High Long-term Local Control with Sacrectomy for Primary High-grade Bone Sarcoma in Children
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Sacrectomy may offer curative potential for primary sarcomas of the sacrum. However, it is unclear whether and to what extent sacrectomies achieve local control.
We therefore determined the curative potential, walking ability, continence control, and quality of life for children after sacrectomy for primary bone sarcoma.
We retrospectively reviewed eight children with high-grade primary bone sarcomas treated with sacrectomy. The average age of the patients was 14 years (range, 4–18 years). There were six Ewing sarcomas and two osteosarcomas. Five patients underwent partial and three underwent total sacrectomies with all resection margins free of tumor. We recorded local and distant recurrences, functional (Musculoskeletal Tumor Society [MSTS] score) and oncologic outcome (survival), walking ability, bladder and bowel control, independence, and reintegration in society. The average followup was 80 months (range, 54–204 months).
Six patients were alive without evidence of disease at last followup. Three patients had metastases develop and two died of disease 3 and 25 months postoperative. MSTS scores among survivors averaged 17.5 points (range, 5–25 points). Seven of the eight patients were able to ambulate, two independently. All initially were incontinent, but at last followup, two were continent and two were incontinent only under stress. Complications occurred in seven of eight, five of whom required additional surgery.
Despite the high incidence of neurologic deficits and complications, sacrectomy achieved local control in patients with high-grade bone sarcomas. Our observations suggest long-term survival and adequate quality of life are possible in the pediatric population.
Level of Evidence
Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
- Davidge KM, Eskicioglu C, Lipa J, Ferguson P, Swallow CJ, Wright FC. Qualitative assessment of patient experiences following sacrectomy. J Surg Oncol. 2010;101:447–450.
- Dickey ID, Hugate RR Jr, Fuchs B, Yaszemski MJ, Sim FH. Reconstruction after total sacrectomy: early experience with a new surgical technique. Clin Orthop Relat Res. 2005;438:42–50. CrossRef
- Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240:205–213. CrossRef
- Dominkus M, Darwish E, Funovics P. Reconstruction of the pelvis after resection of malignant bone tumours in children and adolescents. Recent Results Cancer Res. 2009;179:85–111. CrossRef
- Dormans JP, Pill SG. Benign and malignant tumors of the spine in children. Spine: State of Arts Review. 2000;14:263–279.
- Enneking WF, Dunham W, Gebhardt MC, Malawar M, Pritchard DJ. A system for the functional evaluation of reconstructive procedures after surgical treatment of tumors of the musculoskeletal system. Clin Orthop Relat Res. 1993;286:241–246.
- Enneking WF, Spanier S, Goodman MA. A system for the surgical staging of musculoskeletal sarcoma. 1980. Clinical Orthop Relat Res. 2003;415:4–18. CrossRef
- Fourney DR, Rhines LD, Hentschel SJ, Skibber JM, Wolinsky JP, Weber KL, Suki D, Gallia GL, Garonzik I, Gokaslan ZL. En bloc resection of primary sacral tumors: classification of surgical approaches and outcome. J Neurosurg Spine. 2005;3:111–122. CrossRef
- Grubb MR, Currier BL, Pritchard DJ, Ebersold MJ. Primary Ewing’s sarcoma of the spine. Spine (Phila Pa 1976). 1994;19:309–313. CrossRef
- Hashimoto M, Akabane Y, Tate E. Ewing’s sarcoma of the sacrum. Radiat Med. 1999;17:451–453.
- Hugate RR Jr, Dickey I, Phimolsarnti R, Yaszemski MJ, Sim FH. Mechanical effects of partial sacrectomy: when is reconstruction necessary? Clin Orthop Relat Res. 2006;450:82–88. CrossRef
- Hulen CA, Temple HT, Fox WP, Sama AA, Green BA, Eismont FJ. Oncologic and functional outcome following sacrectomy for sacral chordoma. J Bone Joint Surg Am. 2006;88:1532–1539. CrossRef
- Ilaslan H, Sundaram M, Unni KK, Dekutoski MB. Primary Ewing’s sarcoma of the vertebral column. Skeletal Radiol. 2004;33:506–513. CrossRef
- Ilaslan H, Sundaram M, Unni KK, Shives TC. Primary vertebral osteosarcoma: imaging findings. Radiology. 2004;230:697–702. CrossRef
- Iwamoto Y. Diagnosis and treatment of Ewing’s sarcoma. Jpn J Clin Oncol. 2007;37:79–89. CrossRef
- Kelley SP, Ashford RU, Rao AS, Dickson RA. Primary bone tumours of the spine: a 42-year survey from the Leeds Regional Bone Tumour Registry. Eur Spine J. 2007;16:405–409. CrossRef
- Kozlowski K, Barylak A, Campbell J, Hoeffel JD, Beluffi G, Masel J, Panuel M, Pelizza A, Taccone A, Arico M. Primary sacral bone tumours in children (report of 16 cases with a short literature review). Australas Radiol. 1990;34:142–149. CrossRef
- Lahl M, Fisher VL, Laschinger K. Ewing’s sarcoma family of tumors: an overview from diagnosis to survivorship. Clin J Oncol Nurs. 2008;12:89–97. CrossRef
- Lam CH, Naqib MG. Nonteratomatous tumors in the pediatric sacral region. Spine (Phila Pa 1976). 2002;27:E284–287. CrossRef
- Llauger J, Palmer J, Amores S, Bague S, Camins A. Primary tumors of the sacrum: diagnostic imaging. AJR Am J Roentgenol. 2000;174:417–424.
- Matsuo T, Sugita T, Sato K, Hotta T, Tsuchiya H, Shimose S, Kubo T, Ochi M. Clinical outcomes of 54 osteosarcomas registered by Japanese musculoskeletal oncology group. Oncology. 2005;68:375–381. CrossRef
- Ohata N, Ozaki T, Kunisada T, Morimoto Y, Tanaka M, Inoue H. Extended total sacrectomy and reconstruction for sacral tumor. Spine (Phila Pa 1976). 2004;29:E123–126. CrossRef
- Ozaki T, Flege S, Liljenqvist U, Hillmann A, Delling G, Salzer-Kuntschik M, Jurgens H, Kotz R, Winkelmann W, Bielack SS. Osteosarcoma of the spine: experience of the Cooperative Osteosarcoma Study Group. Cancer. 2002;94:1069–1077. CrossRef
- Randall RL, Bruckner J, Lloyd C, Pohlman TH, Conrad EU 3rd. Sacral resection and reconstruction for tumors and tumor-like conditions. Orthopedics. 2005;28:307–313.
- Sahakitrungruang C, Chantra K, Dusitanond N, Atittharnsakul P, Rojanasakul A. Sacrectomy for primary sacral tumors. Dis Colon Rectum. 2009;52:913–918. CrossRef
- Sar C, Eralp L. Surgical treatment of primary tumors of the sacrum. Arch Orthop Trauma Surg. 2002;122:148–155. CrossRef
- Sciubba DM, Nelson C, Gok B, McGirt MJ, McLoughlin GS, Noggle JC, Wolinsky JP, Witham TF, Bydon A, Gokaslan ZL. Evaluation of factors associated with postoperative infection following sacral tumor resection. J Neurosurg Spine. 2008;9:593–599. CrossRef
- Spiegel DA, Richardson WJ, Scully SP, Harrelson JM. Long-term survival following total sacrectomy with reconstruction for the treatment of primary osteosarcoma of the sacrum: a case report. J Bone Joint Surg Am. 1999;81:848–855.
- Todd LT Jr. Yaszemski MJ, Currier BL, Fuchs B, Kim CW, Sim FH. Bowel and bladder function after major sacral resection. Clin Orthop Relat Res. 2002;397:36–39. CrossRef
- Weber K, Damron TA, Frassica FJ, Sim FH. Malignant bone tumors. Instr Course Lect. 2008;57:673–688.
- Wuisman P, Lieshout O, Sugihara S, van Dijk M. Total sacrectomy and reconstruction: oncologic and functional outcome. Clin Orthop Relat Res. 2000;381:192–203. CrossRef
- Zileli M, Hoscoskun C, Brastianos P, Sabah D. Surgical treatment of primary sacral tumors: complications associated with sacrectomy. Neurosurg Focus. 2003;15:E9.
- High Long-term Local Control with Sacrectomy for Primary High-grade Bone Sarcoma in Children
Clinical Orthopaedics and Related Research®
Volume 470, Issue 5 , pp 1491-1497
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- 1. Bone and Soft-Tissue Tumors Program, Children’s Orthopaedic Center, Children’s Hospital Los Angeles; Keck School of Medicine, University of Southern California, 4650 W Sunset Blvd., Mailstop #69, Los Angeles, CA, 90027, USA
- 2. College of Medicine, University of Illinois at Urbana-Champaign, Champaign, IL, USA