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Do Patients With Ewing’s Sarcoma Continue With Sports Activities After Limb Salvage Surgery of the Lower Extremity?

  • Symposium: 2013 Meetings of the Musculoskeletal Tumor Society and the International Society of Limb Salvage
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Background

Limb salvage surgery has evolved to become the standard method of treating sarcomas of the extremities with acceptable oncologic results. However, little information exists relative to the activity level or ability to participate in sports after tumor reconstructions.

Questions/purposes

The aims of the study were to answer the following questions: (1) Which sports activity levels and what types of sports can be expected in the long term after tumor reconstruction? (2) Which frequency durations are patients with Ewing’s sarcoma able to perform in long-term followup after local control? (3) Do surgical complications affect sports activity level?

Methods

Thirty patients (13 females, 17 males; mean age, 18 ± 8 years; range, 2–36 years at diagnosis; mean followup 16 ± 6 years [minimum, 5 years]) were included. Tumors were located in the pelvis, femur, tibia, and fibula. Surgical procedures included surgical resections alone (n = 8), surgical resection with biological reconstruction (n = 9), or endoprosthetic reconstruction (n = 13). We assessed UCLA sports activity levels, kinds of sports as well as the frequency per week and the duration of each training unit at long term (minimum followup, 5 years).

Results

In long-term followup 83% patients (25 of 30) were performing athletic activity regularly. The hours/week of sports depended on type of surgery and were highest after resections in the pelvis and femur (5.8) and were lowest after megaprosthetic reconstruction of the pelvis (1.0). Patients undergoing biologic reconstructions were able to perform high-impact sports. UCLA sports activity levels were high after joint-preserving vascularized fibula for tibia reconstruction (7.4) and after megaprosthetic reconstruction of the lower extremity (6.3–6.4) and were low after tumors located in the fibula (4.2). Complications during followup did not significantly influence sports activity in long-term survivors.

Conclusions

Long-term survivors can achieve high levels of sports activity in many instances. Tumor sites are associated with the postoperative sports activity levels. This information can help surgeons counsel patients in terms of athletic expectations after limb salvage reconstruction for patients with Ewing’s sarcoma.

Level of Evidence

Level III, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

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References

  1. Aksnes LH, Bauer HCF, Dahl AA, Fosså SD, Hjorth L, Jebsen N, Lernedal H, Hall KS. Health status at long-term follow-up in patients treated for extremity localized Ewing sarcoma or osteosarcoma: a Scandinavian sarcoma group study. Pediatr Blood Cancer. 2009;53:84–89.

    Article  CAS  PubMed  Google Scholar 

  2. Arndt CAS, Rose PS, Folpe AL, Laack NN. Common musculoskeletal tumors of childhood and adolescence. Mayo Clin Proc. 2012;87:475–487.

    Article  PubMed Central  PubMed  Google Scholar 

  3. Bielack S, Jürgens H, Jundt G, Kevric M, Kühne T, Reichardt P, Zoubek A, Werner M, Winkelmann W, Kotz R. Osteosarcoma: the COSS experience. Cancer Treat Res. 2009;152:289–308.

    Article  PubMed  Google Scholar 

  4. Burnham TR, Wilcox A. Effects of exercise on physiological and psychological variables in cancer survivors. Med Sci Sports Exerc. 2002;34:1863–1867.

    Article  PubMed  Google Scholar 

  5. Chatterji U, Ashworth MJ, Lewis PL, Dobson PJ. Effect of total knee arthroplasty on recreational and sporting activity. ANZ J Surg. 2005;75:405–408.

    Article  PubMed  Google Scholar 

  6. De Backer IC, Vreugdenhil G, Nijziel MR, Kester AD, van Breda E, Schep G. Long-term follow-up after cancer rehabilitation using high-intensity resistance training: persistent improvement of physical performance and quality of life. Br J Cancer. 2008;99:30–36.

    Article  PubMed Central  PubMed  Google Scholar 

  7. DiCaprio MR, Friedlaender GE. Malignant bone tumors: limb sparing versus amputation. J Am Acad Orthop Surg. 2003;11:25–37.

    PubMed  Google Scholar 

  8. Dirksen U, Jürgens H. Approaching Ewing sarcoma. Future Oncol. 2010;6:1155–1162.

    Article  PubMed  Google Scholar 

  9. Doukas WC, Hayda RA, Frisch HM, Andersen RC, Mazurek MT, Ficke JR, Keeling JJ, Pasquina PF, Wain HJ, Carlini AR, MacKenzie EJ. The Military Extremity Trauma Amputation/Limb Salvage (METALS) study: outcomes of amputation versus limb salvage following major lower-extremity trauma. J Bone Joint Surg Am. 2013;95:138–145.

    Article  PubMed  Google Scholar 

  10. Dunst J, Jürgens H, Sauer R, Pape H, Paulussen M, Winkelmann W, Rübe C. Radiation therapy in Ewing’s sarcoma: an update of the CESS 86 trial. Int J Radiat Oncol Biol Phys. 1995;32:919–930.

    Article  CAS  PubMed  Google Scholar 

  11. Eiser C. Assessment of health-related quality of life after bone cancer in young people: easier said than done. Eur J Cancer. 2009;45:1744–1747.

    Article  PubMed  Google Scholar 

  12. Enneking WF, Dunham WK. Resection and reconstruction for primary neoplasms involving the innominate bone. J Bone Joint Surg Am. 1978;60:731–746.

    CAS  PubMed  Google Scholar 

  13. Enneking WF, Spanier SS, Goodman MA. A system for the surgical staging of musculoskeletal sarcoma. Clin Orthop Relat Res. 1980;153:106–120.

    PubMed  Google Scholar 

  14. Fuchs B, Valenzuela RG, Inwards C, Sim FH, Rock MG. Complications in long-term survivors of Ewing sarcoma. Cancer. 2003;98:2687–2692.

    Article  PubMed  Google Scholar 

  15. Garber CE, Blissmer B, Deschenes MR, Franklin BA, Lamonte MJ, Lee I-M, Nieman DC, Swain DP, American College of Sports Medicine. American College of Sports Medicine position stand. Quantity and quality of exercise for developing and maintaining cardiorespiratory, musculoskeletal, and neuromotor fitness in apparently healthy adults: guidance for prescribing exercise. Med Sci Sports Exerc. 2011;43:1334–1359.

    Article  PubMed  Google Scholar 

  16. Ginsberg JP, Goodman P, Leisenring W, Ness KK, Meyers PA, Wolden SL, Smith SM, Stovall M, Hammond S, Robison LL, Oeffinger KC. Long-term survivors of childhood Ewing sarcoma: report from the childhood cancer survivor study. J Natl Cancer Inst. 2010;102:1272–1283.

    Article  PubMed Central  PubMed  Google Scholar 

  17. Healy WL, Sharma S, Schwartz B, Iorio R. Athletic activity after total joint arthroplasty. J Bone Joint Surg Am. 2008;90:2245–2252.

    Article  PubMed  Google Scholar 

  18. Henderson ER, Groundland JS, Pala E, Dennis JA, Wooten R, Cheong D, Windhager R, Kotz RI, Mercuri M, Funovics PT, Hornicek FJ, Temple HT, Ruggieri P, Letson GD. Failure mode classification for tumor endoprostheses: retrospective review of five institutions and a literature review. J Bone Joint Surg Am. 2011;93:418–429.

    Article  PubMed  Google Scholar 

  19. Juergens C, Weston C, Lewis I, Whelan J, Paulussen M, Oberlin O, Michon J, Zoubek A, Juergens H, Craft A. Safety assessment of intensive induction with vincristine, ifosfamide, doxorubicin, and etoposide (VIDE) in the treatment of Ewing tumors in the EURO-EWING 99 clinical trial. Pediatr Blood Cancer. 2006;47:22-29.

    Article  PubMed  Google Scholar 

  20. Jürgens H, Bier V, Dunst J, Harms D, Jobke A, Kotz R, Kühl J, Müller-Weihrich S, Ritter J, Salzer-Kuntschik M. [The German Society of Pediatric Oncology Cooperative Ewing Sarcoma Studies CESS 81/86: report after 6 1/2 years] [in German]. Klin Padiatr. 1988;200:243–252.

    Article  PubMed  Google Scholar 

  21. Mondloch MV, Cole DC, Frank JW. Does how you do depend on how you think you’ll do? A systematic review of the evidence for a relation between patients’ recovery expectations and health outcomes. CMAJ. 2001;165:174–179.

    CAS  PubMed Central  PubMed  Google Scholar 

  22. Naal FD, Impellizzeri FM, Leunig M. Which is the best activity rating scale for patients undergoing total joint arthroplasty? Clin Orthop Relat Res. 2009;467:958–965.

    Article  PubMed Central  PubMed  Google Scholar 

  23. Paulussen M, Craft AW, Lewis I, Hackshaw A, Douglas C, Dunst J, Schuck A, Winkelmann W, Köhler G, Poremba C, Zoubek A, Ladenstein R, van den Berg H, Hunold A, Cassoni A, Spooner D, Grimer R, Whelan J, McTiernan A, Jürgens H. Results of the EICESS-92 Study: two randomized trials of Ewing’s sarcoma treatment–cyclophosphamide compared with ifosfamide in standard-risk patients and assessment of benefit of etoposide added to standard treatment in high-risk patients. J Clin Oncol. 2008;26:4385–4393.

    Article  CAS  PubMed  Google Scholar 

  24. Porsch M, Kornhuber B, Hovy L. Functional results after partial pelvic resection in Ewing’s sarcoma of the ilium. Arch Orthop Trauma Surg. 1999;119:199–204.

    Article  CAS  PubMed  Google Scholar 

  25. Potratz J, Dirksen U, Jürgens H, Craft A. Ewing sarcoma: clinical state-of-the-art. Pediatr Hematol Oncol. 2012;29:1–11.

    Article  CAS  PubMed  Google Scholar 

  26. Rödl RW, Hoffmann C, Gosheger G, Leidinger B, Jürgens H, Winkelmann W. Ewing’s sarcoma of the pelvis: combined surgery and radiotherapy treatment. J Surg Oncol. 2003;83:154–160.

    Article  PubMed  Google Scholar 

  27. Rueegg CS, Michel G, Wengenroth L, von der Weid NX, Bergstraesser E, Kuehni CE. Physical performance limitations in adolescent and adult survivors of childhood cancer and their siblings. PLoS One. 2012;7. Available at: www.ncbi.nlm.nih.gov/pmc/articles/PMC3474773/. Accessed March 12, 2013.

  28. Ruggieri P, Mavrogenis AF, Mercuri M. Quality of life following limb-salvage surgery for bone sarcomas. Expert Rev Pharmacoecon Outcomes Res. 2011;11:59–73.

    Article  PubMed  Google Scholar 

  29. Schneider CM, Hsieh CC, Sprod LK, Carter SD, Hayward R. Cancer treatment-induced alterations in muscular fitness and quality of life: the role of exercise training. Ann Oncol. 2007;18:1957–1962.

    Article  CAS  PubMed  Google Scholar 

  30. Schrager J, Patzer RE, Mink PJ, Ward KC, Goodman M. Survival outcomes of pediatric osteosarcoma and Ewing’s sarcoma: a comparison of surgery type within the SEER database, 1988-2007. J Registry Manag. 2011;38:153–161.

    PubMed  Google Scholar 

  31. Schuck A, Ahrens S, Paulussen M, Kuhlen M, Könemann S, Rübe C, Winkelmann W, Kotz R, Dunst J, Willich N, Jürgens H. Local therapy in localized Ewing tumors: results of 1058 patients treated in the CESS 81, CESS 86, and EICESS 92 trials. Int J Radiat Oncol Biol Phys. 2003;55:168–177.

    Article  PubMed  Google Scholar 

  32. Sluga M, Windhager R, Lang S, Heinzl H, Bielack S, Kotz R. Local and systemic control after ablative and limb sparing surgery in patients with osteosarcoma. Clin Orthop Relat Res. 1999;358:120–127.

    Article  PubMed  Google Scholar 

  33. Sprod LK, Hsieh CC, Hayward R, Schneider CM. Three versus six months of exercise training in breast cancer survivors. Breast Cancer Res Treat. 2010;121:413–419.

    Article  PubMed Central  PubMed  Google Scholar 

  34. Tammelin T, Näyhä S, Hills AP, Järvelin MR. Adolescent participation in sports and adult physical activity. Am J Prev Med. 2003;24:22–28.

    Article  PubMed  Google Scholar 

  35. Telama R, Yang X, Laakso L, Viikari J. Physical activity in childhood and adolescence as predictor of physical activity in young adulthood. Am J Prev Med. 1997;13:317–323.

    CAS  PubMed  Google Scholar 

  36. Terwee CB, Bouwmeester W, van Elsland SL, de Vet HCW, Dekker J. Instruments to assess physical activity in patients with osteoarthritis of the hip or knee: a systematic review of measurement properties. Osteoarthritis Cartilage. 2011;19:620–633.

    Article  CAS  PubMed  Google Scholar 

  37. Thomas IH, Cole WG, Waters KD, Menelaus MB. Function after partial pelvic resection for Ewing’s sarcoma. J Bone Joint Surg Br. 1987;69:271–275.

    CAS  PubMed  Google Scholar 

  38. Vogel LA, Carotenuto G, Basti JJ, Levine WN. Physical activity after total joint arthroplasty. Sports Health. 2011;3:441–450.

    Article  PubMed Central  PubMed  Google Scholar 

  39. Zahiri CA, Schmalzried TP, Szuszczewicz ES, Amstutz HC. Assessing activity in joint replacement patients. J Arthroplasty. 1998;13:890–895.

    Article  CAS  PubMed  Google Scholar 

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Acknowledgments

We thank Prof M. Dominkus for being in charge of the local tumor registry for many years providing necessary basic information. Furthermore, we thank the former and present secretaries of the tumor registry, Mag. T. Zettl and O. Wallner, respectively.

Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, Medical University of Vienna, Waehringer Guertel 18-20, A-1090, Vienna, Austria

    Gerhard Martin Hobusch MD, Nikolaus Lang MD, Reinhard Schuh MD, Reinhard Windhager MD & Jochen Gerhard Hofstaetter MD

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  1. Gerhard Martin Hobusch MD
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  2. Nikolaus Lang MD
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  3. Reinhard Schuh MD
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  4. Reinhard Windhager MD
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  5. Jochen Gerhard Hofstaetter MD
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Corresponding author

Correspondence to Gerhard Martin Hobusch MD.

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Each author certifies that he or she, or a member of his or her immediate family, has no funding or commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.

All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research editors and board members are on file with the publication and can be viewed on request.

Clinical Orthopaedics and Related Research neither advocates nor endorses the use of any treatment, drug, or device. Readers are encouraged to always seek additional information, including FDA-approval status, of any drug or device prior to clinical use.

Each author certifies that his or her institution approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.

This paper was in part presented at the ISOLS meeting 2013 in Bologna, Italy, and was awarded a Poster Award.

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Hobusch, G.M., Lang, N., Schuh, R. et al. Do Patients With Ewing’s Sarcoma Continue With Sports Activities After Limb Salvage Surgery of the Lower Extremity?. Clin Orthop Relat Res 473, 839–846 (2015). https://doi.org/10.1007/s11999-014-3622-x

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  • DOI: https://doi.org/10.1007/s11999-014-3622-x

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