Volume 1 | Issue 1 | October 2020-March 2021 | page: 28-32 | Rohit A Thaker, Himanshu Dodiya, Shrikant Dhanani, Ankur Patel
Authors: Rohit A Thaker , Himanshu Dodiya , Shrikant Dhanani , Ankur Patel 
 Orthoplus Hospital, Spine Care Associates, Ahmedabad, Gujarat, India.
 Spine Care Associates, Ahmedabad, Gujarat, India.
 Sparsh Spine Hospital, Himmatnagar, Gujarat, India.
Address of Correspondence
Dr. Rohit A Thaker,
Consultat Spine Surgeon, Orthoplus Hospital, Spine Care Associates, Ahmedabad, Gujrat, India.
Primary involvement of mobile spine compared to non-mobile spine is very less in case of Ewing’s sarcoma (ES). There are no fixed guidelines for these types of tumors because of their low incidence. These tumors usually have very high sensitivity to chemotherapy and radiotherapy. Goal for the management of ES of the spine is adequate local control through complete removal of tumor by doing aggressive resection along with restoration of spinal stability and preservation of neurology. En bloc spondylectomy or extralesional resection with wide disease-free margin provides good oncological results with a longer survival. Whenever it is possible to give neoadjuvant chemotherapy, it is always better because it helps to shrink tumor, treat micrometastasis, and make surgical excision easier with wide margin resection. However, in some case of spinal ES, it may not be possible because of neurological compromise and they might have to be addressed first by surgery and neurological decompression. We report here one such cases of primary ES of mobile lumbar spine treated with neoadjuvant chemotherapy and then with en bloc excision of tumor. The clinical picture and imaging characteristics of patient were analyzed as well as the management modalities and outcome has been discussed.
Keywords: Ewing’s sarcoma, spine surgery, neoadjuvant chemotherapy, lumbar spine.
1. Berger M, Fagioli F, Abate M, Riccardi R, Prete A, Cozza R, et al. Unusual sites of Ewing Sarcoma (ES): A retrospective multicenter 30-year experience of the Italian Association of Pediatric Hematology and Oncology (AIEOP) and Italian Sarcoma Group (ISG). Eur J Cancer 2013;49:3658-65.
2. Gupta AA, Pappo A, Saunders N, Hopyan S, Ferguson P, Wunder J, et al. Clinical outcome of children and adults with localized Ewing sarcoma: Impact of chemotherapy dose and timing of local therapy. Cancer 2010;116:3189-94.
3. Pilepich MV, Vietti TJ, Nesbit ME, Tefft M, Kissane J, Burgert O, et al. Ewing’s sarcoma of the vertebral column. Int J Radiat Oncol Biol Phys 1981;7:27-31.
4. Mirzaei L, Kaal SE, Schreuder HW, Bartels RH. The neurological compromised spine due to Ewing sarcoma. What first: Surgery or chemotherapy? Therapy, survival, and neurological outcome of 15 cases with primary Ewing sarcoma of the vertebral column. Neurosurgery 2015;77:718-24.
5. Marina NM, Pappo AS, Parham DM, Cain AM, Rao BN, Poquette CA, et al. Chemotherapy dose-intensification for pediatric patients with Ewing’s family of tumors and desmoplastic small round-cell tumors: A feasibility study at St. Jude Children’s Research Hospital. J Clin Oncol 1999;17:180-90.
6. Ferrari S, Palmerini E, Alberghini M, Staals E, Mercuri M, Barbieri E, et al. Vincristine, doxorubicin, cyclophosfamide, actinomycin D, ifosfamide, and etoposide in adult and pediatric patients with nonmetastatic Ewing sarcoma. Final results of a monoinstitutional study. Tumori 2010;96:213-8.
7. Gaspar N, Hawkins DS, Dirksen U, Lewis IJ, Ferrari S, Le Deley MC, et al. Ewing sarcoma: Current management and future approaches through collaboration. J Clin Oncol 2015;33:3036-46.
8. Gopalakrishnan CV, Shrivastava A, Easwer HV, Nair S. Primary Ewing’s sarcoma of the spine presenting as acute paraplegia. J Pediatr Neurosci 2012;7:64-6.
9. Vogin G, Helfre S, Glorion C, Mosseri V, Mascard E, Oberlin O, et al. Local control and sequelae in localised Ewing tumours of the spine: A French retrospective study. Eur J Cancer 2013;49:1314-23.
10. Papagelopoulos PJ, Currier BL, Galanis E, Grubb MJ, Pritchard DJ, Ebersold MJ. Vertebra plana caused by primary Ewing sarcoma: Case report and review of the literature. J Spinal Disord Tech 2002;15:252-7.
11. Erlemann R, Sciuk J, Bosse A, Ritter J, Kusnierz-Glaz CR. Response of osteosarcoma and Ewing sarcoma to preoperative chemotherapy: Assessment with dynamic and static MR imaging and skeletal scintigraphy. Radiology 1990;175:791-6.
12. Estes DN, Magill HL, Thompson EI, Hayes FA. Primary Ewing sarcoma: Follow-up with Ga-67 scintigraphy. Radiology 1990;177:449-53.
13. Schmidt D, Harms D, Pilon VA. Small-cell pediatric tumors: Histology, immunohistochemistry, and electron microscopy. Clin Lab Med 1987;7:63-89.
14. Venkateswaran L, Rodriguez-Galindo C, Merchant TE, Poquette CA, Rao BN, Pappo AS. Primary Ewing tumor of the vertebrae: Clinical characteristics, prognostic factors, and outcome. Med Pediatr Oncol 2001;37:30-5.
15. O’Phelan KH, Bunney EB, Weingart SD, Smith WS. Emergency neurological life support: Spinal cord compression (SCC). Neurocrit Care 2012;17:S96-101.
16. Boriani S, Amendola L, Corghi A, Cappuccio M, Bandiera S, Ferrari S, et al. Ewing’s sarcoma of the mobile spine. Eur Rev Med Pharmacol Sci 2011;15:831-9.
17. Subbiah V, Anderson P, Lazar AJ, Burdett E, Raymond K, Ludwig JA. Ewing’s sarcoma: Standard and experimental treatment options. Curr Treat Options Oncol 2009;10:126-40.
18. Zhang J, Huang Y, Lu J, He A, Zhou Y, Hu H, et al. Impact of first-line treatment on outcomes of Ewing sarcoma of the spine. Am J Cancer Res 2018;8:1262-72.
19. Arshi A, Sharim J, Park DY, Park HY, Yazdanshenas H, Bernthal NM, et al. Prognostic determinants and treatment outcomes analysis of osteosarcoma and Ewing sarcoma of the spine. Spine J 2017;17:645-55.
20. Uyeturk U, Helvaci K, Demirci A, Sonmez OU, Turker I, Afsar CU, et al. Clinical outcomes and prognostic factors of adult’s Ewing sarcoma family of tumors: Single center experience. Contemp Oncol (Pozn) 2016;20:141-6.
|How to Cite this Article: Thaker RA, Dodiya H, Dhanani S, Patel A| Primary Ewing’s Sarcoma of Lumbar Spine Treated with Neoadjuvant Chemotherapy and Surgery – A Case Report| Back Bone: The Spine Journal | October 2020-March 2021; 1(1): 28-32.|