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The safe surgical margin in Ewing's sarcoma.

Marie-Caroline Nogaro¹, Max Mifsud¹, Catherine McCarthy²

¹Department of Orthopaedics, Nuffield Orthopaedic Centre, Oxford, UK.

Surgical Oncology

|March 31, 2022

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Pre-chemotherapy MRI is recommended for planning surgical resection margins in Ewing's sarcoma. Post-chemotherapy MRI increases the risk of resecting through abnormal bone without clear benefits for bone preservation.

Area of Science:

Orthopedic Oncology
Radiology
Surgical Pathology

Background:

Recent evidence suggests post-chemotherapy MRI aids safe resection of primary bone sarcoma by providing clear disease margins.
This study challenges this view by comparing pre- and post-chemotherapy MRI measurements with post-operative histological analysis.

Purpose of the Study:

To determine the accuracy of pre- and post-chemotherapy MRI in defining surgical resection margins for long bone Ewing's sarcoma.
To compare radiological measurements with post-operative histological findings to identify the optimal imaging modality for surgical planning.

Main Methods:

Retrospective analysis of 10 patients with long bone Ewing's sarcoma.
Correlation of pre- and post-chemotherapy MRI measurements with gross and microscopic histological specimens.

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Assessment of pathological disease extent to guide surgical margin determination.

Main Results:

Discrepancies were found between histological and radiological assessments of pathological disease extent.
The average discrepancy between bone length on histology and MRI was 2.7 cm.
Using pre-chemotherapy MRI, 7/10 patients had resection margins through pathologically abnormal bone; using post-chemotherapy MRI would have increased this to 10/10.

Conclusions:

Post-chemotherapy MRI for surgical planning increases the risk of resecting through histologically abnormal bone.
There is no significant benefit in bone preservation for joint or physeal sparing surgery when using post-chemotherapy MRI.
Current guidelines recommending pre-chemotherapy MRI for planning safe surgical resection margins in Ewing's sarcoma are supported.