Imaging in bone sarcomas. the chemotherapist's point of view

none4noThe role of imaging in planning oncologic treatment and follow-up of patients with bone sarcomas is dis-cussed in the present article. Tumor staging and radiographic assessment of response to chemotherapy inbone sarcomas may be of difficult interpretation. In particular, the use of the criterion of tumor shrinkageto measure response to chemotherapy is not always applicable in bone tumors where higher calcificationrather than reduction in size is frequently observed. New techniques such as (18)F-FDG PET/CT, dynamiccontrast-enhanced computed tomography or magnetic resonance are now available allowing a moreaccurate staging of patients and adding information for the evaluation of tumor response. Innovativeapproaches aiming to evaluate vascular and metabolic response rather than mono- or bi-dimensionalchanges may be more informative and require further investigations. © 2011 Elsevier Ireland Ltd. All rights reserved.openFerrari, Stefano; Balladelli, Alba; Palmerini, Emanuela; Vanel, DanielFerrari, Stefano; Balladelli, Alba; Palmerini, Emanuela; Vanel, Danie

Treatment of nonmetastatic Ewing’s sarcoma family tumors of the spine and sacrum: the experience from a single institution

The objective of this study is to determine the best local treatment combined with neoadjuvant chemotherapy for ESFT of the spine and sacrum, for the best local treatment for Ewing sarcoma family tumors (ESFT) according to the primary site is still unclear. Nowadays surgery is used in local treatment of ESFT, but literature is scarce on the best local treatment in sites where surgery is problematic, such as the spine. This study evaluates the outcome and the rate of local recurrence of ESFT in the spine and sacrum when treated with neoadjuvant chemotherapy, and locally by radiotherapy alone or surgery, followed by reduced doses of radiotherapy. Forty-three patients with nonmetastatic ESFT located in the spine and sacrum were treated at our institution between 1983 and 2000 with neoadjuvant chemotherapy, and locally by radiotherapy alone in 26 cases, and surgery followed by radiotherapy at reduced doses in 17. The 5- and 10-year event-free survival (EFS) was 37 and 30%, and the 5- and 10-year overall survival was (OS) 42 and 32%. The prognosis was unrelated to gender and age, tumor volume, chemotherapy protocol, and local treatment. The outcome seemed worse for patients with primary tumors located in the sacrum than for patients with tumors located in the rest of the spine (5-year EFS = 23 vs. 46%). For these patients the results were significantly worse than for those we achieved with neoadjuvant treatment for ESFT located in other sites. However, no differences were observed between patients locally treated with radiotherapy alone and those treated by radiotherapy followed by surgery. We concluded that regardless of the type of local treatment even when associated with neoadjuvant therapy, ESFT in the spine and sacrum has a poor outcome and prognosis is significantly worse than that of primary ESFT in other sites