Central Nervous System Involvement in Children with Sarcoma

Abstract

Objectives: To summarize and analyze the experience in CNS involvement (CNSI) in children with sarcomas treated in the above-mentioned institutions. Patients and Methods: From 1990 to 2001, all medical charts were retrospectively reviewed: 19 sarcoma patients (12 boys and 7 girls) were diagnosed with CNSI (4 osteogenic sarcomas, 11 Ewing sarcomas, 2 rhabdomyosarcomas, 1 alveolar soft part sarcoma and 1 mesenchymal chondrosarcoma). Mean age of all patients at the time of initial diagnosis was 14.9 years (range: 4–24 years), mean age at the time when CNSI was diagnosed was 16.9 years (range: 5.5–27 years). Results: The frequency of CNSI among our patients was 6.17%. The following symptoms and signs (sometimes combined) presented: headache (10 patients), nausea and vomiting (6 patients), seizures (11 patients) and focal neurological signs (9 patients). The mean duration of time elapsed since diagnosis of CNSI till death or last follow-up was 5.2 months (SD: ±5.7 months). Four patients received chemotherapy (CT) alone, 8 CT and radiotherapy (RT), 2 RT alone, 3 supportive treatment only, 1 CT and surgery and 1 surgery alone. Sixteen patients died; there was no significant difference in the duration of survival between those who were treated with RT or surgery (mean ± SD: 6.77 ± 6.56 months) and those who received only CT or supportive treatment (mean ± SD: 2.60 ± 2.94 months) (p = 0.07). Brain disease was the main cause of death in all but 1 patient who died 4 days after autologous bone marrow transplantation from uncontrolled sepsis. In 16 patients, CNSI was part of a metastatic disease. Conclusions: Among children with sarcoma, CNSI is encountered in 6.17% of cases. More effective therapy has to be developed in order to improve their outcome.

Posterior fossa brain metastasis from primary osteogenic sarcoma: A rare entity

“…Three percent of the brain metastasis is found to be from primary sarcoma 4,5 .In the literature review, only 11 cases of primary intracerebral or meningeal osteogenic sarcoma has been reported without any skeletal involvement 6 .Brain metastasis in primary osteosarcoma is rare with reported incidence of 1.8 -5.6% 7 .The two hypothesis regarding spread of sarcoma to brain arehematogenous dissemination and contiguous spread through skull bones into intracranial structures. There is another hypothesis of lung tumor emboli invading the brain in patients with prior pulmonary metastasis 8 .…”

Ewing's Sarcoma: Dural Metastases after Intracranial Hemorrhage

“…ES is an aggressive cancer and often spreads hematogenously. In the medical literature the distribution of metastases is 38% lung, 31% bone and 11% bone marrow metastasis [2]. Central nervous system metastases of ES are rarely seen.…”

“…Central nervous system metastases of ES are rarely seen. Usually, they are seen as skull or brain parenchyma metastasis [2]. Dural metastasis of ES is reported more rarely and the mechanism is frequently a direct extension to the dura mater from the skull [3,4].…”

Brain Metastasis of Undifferentiated Sarcoma and Response to Temozolomide Treatment -Case Report-

“…A review of 411 patients with various types of sarcomas identified 18 patients with brain metastasis, an overall incidence of 4.3%. 15) Brain metastasis from STSs is less frequent than from bone sarcomas. In particular, brain metastasis from undifferentiated sarcoma is rare with few reported cases.…”