ABSTRACT
CASE: A 13-year-old adolescent boy visited our hospital with a growing mass on his left leg. Investigations and examinations were performed to obtain a final diagnosis of Ewing sarcoma in the head of the left fibula with lung metastasis. Neoadjuvant chemotherapy was extended to 11 courses with radiation before wide tumor resection could be performed. The final 3 adjuvant chemotherapy courses were administered to complete the original protocol while surgical resection complications were also treated. The pathological report revealed free margin resection with nonviable tumor cells. CONCLUSION: An extended neoadjuvant chemotherapy regimen with additional radiation therapy for Ewing sarcoma provided extra local control and allowed limb salvage.
Subject(s)
Bone Neoplasms , COVID-19 , Sarcoma, Ewing , Male , Adolescent , Humans , Sarcoma, Ewing/drug therapy , Sarcoma, Ewing/surgery , Sarcoma, Ewing/pathology , Neoadjuvant Therapy , Bone Neoplasms/drug therapy , Bone Neoplasms/surgery , Bone Neoplasms/pathology , Chemotherapy, AdjuvantABSTRACT
The novel coronavirus, SARS-CoV-2, causes much more severe disease in adults than in children. Although it is anticipated that immune compromised children and children with cancer may be at higher risk of developing severe or fatal COVID-19, there are no currently published reports of fatal disease in a child with cancer. Because of the discrepancy in disease severity between adult and pediatric patients, we report the case of an adolescent with pulmonary metastatic osteosarcoma who died of COVID-19 early in the course of the pandemic in New York City in the hope that heightening awareness that pulmonary metastatic disease may predispose to a more severe outcome will increase surveillance in this vulnerable population.
Subject(s)
Bone Neoplasms/pathology , COVID-19/complications , Lung Neoplasms/secondary , Osteosarcoma/pathology , Respiratory Insufficiency/pathology , SARS-CoV-2/isolation & purification , Bone Neoplasms/complications , Bone Neoplasms/virology , COVID-19/virology , Child , Humans , Lung Neoplasms/complications , Lung Neoplasms/virology , Male , Osteosarcoma/complications , Osteosarcoma/virology , Respiratory Insufficiency/etiology , Severity of Illness IndexABSTRACT
BACKGROUND AND OBJECTIVES: Coronavirus disease 2019 (COVID-19) lockdown has presented a unique challenge for sarcoma care. The purpose of this study is to evaluate the early results and feasibility of surgeries for bone sarcomas during the COVID-19 lockdown. METHODS: Our prospectively collected orthopaedic oncological database was reviewed to include two groups of patients- those who underwent surgery in the immediate 4 weeks before lockdown (non-lockdown group) and those operated in the first 4 weeks of lockdown (lockdown group). All patients were followed-up clinically and telephonically to collect the outcome data. RESULTS: Out of the 91 patients who qualified for inclusion, fifty were classified into the non-lockdown group while 41 patients formed the lockdown group. Both the groups were comparable with respect to baseline demographic parameters. However, during the lockdown period 37 patients (90%) had undergone a major surgical intervention as against 24 patients (48%) in the non-lockdown group (P < .001). There was no significant difference in type of anaesthesia, median estimated blood loss and procedure duration. None of the patients/health care workers had evidence of severe acute respiratory syndrome-coronavirus 2 infection at 15 days follow-up. CONCLUSION: Our study results suggest that appendicular bone tumours can be safely operated with adequate precautions during the lockdown period.
Subject(s)
Bone Neoplasms/surgery , COVID-19/epidemiology , Sarcoma/surgery , Adult , Bone Neoplasms/pathology , COVID-19/diagnosis , COVID-19/transmission , Chondrosarcoma/pathology , Chondrosarcoma/surgery , Feasibility Studies , Female , Humans , India/epidemiology , Infectious Disease Transmission, Patient-to-Professional/prevention & control , Limb Salvage/methods , Limb Salvage/standards , Male , Orthopedic Procedures/methods , Orthopedic Procedures/standards , Osteosarcoma/pathology , Osteosarcoma/surgery , Pandemics , Sarcoma/pathology , Sarcoma, Ewing/pathology , Sarcoma, Ewing/surgery , Tertiary Care Centers , Young AdultABSTRACT
A 17-year-old man with osteosarcoma of the proximal humerus was planned for possible limb salvage surgery after standard neoadjuvant chemotherapy. However, during the surgical phase of treatment, the COVID-19 or SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) outbreak occurred changing the healthcare landscape due to uncertainty regarding the virus, risk of COVID-19 infection and complications, and implementation of an enhanced community quarantine restricting movement of people within cities. Instead of limb salvage surgery, the patient underwent a forequarter amputation. Exposure to the virus in a high-risk hospital setting was minimised with patient discharge after a short hospital stay and home convalescence monitored by video conferencing. Multidisciplinary sarcoma team meetings with family members and a sarcoma navigator nurse were crucial in managing expectations and deciding on appropriate treatment in the setting of a novel infectious disease causing a pandemic.