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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.

Journal of the College of Physicians and Surgeons--Pakistan : JCPSP

|September 15, 2017

Summary

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.

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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.