in the control group (p = 0.005). The mean MSTS score was 98.3% and 74% in the case and control group, respectively (p < 0.001).
The oncologic outcome of extended curettage and local adjuvant therapy in paediatric ES with complete radiological response to neoadjuvant chemotherapy is comparable to wide resection, yet it offers considerably better functional results.
KeywordsEwing’s sarcoma Neoadjuvant chemotherapy Wide resection Curettage Paediatrics
Compliance with ethical standards
Conflict of interest
The authors declare that there is no conflict of interest.
- 1.Ewing J (1921) Diffuse endothelioma of bone. Proc New York Path 21:17–24Google Scholar
- 2.Abdel-Mota’al MM, Katchy K, Mallur A, Ahmad F, El-Alfy B (2008) Management of unicameral bone cyst of proximal femur: experience of 14 cases and review of literature. Kuwait Med J 40:202–210Google Scholar
- 3.Canale ST, Beaty JH (2012) Campbell’s operative orthopaedics. Elsevier/Mosby, Philadelphia, PAGoogle Scholar
- 9.Verma V, Denniston KA, Lin CJ, Lin C (2017) A comparison of pediatric vs. adult patients with the Ewing sarcoma family of tumors. Front Oncol 7Google Scholar
- 12.Oberlin O, Patte C, Demeocq F, Lacombe M, Brunat-Mentigny M, Demaille M-C, Tron P, Bui BNg, Lemerle J (1985) The response to initial chemotherapy as a prognostic factor in localized Ewing’s sarcoma. Eur J Cancer 21 (4):463–467Google Scholar
- 13.Juergens C, Weston C, Lewis I, Whelan J, Paulussen M, Oberlin O, Michon J, Zoubek A, Juergens H, Craft A (2006) Safety assessment of intensive induction with vincristine, ifosfamide, doxorubicin, and etoposide (VIDE) in the treatment of Ewing tumors in the EURO-EWING 99 clinical trial. Pediatr Blood Cancer 47(1):22–29CrossRefGoogle Scholar
- 17.Jamshidi K, Bahrabadi M, Mirzaei A (2017) Long-term results of osteoarticular allograft reconstruction in children with distal femoral bone tumors. Arch Bone Joint Surg 5(5):296Google Scholar
- 19.McTiernan AM, Cassoni AM, Driver D, Michelagnoli MP, Kilby AM, Whelan JS (2006) Improving outcomes after relapse in Ewing’s sarcoma: analysis of 114 patients from a single institution. Sarcoma. https://doi.org/10.1155/SRCM/2006/83548
- 26.Bacci G, Ferrari S, Longhi A, Donati D, De Paolis M, Forni C, Versari M, Setola E, Briccoli A, Barbieri E (2003) Therapy and survival after recurrence of Ewing’s tumors: the Rizzoli experience in 195 patients treated with adjuvant and neoadjuvant chemotherapy from 1979 to 1997. Ann Oncol 14(11):1654–1659CrossRefGoogle Scholar