Surgical management of pelvic Ewing's sarcoma in children and adolescents

Fan,Hongbin; Guo,Zheng; Fu,Jun; Li,Xiangdong; Li,Jing; Wang,Zhen

doi:10.3892/ol.2017.6677

Surgical management of pelvic Ewing's sarcoma in children and adolescents

Authors:
- Hongbin Fan
- Zheng Guo
- Jun Fu
- Xiangdong Li
- Jing Li
- Zhen Wang
View Affiliations

Affiliations: Department of Orthopedic Surgery, Xi‑Jing Hospital, The Fourth Military Medical University, Xi'an, Shaanxi 710032, P.R. China
Published online on: July 26, 2017 https://doi.org/10.3892/ol.2017.6677
Pages: 3917-3926
Copyright: © Fan et al. This is an open access article distributed under the terms of Creative Commons Attribution License.

Metrics: Total Views: 0 (Spandidos Publications: | PMC Statistics: )

Metrics: Total PDF Downloads: 0 (Spandidos Publications: | PMC Statistics: )

Cited By (CrossRef): 0 citations Loading Articles...

Abstract

The present study describes a novel surgical strategy used to treat immature pelvic Ewing's sarcoma (ES), one made possible owing to the intrinsic structure of the skeletally immature pelvis. A total of 12 children and adolescents with open triradiate cartilage received limb‑salvage surgeries following a diagnosis of pelvic ES. In total, 3 patients with iliac lesions (2 lesions with extension into the sacrum) received surgical tumor excisions and allograft reconstructions. Another 8 patients with periacetabular lesions received trans‑acetabular osteotomies and allograft reconstructions. No reconstruction was performed on 1 patient following excision of a pubic lesion. The median follow‑up time was 39 months. At the time of the final follow‑up appointment, 9 patients exhibited no evidence of disease, 2 patients had slow progressive pulmonary metastasis, 1 patient exhibited local recurrence of the disease and 1 patient had succumbed to the disease 24 months after surgery. Complications included issues with wound healing in 1 patient, a discrepancy in leg length in another and a screw loosening in a further patient. The patients had a mean Musculoskeletal Tumor Society score of 26 points and a mean International Society of Limb Salvage radiographic score of 90.1%. The proposed surgical strategy for children and adolescents with pelvic ES in the present study could provide a feasible solution for acetabulum salvage and local tumor control.

View Figures

View References

1	de Gauzy Sales J, Lafontan V, Urseï M and Accadbled F: Ewing sarcoma of the acetabulum in children: A ‘growth plate-based’ surgical strategy. J Pediatr Orthop. 34:326–330. 2014. View Article : Google Scholar : PubMed/NCBI
2	Devaney K, Abbondanzo SL, Shekitka KM, Wolov RB and Sweet DE: MIC2 detection in tumors of bone and adjacent soft tissues. Clin Orthop Relat Res. 176–187. 1995.PubMed/NCBI
3	Abed R and Grimer R: Surgical modalities in the treatment of bone sarcoma in children. Cancer Treat Rev. 36:342–347. 2010. View Article : Google Scholar : PubMed/NCBI
4	Frassica FJ, Frassica DA, Pritchard DJ, Schomberg PJ, Wold LE and Sim FH: Ewing sarcoma of the pelvis. Clinicopathological features and treatment. J Bone Joint Surg Am. 75:1457–1465. 1993. View Article : Google Scholar : PubMed/NCBI
5	Ginsberg JP, Woo SY and Johnson ME: Ewing's sarcoma family of tumors: Ewing's sarcoma of bone and soft tissue and the peripheral primitive neuroectodermal tumorsPizzo PA and Poplack DG: Principles and Practice of Pediatric Oncology. 4th. Philidelphia, PA: Lippincott Williams & Wilkins; pp. 973–101614. 2002
6	Falk S and Alpert M: Five year survival of patients with Ewing's sarcoma. Surg Gynecol Obstet. 124:319–324. 1967.PubMed/NCBI
7	Bacci G, Ferrari S, Bertoni F, Rimondini S, Longhi A, Bacchini P, Forni C, Manfrini M, Donati D and Picci P: Prognostic factors in nonmetastatic Ewing's sarcoma of bone treated with adjuvant chemotherapy: Analysis of 359 patients at the Istituto Rizzoli. J Clin Oncol. 18:4–11. 2000. View Article : Google Scholar : PubMed/NCBI
8	Bhagat S, Sharma H, Pillai DS and Jane MJ: Pelvic Ewing's sarcoma: A review from Scottish Bone Tumour Registry. J Orthop Surg (Hong Kong). 16:333–338. 2008. View Article : Google Scholar : PubMed/NCBI
9	Sucato DJ, Rougraff B, McGrath BE, Sizinski J, Davis M, Papandonatos G, Green D, Szarzanowicz T and Mindell ER: Ewing's sarcoma of the pelvis. Long-term survival and functional outcome. Clin Orthop Relat Res. 193–201. 2000. View Article : Google Scholar : PubMed/NCBI
10	Enneking WF and Dunham WK: Resection and reconstruction for primary neo-plasms involving the innominate bone. J Bone Joint Surg Am. 60:731–746. 1978. View Article : Google Scholar : PubMed/NCBI
11	O'Connor MI and Sim FH: Salvage of the limb in the treatment of malignant pelvic tumors. J Bone Joint Surg Am. 71:481–494. 1989. View Article : Google Scholar : PubMed/NCBI
12	Jansen JA, van de Sande MA and Dijkstra PD: Poor long-term clinical results of saddle prosthesis after resection of periacetabular tumors. Clin Orthop Relat Res. 471:324–331. 2013. View Article : Google Scholar : PubMed/NCBI
13	Gebert C, Wessling M, Hoffmann C, Roedl R, Winkelmann W, Gosheger G and Hardes J: Hip transposition as a limb salvage procedure following the resection of periacetabular tumors. J Surg Oncol. 103:269–275. 2011. View Article : Google Scholar : PubMed/NCBI
14	Liporace FA, Ong B, Mohaideen A, Ong A and Koval KJ: Development and injury of the triradiate cartilage with its effects on acetabular development: Review of the literature. J Trauma. 54:1245–1249. 2003. View Article : Google Scholar : PubMed/NCBI
15	Ponseti IV: Growth and development of the acetabulum in the normal child. Anatomical, histological, and roentgenographic studies. J Bone Joint Surg Am. 60:575–585. 1978. View Article : Google Scholar : PubMed/NCBI
16	Cheung WH, Lee KM, Fung KP and Leung KS: Growth plate chondrocytes inhibit neo-angiogenesis: A possible mechanism for tumor control. Cancer Lett. 163:25–32. 2001. View Article : Google Scholar : PubMed/NCBI
17	Winkelmann W: A new surgical method in malignant tumors of the ilium. Z Orthop Ihre Grenzgeb. 126:671–674. 1988.(In German). View Article : Google Scholar : PubMed/NCBI
18	Therasse P, Arbuck SG, Eisenhauer EA, Wanders J, Kaplan RS, Rubinstein L, Verweij J, Van Glabbeke M, van Oosterom AT, Christian MC and Gwyther SG: New Guidelines to Evaluate the Response to Treatment in Solid Tumors. J Natl Cancer Inst. 92:205–216. 2000. View Article : Google Scholar
19	Enneking WF, Spanier SS and Goodman MA: A system for the surgical staging of musculoskeletal sarcoma. Clin Orthop Relat Res. 106–120. 1980.PubMed/NCBI
20	Fan H, Guo Z, Wang Z, Li J and Li X: Surgical technique: Unicondylar osteoallograft prosthesis composite in tumor limb salvage surgery. Clin Orthop Relat Res. 470:3577–3586. 2012. View Article : Google Scholar : PubMed/NCBI
21	Enneking WF, Dunham W, Gebhardt MC, Malawar M and Pritchard DJ: A system for the functional evaluation of reconstructive procedures after surgical treatment of tumors of the musculoskeletal system. Clin Orthop Relat Res. 241–246. 1993.PubMed/NCBI
22	Glasser D and Langlais F: The ISOLS radiological implant evaluation systemLanglais F and Tomeno B: Limb Salvage: Major Reconstructions in Oncologic and Nontumoral Conditions. Springer-Verlag; Heidelberg, Germany: pp. 23–31. 1991
23	Biermann JS, Chow W, Reed DR, Lucas D, Adkins DR, Agulnik M, Benjamin RS, Brigman B, Budd GT, Curry WT, et al: NCCN Guidelines Insights: Bone Cancer, Version 2.2017. J Natl Compr Canc Netw. 15:155–167. 2017. View Article : Google Scholar : PubMed/NCBI
24	Ferrari S, Bertoni F, Palmerini E, Errani C, Bacchini P, Pignotti E, Mercuri M, Longhi A, Cesari M and Picci P: Predictive factors of histologic response to primary chemotherapy in patients with Ewing sarcoma. J Pediatr Hematol Oncol. 29:364–368. 2007. View Article : Google Scholar : PubMed/NCBI
25	Li WK, Lane JM, Rosen G, Marcove RC, Caparros B, Huvos A and Groshen S: Pelvic Ewing's sarcoma. Advances in treatment. J Bone Joint Surg Am. 65:738–747. 1983. View Article : Google Scholar : PubMed/NCBI
26	Rödl RW, Hoffmann C, Gosheger G, Leidinger B, Jürgens H and Winkelmann W: Ewing's sarcoma of the pelvis: Combined surgery and radiotherapy treatment. J Surg Oncol. 83:154–160. 2003. View Article : Google Scholar : PubMed/NCBI
27	Hubert DM, Low DW, Serletti JM, Chang B and Dormans JP: Fibula free flap reconstruction of the pelvis in children after limb-sparing internal hemipelvectomy for bone sarcoma. Plast Reconstr Surg. 125:195–200. 2010. View Article : Google Scholar : PubMed/NCBI
28	Porsch M, Kornhuber B and Hovy L: Functional results after partial pelvic resection in Ewing's sarcoma of the ilium. Arch Orthop Trauma Surg. 119:199–204. 1999. View Article : Google Scholar : PubMed/NCBI
29	Campanacci D, Chacon S, Mondanelli N, Beltrami G, Scoccianti G, Caff G, Frenos F and Capanna R: Pelvic massive allograft reconstruction after bone tumour resection. Int Orthop. 36:2529–2536. 2012. View Article : Google Scholar : PubMed/NCBI
30	Portinaro NM, Murray DW and Benson MK: Microanatomy of the acetabular cavity and its relation to growth. J Bone Joint Surg Br. 83:377–383. 2001. View Article : Google Scholar : PubMed/NCBI
31	Panuel M, Gentet JC, Scheiner C, Jouve JL, Bollini G, Petit P, Bourliere-Najean B and Devred P: Physeal and epiphyseal extent of primary malignant bone tumors in childhood. Correlation of preoperative MRI and the pathologic examination. Pediatr Radiol. 23:421–424. 1993. View Article : Google Scholar : PubMed/NCBI
32	Langer R, Brem H, Falterman K, Klein M and Folkman J: Isolations of a cartilage factor that inhibits tumor neovascularization. Science. 193:70–72. 1976. View Article : Google Scholar : PubMed/NCBI
33	San-Julian M, Aquerreta JD, Benito A and Cañadell J: Indications for epiphyseal preservation in metaphyseal malignant bone tumors of children: Relationship between image methods and histological findings. J Pediatr Orthop. 19:543–548. 1999. View Article : Google Scholar : PubMed/NCBI