Gutiérrez-Ureña JA , González-Valdez JA , Ramírez-Urenda XA , Orozco-Pérez J , Trujillo-Ponce SA , Aguirre-Jáuregui O , Erro-Aboytia R

Language: Spanish
References: 14
Page: 91-96
PDF size: 632.56 Kb.

ABSTRACT

Introduction: Bone tumors of the thoracic wall are infrequent in the pediatric population, but in most cases are malignant, being Ewing sarcoma the most prevalent. Malignant tumors of the thoracic wall tend to be aggressive, and require multidisciplinary and comprehensive treatment.
Material and Methods: A prospective, descriptive study of case series was designed including patients diagnosed with primary thoracic wall bone tumors from January 2006 through September 2012. Variables such as: clinical findings, histology, location of the tumor, medical and surgical treatment, complications and current health state were analyzed.
Results: A total of seven patients between the ages of 10 months and 15 years were included (mean age 7.7 years). Most frequent clinical findings were: pain and deformity of the thoracic wall in all seven patients (100 %). In all seven patients osteoblastic and osteolitic lesions were found in chest x-rays, two patients presented pleural effusion (28.5%). Osteolitic lesions were demonstrated by CT scan as well as hot spots in bone scintigraphy (MDP technetium 99m) in 100% of patients. Histopathology reports concluded Ewing sarcoma in five patients (71.45%) and osteosarcoma in two cases (28.6%). Regarding treatment, all patients received neoadjuvant chemotherapy. The surgical procedure used was block tumor resection with disease free margins of 1 to 5 cm. Reconstruction was performed using a polypropylene mesh. All patients received adjuvant chemotherapy, and five of them radiotherapy. Average follow up was 29.5 months. Tumor reappearance was documented in three patients, in these patients, disease free margins were shorter than 1 cm. currently, four patients are still alive (57.2%), three of them with no active tumor. Survival rate is 57.2 and disease free rate 42.8%.
Discussion: Thoracic wall bone tumors are rare and display an aggressive behavior, treatment should be multimodal and completely coordinated. Block tumor resection surgery with wide disease - free margins has the most important prognostic survival rate for patients affected with this disease.

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