Surgical treatment for pelvic Ewing sarcoma: What is a safe and functional acetabular reconstruction when combined with modern multidisciplinary treatments?
Surgical treatment for pelvic Ewing sarcoma: What is a safe and functional acetabular reconstruction when combined with modern multidisciplinary treatments?
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DOI：
10.1002/jso.25660
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发表时间：
2019-08-05
影响因子：
2.5
通讯作者：
Jeys, Lee M.
中科院分区：
文献类型：
--
作者：
Fujiwara, Tomohiro;Lex, Johnathan R.;Jeys, Lee M.
目的 本研究的目的是阐明哪种局部治疗在盆腔尤文肉瘤 (ES) 中在肿瘤学和功能上有效。方法 对 1986 年至 2016 年间在超区域中心连续接受盆腔切除和化疗后髋臼重建的一系列患者进行评估。结果 该队列由 35 名患者组成。 5年总生存率（OS）和局部无复发生存率（LRFS）分别为61%和72%。术前放疗 (RT) 和手术在 92% 的患者中提供了极好的/良好的组织学反应，并且与单独手术或术后放疗相比，获得了显着更好的 OS（5 年，64%）和 LRFS（5 年，100%）。髋关节转位患者的肌肉骨骼肿瘤协会功能评分明显优于使用定制假体、辐照自体移植物和冰淇淋蛋筒假体进行结构重建的患者（74% vs 57%；P = .031）。如果患者有深度感染，这些分数会显着降低 (P = .035)，这是结构重建中最常见的并发症 (28%)，但即使在术前 RT 后进行髋关节转位，也不会发生这种情况。结论 髋关节转位髋臼重建术即使联合术前放疗，也能保证盆腔ES患者无深部感染，功能良好，提高了肿瘤坏死率，提高了局部控制率和生存率。
Purpose The purpose of this study was to clarify which local treatment is oncologically and functionally effective in pelvic Ewing sarcoma (ES). Methods A consecutive series of patients who underwent pelvic resections and acetabular reconstructions after chemotherapy between 1986 and 2016 at a supra-regional center were evaluated. Results The cohort consisted of 35 patients. The 5-year overall survival (OS) and local recurrence-free survival (LRFS) was 61% and 72%, respectively. Preoperative radiotherapy (RT) and surgery provided an excellent/good histological response in 92% and achieved significantly better OS (5 years, 64%) and LRFS (5 years, 100%) than surgery alone or surgery with postoperative RT. The Musculoskeletal Tumor Society functional scores were significantly better in patients with hip transposition than those with structural reconstructions (74% vs 57%; P = .031) using custom-made prostheses, irradiated autografts, and ice-cream cone prostheses. These scores were significantly lower if patients had deep infection (P = .035), which was the most common complication (28%) in structural reconstructions but did not occur in hip transposition even when performed after preoperative RT. Conclusion Acetabular reconstruction with hip transposition resulted in no deep infection and superior function in patients with pelvic ES even when combined with preoperative RT, which improved tumor necrosis and rate of local control and survival.