TY - JOUR
T1 - Ewing's Sarcoma of the Spine: Prognostic Variables for Survival and Local Control in Surgically Treated Patients.
AU - Charest-Morin, Raphaële
AU - Dirks, M.S.
AU - Patel, S
AU - Boriani, Stefano
AU - Luzzati, Alessandro
AU - Fehlings, Michael G.
AU - Fisher, Charles G.
AU - Dekutoski, Mark B.
AU - Williams, R.
AU - Quraishi, Nasir A
AU - Gokaslan, Ziya L.
AU - Bettegowda, Chetan
AU - Germscheid, Niccole M.
AU - Varga, Peter Pal
AU - Rhines, Laurence D.
PY - 2017
Y1 - 2017
N2 - STUDY DESIGN:
Multicenter, ambispective observational study.
OBJECTIVES:
To quantify mortality and local recurrence after surgical treatment of spinal Ewing's sarcoma (ES) and to determine whether an Enneking appropriate procedure and surgical margins (en bloc resection with wide/marginal margins) are associated with improved prognosis.
SUMMARY OF BACKGROUND DATA:
Treatment of primary ES of the spine is complex. Ambiguity remains regarding the role and optimal type of surgery in the treatment of spinal ES.
METHODS:
The AOSpine Knowledge Forum Tumor developed a multicenter database including demographics, diagnosis, treatment, mortality, and recurrence rate data for spinal ES. Patients were stratified based on surgical margins and Enneking appropriateness. Survival and recurrence were analyzed using Kaplan-Meier curves and log-rank tests.
RESULTS:
Fifty-eight patients diagnosed with primary spinal ES underwent surgery. Enneking appropriateness of surgery was known for 55 patients; 24 (44%) treated Enneking appropriately (EA) and 31 (56%) treated Enneking inappropriately (EI). A statistically significant difference in favor of EA-treated patients was found with regards to survival (p = 0.034). Neoadjuvant and postoperative chemotherapy was significantly associated with increased survival (p = 0.008). Local recurrence occurred in 22% (N = 5) of patients with an EA procedure versus 38% (N = 11) of patients with an EI procedure. The timing of chemotherapy treatment was significantly different between the Enneking cohorts (p < 0.001) and all EA-treated patients received chemotherapy treatment. Although, local recurrence was not significantly different between Enneking cohorts (p = 0.140), intralesional surgical margins and patients who received a previous spine tumor operation were associated with increased local recurrence (p = 0.025 and p = 0.018, respectively).
CONCLUSION:
Surgery should be undertaken when an en bloc resection with wide/marginal margins is feasible. An EA surgery correlates with improved survival, but the impact of other prognostic factors needs to be evaluated. En bloc resection with wide/marginal margins is associated with local control.
AB - STUDY DESIGN:
Multicenter, ambispective observational study.
OBJECTIVES:
To quantify mortality and local recurrence after surgical treatment of spinal Ewing's sarcoma (ES) and to determine whether an Enneking appropriate procedure and surgical margins (en bloc resection with wide/marginal margins) are associated with improved prognosis.
SUMMARY OF BACKGROUND DATA:
Treatment of primary ES of the spine is complex. Ambiguity remains regarding the role and optimal type of surgery in the treatment of spinal ES.
METHODS:
The AOSpine Knowledge Forum Tumor developed a multicenter database including demographics, diagnosis, treatment, mortality, and recurrence rate data for spinal ES. Patients were stratified based on surgical margins and Enneking appropriateness. Survival and recurrence were analyzed using Kaplan-Meier curves and log-rank tests.
RESULTS:
Fifty-eight patients diagnosed with primary spinal ES underwent surgery. Enneking appropriateness of surgery was known for 55 patients; 24 (44%) treated Enneking appropriately (EA) and 31 (56%) treated Enneking inappropriately (EI). A statistically significant difference in favor of EA-treated patients was found with regards to survival (p = 0.034). Neoadjuvant and postoperative chemotherapy was significantly associated with increased survival (p = 0.008). Local recurrence occurred in 22% (N = 5) of patients with an EA procedure versus 38% (N = 11) of patients with an EI procedure. The timing of chemotherapy treatment was significantly different between the Enneking cohorts (p < 0.001) and all EA-treated patients received chemotherapy treatment. Although, local recurrence was not significantly different between Enneking cohorts (p = 0.140), intralesional surgical margins and patients who received a previous spine tumor operation were associated with increased local recurrence (p = 0.025 and p = 0.018, respectively).
CONCLUSION:
Surgery should be undertaken when an en bloc resection with wide/marginal margins is feasible. An EA surgery correlates with improved survival, but the impact of other prognostic factors needs to be evaluated. En bloc resection with wide/marginal margins is associated with local control.
U2 - 10.1097/BRS.0000000000002386
DO - 10.1097/BRS.0000000000002386
M3 - Article
JO - Spine
JF - Spine
SN - 0362-2436
ER -