Head and neck Ewing sarcoma: French surgical practice analysis pleads for surgery centralization

Bouaoud, Jebrane; Temam, Stéphane; Galmiche, Louise; Bolle, Nathalie Cozic Stephanie; Belhous, Kahina; Kolb, F.; Qassemyar, Q.; Bidault, François; Couloigner, V.; Picard, A.; Deley, Marie‐Cécile Le; Oukhatar, Céline Mahier-Ait; Gaspar, Nathalie; Kadlub, Natacha

doi:10.1016/j.jcms.2021.01.030

Cited by 5 publications

(3 citation statements)

References 48 publications

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“…This finding raises questions about the role of patient centralization in ensuring the best possible care, and its role in both oncologic and non-oncologic pediatric surgical care is intensively debated. [24][25][26][27] In correspondence with the current literature, [5][6][7] patient age of 10 years or younger and tumor size of 5 cm or smaller were confirmed as positive prognostic factors for EFS in the IRS I-III cohort. Another relevant factor affecting both EFS and OS is the presence of bilateral tumors, which had the highest mortality rate (100%) in our study.…”

Section: Discussionsupporting

confidence: 69%

Importance of Adequate Surgical Local Control in Fusion-Negative Para-Testicular Rhabdomyosarcoma: Data From the Cooperative Weichteilsarkom Studiengruppe Trials (CWS-96 and CWS-2002P) and the European Soft Tissue Sarcoma Registry (SoTiSaR)

Martynov,

Sparber-Sauer,

Heinz

et al. 2024

Ann Surg Oncol

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Background This study aimed to assess the impact that the quality of primary and subsequent surgeries has on the survival of patients with para-testicular rhabdomyosarcoma (PTRMS). Methods Patients with localized (IRS I–III) and metastatic (IRS IV) PTRMS were enrolled in the two Cooperative Weichteilsarkom Studiengruppe (CWS) trials (CWS-96, CWS-2002P) and the Soft Tissue Sarcoma Registry (SoTiSaR). Results Among 196 patients (median age, 8.4 years), 106 (54.1%) had primary complete resection. Image-defined lymph node (LN) disease was detected in 21 (11.5%) patients in the localized cohort and 12 (92.3%) patients in the metastatic cohort. The 5-year event-free survival (EFS) and overall survival (OS) were respectively 87.3% and 94.0% for the patients with localized PTRMS and 46.2% and 42.2% for the patients with metastatic PTRMS. Protocol violations during the primary surgery (PV-PS) were observed in 70 (42%) of the IRS I–III patients. This resulted in higher rates of R1/R2 resections (n = 53 [76%] vs n = 20 [21%]; p < 0.001) with a need for pretreatment re-excision (PRE) (n = 50 [83%] vs n = 10 [17%]; p < 0.001) compared with the patients undergoing correct primary surgery. Protocol violations during PRE occurred for 13 (20%) patients. Although PV-PS did not influence the 5-year EFS or OS in the localized PTRMS cohort, the unadjusted log-rank test showed that R status after PRE is a prognostic factor for 5-year OS (R1 vs R0 [81.8% vs 97.6%]; p = 0.02). Conclusions The quality of surgical local control in PTRMS is unsatisfactory. Emphasis should be placed on evaluating the resection status after PRE in further clinical trials.

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Section: Discussionsupporting

confidence: 69%

Importance of Adequate Surgical Local Control in Fusion-Negative Para-Testicular Rhabdomyosarcoma: Data From the Cooperative Weichteilsarkom Studiengruppe Trials (CWS-96 and CWS-2002P) and the European Soft Tissue Sarcoma Registry (SoTiSaR)

Martynov,

Sparber-Sauer,

Heinz

et al. 2024

Ann Surg Oncol

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“…In the early 20 th century, radiotherapy was the primary therapy modality, and the overall survival was 30%. Today, the combination of chemotherapy and radiotherapy is the standard treatment approach, with surgery reserved for resistant/recurrence disease if the site of the neoplasm is amenable to surgery (9)(10)(11)(12). Therapy and event-free survival for ES/PNET have significantly improved over the years with the 5-year survival rate being barely achieved before using neo-adjuvant chemotherapy.…”

Section: Introductionmentioning

confidence: 99%

Features of Metastatic Ewing Sarcoma

Zetouni

Sergi

2022

Metastasis

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Since its first description in 1921, Ewing sarcoma has been the subject of several morphologic and genetic investigations. Currently, the overall survival for localized Ewing sarcoma is 65-70%. However, in patients presenting with metastatic disease, the overall survival is poor, being in the range of 20-30%. There are several unknown features of Ewing sarcoma, such as its cell of origin, genetic background, chemotherapy resistance, and abnormal presentation sites, among others. A better understanding of the molecular basis of the development of Ewing sarcoma is needed to help improve survival, especially in metastatic/ resistance cases. In this chapter, we provide an overview of the features of metastatic Ewing sarcoma.

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“…we have recently reported the importance of considering the initial tumor extension and not the post-neoCT residual tumoral volume for head and neck sarcoma resection. 7,8 Indeed, planned postchemotherapy surgery of the head and neck sarcoma initial tumor bed limits resections in postchemotherapy fibrosis, which is associated with fatal local relapses, and thus improve prognosis. 7,9 In conclusion, Shim et al reported survival analysis of large cohort of a rare disease, HNOS.…”

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confidence: 99%

Comment to: “Head and neck osteosarcomas: An analysis of treatment trends and survival outcomes in the United States (2004–2016)”

2021

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Rs e e p a g e 4 0 2 0 -4 0 2 1 Comment to: "Head and neck osteosarcomas: An analysis of treatment trends and survival outcomes in the United States (2004States ( -2016"We read, with great enthusiasm, the article by Shim et al., reporting the survival analysis of 821 patients diagnosed with head and neck osteosarcomas (HNOSs) from the National Cancer Database. 1 We would like to acknowledge the authors for this effort, which reflects the conflicting results regarding the benefits of neoadjuvant chemotherapy (neoCT). The authors concluded that "short-term survival improvement in patients receiving both neoadjuvant and adjuvant chemotherapy displays promise." We would like to bring some precisions regarding this conclusion. While large, the studied cohort is retrospective and heterogeneous. Indeed, patients who have received neoCT (108/841) had significantly more mandible, pT1, nonmetastatic, and early American Joint Committee on Cancer (AJCC) stage tumors, which are known to be easier resectable as shown by the significant higher rate of negative surgical margin in these patients. Nevertheless, we recently reported that small tumor size and R0 (clear margins) surgical resections are significantly and independently associated with better outcomes for HNOS patients. 2 Beside these biases, no significant result is shown in all the Cox regression models. Moreover, pathological response to neoCT (>90% of tumor cell necrosis), which has been previously reported to be significantly associated with better overall survival (OS), 3 is not evaluated in the Shim et al. study. Of note, less than 30% of HNOS patients achieve good histological response after neo-CT 4 and no significant benefit of neoCT on OS has been reported in recent large series. 5,6 In the present study, the primary outcome was OS while comparing disease-free survivals between neoCT versus non-neoCT HNOS patients seems to be more relevant to assess the benefit of such treatment, especially when their using is still debated. Finally, the authors discuss results published by the Canadian Society of Otolaryngology 6 (35 HNOS patients) and stated that the reported trend toward improved early survival with adjuvant chemotherapy "may be due in part to benefits of neoCT in decreasing the confines of the tumor allowing for a more complete surgical resection." However,

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Head and neck Ewing sarcoma: French surgical practice analysis pleads for surgery centralization

Cited by 5 publications

References 48 publications

Importance of Adequate Surgical Local Control in Fusion-Negative Para-Testicular Rhabdomyosarcoma: Data From the Cooperative Weichteilsarkom Studiengruppe Trials (CWS-96 and CWS-2002P) and the European Soft Tissue Sarcoma Registry (SoTiSaR)

Importance of Adequate Surgical Local Control in Fusion-Negative Para-Testicular Rhabdomyosarcoma: Data From the Cooperative Weichteilsarkom Studiengruppe Trials (CWS-96 and CWS-2002P) and the European Soft Tissue Sarcoma Registry (SoTiSaR)

Features of Metastatic Ewing Sarcoma

Comment to: “Head and neck osteosarcomas: An analysis of treatment trends and survival outcomes in the United States (2004–2016)”

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