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Related Concept Videos

Bone Disorders01:29

Bone Disorders

Aging and its effect on bone remodeling is the most common cause of bone disorders. In young and healthy people, bone deposition and resorption happen at an equal rate to maintain optimal bone health.
Bone deposition is also affected by the levels of sex hormones like estrogen and testosterone that promote osteoblast activity and bone matrix synthesis. When the level of these hormones decreases due to aging, it causes a reduction in bone deposition. As a result, bone resorption by osteoclasts...

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Three-Dimensional Bone Extracellular Matrix Model for Osteosarcoma
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Ewing and osteogenic sarcoma: evidence for multidisciplinary management.

Daniel M Sciubba1, Scott H Okuno, Mark B Dekutoski

  • 1Department of Neurosurgery, Johns Hopkins University, Baltimore, MD, USA. dsciubb1@jhmi.edu

Spine
|October 16, 2009
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Summary

Neoadjuvant chemotherapy significantly improves survival and local control for spinal Ewing sarcoma (ES) and osteosarcoma (OS). En bloc surgical resection may enhance survival and reduce recurrence for spinal OS, and improve local control for spinal ES.

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Area of Science:

  • Orthopedic Oncology
  • Neoadjuvant Chemotherapy
  • Surgical Resection

Background:

  • Spinal Ewing sarcoma (ES) and osteosarcoma (OS) are treated with multimodal therapy including chemotherapy, radiation, and surgery.
  • The impact of surgical resection extent on survival and local control for spinal ES and OS remains unclear.

Purpose of the Study:

  • To review and classify evidence on neoadjuvant chemotherapy's role in spinal ES and OS.
  • To assess the impact of surgical resection extent on clinical outcomes, including survival and local control, for spinal ES and OS.

Main Methods:

  • Systematic literature review (1960-2008) of 208 articles, with 16 selected for in-depth analysis.
  • Expert consensus recommendations generated by an international focus group after reviewing and grading the literature.

Main Results:

  • Moderate evidence strongly recommends neoadjuvant chemotherapy for improved local control and survival in both spinal ES and OS.
  • Very low evidence weakly recommends en bloc resection for improved local control in spinal ES, but not overall survival.
  • Very low evidence strongly recommends en bloc resection for improved local control and potentially survival in spinal OS.

Conclusions:

  • Multimodality treatment, particularly neoadjuvant chemotherapy, is crucial for favorable outcomes in spinal ES and OS.
  • Advances in chemotherapy have driven significant survival improvements.
  • En bloc surgical resection may improve survival and decrease recurrence risk, especially for spinal osteosarcoma.