title: Ewing sarcoma of the mandible in a child: interdisciplinary treatment concepts and surgical reconstruction.
abstract: Ewing's sarcoma is the second most common primary bone malignancy in childhood and adolescence. We present a standardized interdisciplinary treatment protocol according to the EURO-E.W.I.N.G. 99 study, applied in the treatment of a 7-year-old patient with localized Ewing's sarcoma of the left mandible. After six blocks of VIDE (vincristine/ifosfamide/doxorubicin/etoposide) chemotherapy and stem cells rescue, intensity modulated external radiation with 48.6 Gy and subsequent high dose therapy with busulphan-melphalan were administered. Tumor resection and immediate bony reconstruction was performed using a microvascular fibula graft 10 weeks after radiation. Because of the effective neoadjuvant treatment, no extensive soft tissue resection was necessary. Healing of the osteosynthesis was uneventful. No local or systemic recurrence and no signs of significant facial deformity were found after 12 month follow-up. The presented case underlines the requirement for multidisciplinary protocols involving radiologists, pathologists, oncologists, radiation oncologists, and surgeons for accurate diagnosis and appropriate therapy. To preserve cosmetics and function within the craniofacial area after tumor resection in children, microvascular reconstructive procedures can be successfully performed with a vascularized fibular graft.
authors.affiliation: Department of Oral and Maxillofacial Surgery/Plastic Surgery, University of Jena, Jena, Germany. michael@thorwarth-online.de
authors.forename: Stefan
authors.initials: S
authors.lastname: Schultze-Mosgau
authors.forename: Michael
authors.initials: M
authors.lastname: Thorwarth
authors.forename: Falk
authors.initials: F
authors.lastname: Wehrhan
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Holter
authors.forename: Klaus Daniel
authors.initials: KD
authors.lastname: Stachel
authors.forename: Gerhard
authors.initials: G
authors.lastname: Grabenbauer
authors.forename: Kerstin
authors.initials: K
authors.lastname: Amann
authors.forename: Joern-Dirk
authors.initials: JD
authors.lastname: Beck
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D016025:Bone Transplantation; D002648:Child; D004954:Esthetics; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008339:Mandibular Neoplasms / Q000601:surgery*; D008866:Microsurgery; D020360:Neoadjuvant Therapy; D036102:Peripheral Blood Stem Cell Transplantation; D011879:Radiotherapy Dosage; D019651:Plastic Surgery Procedures; D012512:Sarcoma, Ewing / Q000601:surgery*; D016038:Skin Transplantation; D013524:Surgical Flaps; D016896:Treatment Outcome; D014945:Wound Healing / Q000502:physiology