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Bone Marrow Involvement in Metastatic Pediatric Ewing Sarcoma
Saadiya Javed Khan1, Irfana Ishaq1, Haleema Saeed1
1Department of Pediatric Oncology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore.
Insights
Pediatric patients with Ewing sarcoma (ES) and bone metastases show higher bone marrow (BM) involvement. Bone marrow aspiration/biopsy (BMAB) is crucial for staging even in localized ES cases.
Area of Science:
- Pediatric Oncology
- Skeletal Metastasis Research
- Hematopathology
Background:
- Ewing sarcoma (ES) is a rare bone cancer primarily affecting children and young adults.
- Understanding the patterns of metastasis, particularly bone marrow (BM) involvement, is critical for accurate staging and treatment planning in pediatric ES.
- The frequency and significance of BM involvement in relation to metastatic sites in newly-diagnosed pediatric ES remain areas for further investigation.
Purpose of the Study:
- To determine the incidence of bone marrow involvement in pediatric patients with newly-diagnosed Ewing sarcoma.
- To correlate bone marrow involvement with the presence of lung and bone metastatic sites.
- To evaluate the utility of bone marrow aspiration/biopsy (BMAB) in the staging of pediatric ES.
Main Methods:
- An observational study was conducted at Shaukat Khanum Memorial Cancer Hospital, Lahore, Pakistan, between January 2010 and October 2015.
- Medical records of newly-diagnosed pediatric patients with ES were reviewed, excluding those without BMAB.
- Data collected included patient demographics, tumor characteristics, BM diagnosis, metastatic work-up, and outcomes.
Main Results:
- A total of 139 pediatric patients with ES were identified (median age 12 years; median tumor volume 529 ml).
- Bone marrow involvement was detected in 11 patients (7.9%).
- Of those with BM involvement, 5 (45.5%) had bone metastases, 1 (9%) had both pulmonary and bone metastases, and 4 (31.1%) had primary limb disease.
Conclusions:
- Pediatric Ewing sarcoma patients with bone metastatic disease exhibit a higher frequency of bone marrow involvement.
- Bone marrow involvement can occur in the absence of detectable metastatic disease.
- Bone marrow aspiration/biopsy (BMAB) should be considered during the staging process for newly diagnosed pediatric patients with localized Ewing sarcoma.
Objective:
To evaluate the frequency of bone marrow involvement with metastatic lung and bone sites in newly-diagnosed pediatric patients with Ewing sarcoma (ES).
Study Design:
An observational study.
Place And Duration Of Study:
Shaukat Khanum Memorial Cancer Hospital, Lahore, Pakistan, from January 2010 to October 2015.
Methodology:
Newly-diagnosed pediatric-age patients with ES were inducted. Ten patients were excluded because bone marrow aspiration/biopsy (BMAB) was not done. Patients'medical records were reviewed for data collection of age, diagnosis, tumor volume, bone marrow diagnosis, metastatic work-up and outcomes.
Results:
Atotal of 139 patients with median age of 12 years were identified. The median volume of tumors was 529 ml. Eleven patients had bone marrow (BM) disease involvement. Five (45.5%) had bone metastatic disease and 1 (9%) had both pulmonary and bone metastases. Four patients (31.1%) with positive BM had primary limb disease.
Conclusion:
Ewing sarcoma patients with bone metastatic disease have a higher frequency of BM involvement. However, BM can be involved without metastatic disease. BMAB should still be considered at staging for newly diagnosed pediatric patients with localized ES.
