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- Title
Bone tumors – a multidisciplinary challenge.
- Authors
Mihăilă, Raluca; Popescu, Liliana-Cristina; Mateianu, Elena; Komporaly, Isabela; Dragomir, Adelina Silvana; Anghel, Beatrice; Georgescu, Mihai; Georgescu, Bogdan; Bogdan, Sorin; Stănculeanu, Dana Lucia
- Abstract
Objective. Primary malignant bone tumors are rare and heterogeneous, and the diagnosis and multimodal treatment require a multidisciplinary approach in specialized centers, involving pathologists, radiologists, surgeons, and radiation and medical oncologists. The early referral to a specialist center that provides a multidisciplinary diagnosis and therapeutic approach and manages a high number of cases annually could improve the survival for these young patients. Materials and method. The multidisciplinary management of osteosarcoma, chordoma and Ewing’s sarcoma includes surgery, radiotherapy and systemic treatment, which are reviewed in this case series presentation. Surgical excision is the primary treatment for localized bone tumor. Radiation therapy is usually necessary, but chemotherapy plays an important role in some chemosensitive subtypes (highgrade osteosarcoma). In other subtypes, considered chemoresistant (such as chordoma), new targeted therapies have showed improvement in the disease management. Results. The cases presented included chordoma, osteosarcoma and Ewing’s sarcoma patients from our clinical department. The first case is a 58yearold male patient, with multiple comorbidities, diagnosed with sacrococcygeal chondroid chordoma in 2019. Our patient’s tumor was inoperable and local recurrence was observed after radiotherapy. Targeted therapy was an option and the patient started imatinib 800 mg/day, with clinical and imagistic response. The second case is a 37yearold female patient diagnosed with right knee highgrade osteosarcoma. The imagistic workup (MRI, PETCT) confirmed the local disease. The patient started MAPEURAMOS protocol, with reversible hepatic severe toxicity, but with clinical benefit (remission of pain syndrome, without functional impotence – impact on quality of life). Surgery was indicated due to good response to neoadjuvant treatment. The third case is a 27yearold patient diagnosed with spine Ewing’s sarcoma in 2009, amendable to surgery with adjuvant chemotherapy and radiotherapy. In 2020, pleural and pulmonary progression was diagnosed, associated with pain syndrome by the invasion of the costal grid. Chemotherapy was started – Ewing VDC/IE protocol, well tolerated, with hematological grade I/II toxicity, with complete response and indication for bone marrow transplant. Conclusions. Given the diagnosis at a young age, the unfavorable prognosis, the effects and the adverse events of multimodal treatments in the short and long run, the diagnosis, treatment and followup of these patients should be performed in specialized reference centers, with case studies and access to clinical trials.
- Subjects
EWING'S sarcoma; DIAGNOSIS; PROGNOSIS; TUMORS; COMBINED modality therapy
- Publication
Oncolog-Hematolog, 2021, Issue 55, p42
- ISSN
2066-8716
- Publication type
Article