Bone and Joint Reconstruction Research Center, Shafa Orthopedic Hospital, Iran University of Medical Sciences, Tehran, Iran.
Int Orthop. 2019 Feb;43(2):467-473. doi: 10.1007/s00264-018-4094-5. Epub 2018 Aug 11.
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.
尽管广泛切除术是尤文肉瘤（Ewing's sarcoma，ES）的标准治疗方法，但它存在许多并发症，尤其是在儿童中。在本研究中，我们比较了广泛切除术和扩大刮除术联合局部辅助治疗（苯酚化和骨水泥）在完全缓解新辅助化疗的儿童尤文肉瘤中的肿瘤学和功能结果，后者是一种较为广泛的手术。
本病例对照研究纳入了年龄≤10 岁、非可扩张长骨尤文肉瘤且对新辅助化疗完全缓解的儿童患者。26 例患者接受了扩大刮除术和局部辅助治疗（病例组），17 例患者接受了广泛切除术（对照组）。平均随访时间为 60.1±28.7 个月（范围 30-168 个月）。功能结果采用肌肉骨骼肿瘤学会（Musculoskeletal Tumor Society，MSTS）评分系统进行评估。
病例组中有 3 例（11.5%）局部复发和 3 例（11.5%）远处转移，对照组中有 2 例（11.7%）局部复发和 2 例（11.7%）远处转移。两组的局部复发率无统计学差异（p=0.668）。两组的转移率也无统计学差异（p=0.668）。病例组的并发症发生率为 15%，对照组为 53%（p=0.005）。病例组和对照组的 MSTS 评分分别为 98.3%和 74%（p<0.001）。
对于完全缓解新辅助化疗的儿童尤文肉瘤，扩大刮除术联合局部辅助治疗的肿瘤学结果与广泛切除术相当，但功能结果要好得多。
