Bone Tumors in the Young: Comparative Analysis of Osteosarcoma and Ewing Sarcoma in Pakistani Children
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Background: Pediatric bone malignancies constitute a critical subset of childhood cancers, with osteosarcoma (OS) and Ewing sarcoma (ES) representing the two most common primary malignant bone tumors in children and adolescents. Despite advances in diagnosis and treatment, outcomes in low- and middle-income countries (LMICs) like Pakistan remain sub-optimal due to limited diagnostic facilities, treatment delays, and economic barriers.
Objective: This study provides a comprehensive comparative analysis of OS and ES among Pakistani children, focusing on epidemiological trends, clinicopathological features, diagnostic challenges, management practices, and prognostic outcomes.
Methods: This paper integrates data from peer-reviewed literature, registry reports, and regional hospital-based studies between 1995–2024. Comparative data on incidence, treatment modalities, and survival patterns were synthesized from tertiary care centers and pediatric oncology units across Pakistan.
Results: Osteosarcoma accounted for approximately 55–60% of primary bone malignancies, with a mean age of 13.8 years and a male-to-female ratio of 1.8:1. Ewing sarcoma represented 25–30% of cases, predominantly affecting younger children (7–12 years). The most common site for OS was the metaphysis of long bones (femur, tibia), while ES favored diaphyseal regions and pelvic bones. Diagnostic delays averaged 3–6 months. Combined multimodal therapy improved survival, yet 5-year survival rates remained at 35–45%, significantly below global averages. Factors influencing poor outcomes included late presentation, high metastatic burden, and socioeconomic constraints.
Conclusion: OS and ES in Pakistani children reflect global biological patterns but are exacerbated by diagnostic and treatment inequities. Early detection, multidisciplinary management, and national registry implementation are essential to improve pediatric oncology outcomes in Pakistan.
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References
Ashraf T, Ghafoor T, Tanveer S. Pattern of Paediatric Malignancies in Northern Pakistan. Pak J Pathol. 2018.
Qureshi A, Ahmad Z, Azam M. Epidemiological Data for Common Bone Sarcomas. Asian Pac J Cancer Prev. 2010.
Zarghooni K, Bratke G, Landgraf P. Diagnosis and Treatment of Osteosarcoma and Ewing’s Sarcoma in Children. Dtsch Arztebl Int. 2023.
Chanihoon GQ et al. Evaluation of Zinc and Cadmium in Ewing Sarcoma Patients. Chemosphere. 2021.
Manzoor R et al. Chemotherapy-Induced Toxicities in Children with Ewing Sarcoma. J Ayub Med Coll Abbottabad. 2024.
Bhurgri Y et al. Primary Malignancies of Bone and Cartilage in Karachi. Asian Pac J Cancer Prev. 2009.
Kashif A, Waris I. Histological and Radiological Correlation in Bone Tumors. JFJMU. 2013.
Khan S et al. Incidence of Ewing’s Sarcoma in Different Age Groups. Cureus. 2021.
Shah SH, Muzaffar S, Soomro IN. Clinico-Morphological Pattern and Frequency of Bone Cancer. AKU eCommons. 1999.
Umer M et al. Autoclaved Tumor Bone for Skeletal Reconstruction in Pediatric Patients. ISRN Orthop. 2013.
Buckley JD, Pendergrass TW. Epidemiology of osteosarcoma and Ewing’s sarcoma in childhood: a study of 305 cases by the Children’s Cancer Group. Cancer. 1998;83(7):1440–1448.
Monsereenusorn C, Alcasabas AP. Predictors and treatment outcomes of pediatric osteosarcoma in diverse socioeconomic backgrounds in Southeast Asia. Asian Pac J Cancer Prev. 2022.
Chakraborty D, Rangamani S, Kulothungan V. Trends in incidence of Ewing sarcoma of bone in India: Evidence from the National Cancer Registry Programme (1982–2011). Cancer Epidemiol. 2018;54:56–62.
Ramaswamy A, Rekhi B, Bakhshi S. Indian data on bone and soft tissue sarcomas: a summary of published study results. South Asian J Cancer. 2016;5(3):122–130.
Pant G, Verma N, Shukla V. Ewings sarcoma in pediatric population of North India: demographics, outcome & prognostic factors. Cancer Epidemiol. 2024.
Shanmugam S, Govindasamy G. Pediatric bone sarcomas: Outcome of multimodality treatment in a single institution in South India over a decade. Indian J Med Paediatr Oncol. 2019;40(4):531–538.
Lewin J, Puri A, Quek R, Ngan R, Alcasabas AP. Management of sarcoma in the Asia-Pacific region: resource-stratified guidelines. Lancet Oncol. 2013;14(12):e562–e570.
Hirao D, Jesmin S, Maqbool A, Sugasawa T. Osteosarcoma in South Asia: A brief overview. J Biomed Res Environ Sci. 2024;5(7):2035–2042.
Parkes SE, Parke S, Mangham DC. Fifty years of paediatric malignant bone tumours in the West Midlands, UK (1957–2006): incidence, treatment and outcome. J Paediatr Child Health. 2010;46(7–8):473–478.
Smeland S, Bielack SS, Whelan J, et al. Survival and prognosis in osteosarcoma: results of the EURAMOS-1 international trial. J Clin Oncol. 2019;37(12):1062–1070.
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