Paterakis Konstantinos N, Brotis Alexandros, Dardiotis Efthimios, Giannis Theofanis, Tzerefos Christos, Fountas Kostas N
Department of Neurosurgery, University Hospital of Larissa, Greece.
Department of Neurosurgery, University Hospital of Larissa, Greece.
Clin Neurol Neurosurg. 2018 Jan;164:169-181. doi: 10.1016/j.clineuro.2017.11.014. Epub 2017 Dec 7.
Ewing's sarcoma (ES) is an aggressive bone and soft tissue sarcoma that usually affects adolescents and young adults. ES occasionally presents as an intradural-extramedullary lesion of the spine. Our aim was to study the role of the multimodality treatment on the survival (overall survival, recurrence-free survival, and metastasis-free survival) of patients with intradural-extramedullary Ewing's sarcoma. Pubmed, EMBASE, Scopus, Web of Science, Cochrane Reviews were searched up to January 2017, using as mesh terms "intradural extramedullary", "Ewing's sarcoma", AND "treatment". The multidisciplinary treatment was recorded in binary variables under the headings of "surgery", "chemotherapy" and "radiotherapy". We also recorded three time-to-event variables, including death, recurrence, and metastasis. We performed survival analysis for all potential combinations. Twenty articles with twenty-three patients were eligible for the current review. The survival curves of GTR did not differ from the equivalent of STR regarding survival (p=0.098), recurrence-free survival (p=0.318), and metastasis-free survival (p=0.089). Patients who received chemotherapy enjoyed longer survival regarding overall survival (p<0.05), recurrence-free survival (p<0.05), and metastasis-free survival (p<0.05), when compared to those who did not receive chemotherapy. Their overall survival of patients who had radiotherapy was marginally superior to those who did not receive (p=0.0653). However, their recurrence-free survival (p<0.05), and metastasis-free survival (p<0.05) were significantly improved in comparison to the latter. In conclusion, the multimodality treatment is mandatory for the management of patients with intradural extramedullary Ewing's sarcomas, with surgery assisting in the diagnosis and decompression the neural elements. However, it is chemotherapy that improves survival, recurrence-free survival, and metastasis-free survival. Radiotherapy is reserved as an adjuvant therapy in the local control, especially in cases with subtotal tumour resection.
尤因肉瘤（ES）是一种侵袭性骨与软组织肉瘤，通常影响青少年和年轻成年人。ES偶尔表现为脊柱的硬脊膜内髓外病变。我们的目的是研究多模式治疗对硬脊膜内髓外尤因肉瘤患者生存（总生存、无复发生存和无转移生存）的作用。截至2017年1月，检索了PubMed、EMBASE、Scopus、科学网、Cochrane系统评价，使用“硬脊膜内髓外”、“尤因肉瘤”和“治疗”作为主题词。多学科治疗记录在“手术”、“化疗”和“放疗”标题下的二元变量中。我们还记录了三个事件发生时间变量，包括死亡、复发和转移。我们对所有潜在组合进行了生存分析。20篇文章中的23例患者符合本次综述的标准。在总生存（p=0.098）、无复发生存（p=0.318）和无转移生存（p=0.089）方面，根治性切除（GTR）的生存曲线与次全切除（STR）的生存曲线无差异。与未接受化疗的患者相比，接受化疗的患者在总生存（p<0.05）、无复发生存（p<0.05）和无转移生存（p<0.05）方面生存期更长。接受放疗患者的总生存略优于未接受放疗的患者（p=0.0653）。然而，与后者相比，他们的无复发生存（p<0.05）和无转移生存（p<0.05）有显著改善。总之，多模式治疗对于硬脊膜内髓外尤因肉瘤患者的管理是必不可少的，手术有助于诊断和减压神经组织。然而，改善生存、无复发生存和无转移生存的是化疗。放疗作为局部控制的辅助治疗，尤其是在肿瘤次全切除的病例中。
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