# Ewing Sarcoma — GCMD Library living collection

Everything in the library about Ewing sarcoma — built automatically from dossiers that name it.

Updated: n/a · 3 episodes · 87 cited statements

## Episodes
### Surgical Management
- [Dr. Chiara Oreglio - Best of the Best in Pediatric Surgery 2025](https://library.globalcastmd.com/watch/dr-chiara-oreglio-best-of-the-best-in-pediatric-surgery-2025-10042) — video · 9:18 · [machine version](https://library.globalcastmd.com/watch/dr-chiara-oreglio-best-of-the-best-in-pediatric-surgery-2025-10042.md)

### Evidence & Research
- [Current management of pulmonary relapse in Ewing sarcoma: A report from the Pediatric Surgical Oncology Research Collaborative](https://library.globalcastmd.com/watch/current-management-of-pulmonary-relapse-in-ewing-sarcoma-a-report-from-the-pediatric-surgical-oncology-research-collaborative-11335) — video · 1:14 · [machine version](https://library.globalcastmd.com/watch/current-management-of-pulmonary-relapse-in-ewing-sarcoma-a-report-from-the-pediatric-surgical-oncology-research-collaborative-11335.md)

### Case-Based Learning
- [Clinical & Research Update: Sarcoma w/ Drs. Roshni Dasgupta, Joseph Pressey, Arthur Meyer, Luke Pater](https://library.globalcastmd.com/watch/clinical-research-update-sarcoma-w-drs-roshni-dasgupta-joseph-pressey-arthur-meyer-luke-pater-14017) — video · 1:06:24 · [machine version](https://library.globalcastmd.com/watch/clinical-research-update-sarcoma-w-drs-roshni-dasgupta-joseph-pressey-arthur-meyer-luke-pater-14017.md)

## Chapters
- [0:00](https://library.globalcastmd.com/watch/dr-chiara-oreglio-best-of-the-best-in-pediatric-surgery-2025-10042?t=0) Bioprosthetic chest wall reconstruction in pediatric Ewing sarcoma (Ep 1)
- [5:56](https://library.globalcastmd.com/watch/dr-chiara-oreglio-best-of-the-best-in-pediatric-surgery-2025-10042?t=356) Panel discussion on growth accommodation and reintervention (Ep 1)
- [0:00](https://library.globalcastmd.com/watch/current-management-of-pulmonary-relapse-in-ewing-sarcoma-a-report-from-the-pediatric-surgical-oncology-research-collaborative-11335?t=0) Study Background and Design (Ep 2)
- [0:32](https://library.globalcastmd.com/watch/current-management-of-pulmonary-relapse-in-ewing-sarcoma-a-report-from-the-pediatric-surgical-oncology-research-collaborative-11335?t=32) Key Findings on Relapse Patterns and Survival (Ep 2)
- [0:55](https://library.globalcastmd.com/watch/current-management-of-pulmonary-relapse-in-ewing-sarcoma-a-report-from-the-pediatric-surgical-oncology-research-collaborative-11335?t=55) Clinical Implications (Ep 2)
- [4:13](https://library.globalcastmd.com/watch/clinical-research-update-sarcoma-w-drs-roshni-dasgupta-joseph-pressey-arthur-meyer-luke-pater-14017?t=253) Case 1 Introduction: 10-Year-Old with Chest Wall Ewing Sarcoma - Presentation and Imaging (Ep 3)
- [10:05](https://library.globalcastmd.com/watch/clinical-research-update-sarcoma-w-drs-roshni-dasgupta-joseph-pressey-arthur-meyer-luke-pater-14017?t=605) Case 1: Neoadjuvant Chemotherapy and Surgical Planning (Ep 3)
- [14:40](https://library.globalcastmd.com/watch/clinical-research-update-sarcoma-w-drs-roshni-dasgupta-joseph-pressey-arthur-meyer-luke-pater-14017?t=880) Case 1: Radiation Therapy and Completion of Treatment (Ep 3)
- [21:40](https://library.globalcastmd.com/watch/clinical-research-update-sarcoma-w-drs-roshni-dasgupta-joseph-pressey-arthur-meyer-luke-pater-14017?t=1300) Case 2 Introduction: 12-Month-Old with Ovarian Mass - Presentation and Diagnosis (Ep 3)
- [25:53](https://library.globalcastmd.com/watch/clinical-research-update-sarcoma-w-drs-roshni-dasgupta-joseph-pressey-arthur-meyer-luke-pater-14017?t=1553) Case 2: SCCOHT Biology, Staging, and Induction Chemotherapy (Ep 3)
- [36:06](https://library.globalcastmd.com/watch/clinical-research-update-sarcoma-w-drs-roshni-dasgupta-joseph-pressey-arthur-meyer-luke-pater-14017?t=2166) Case 2: Second-Look Surgery with HIPEC and Consolidation (Ep 3)
- [45:28](https://library.globalcastmd.com/watch/clinical-research-update-sarcoma-w-drs-roshni-dasgupta-joseph-pressey-arthur-meyer-luke-pater-14017?t=2728) Case 2: Germline SMARCA4, Radiation Decision, and Long-Term Outcomes (Ep 3)
- [51:36](https://library.globalcastmd.com/watch/clinical-research-update-sarcoma-w-drs-roshni-dasgupta-joseph-pressey-arthur-meyer-luke-pater-14017?t=3096) Case 3 Introduction: 2-Year-Old with Chest Wall Rhabdomyosarcoma - Presentation and Surgical Approach (Ep 3)
- [58:42](https://library.globalcastmd.com/watch/clinical-research-update-sarcoma-w-drs-roshni-dasgupta-joseph-pressey-arthur-meyer-luke-pater-14017?t=3522) Case 3: Radiation Decision and Li-Fraumeni Considerations (Ep 3)
- [60:46](https://library.globalcastmd.com/watch/clinical-research-update-sarcoma-w-drs-roshni-dasgupta-joseph-pressey-arthur-meyer-luke-pater-14017?t=3646) Multidisciplinary Discussion: Germline Testing and Individualized Care (Ep 3)

## Statements
Every statement is attributed, typed, and timestamped; the link is the citation.
- "Writer et al. published a multi-center retrospective study in the Journal of Pediatric Surgery through PeaceSOC in 2024" — Sophia Schermerhorn (clinical) [Ep 2 · 0:05](https://library.globalcastmd.com/watch/current-management-of-pulmonary-relapse-in-ewing-sarcoma-a-report-from-the-pediatric-surgical-oncology-research-collaborative-11335?t=5)
- "PeaceSOC is a network of over 50 centers in North America that work together to improve outcomes in pediatric surgical oncology" — Sophia Schermerhorn (clinical) [Ep 2 · 0:07](https://library.globalcastmd.com/watch/current-management-of-pulmonary-relapse-in-ewing-sarcoma-a-report-from-the-pediatric-surgical-oncology-research-collaborative-11335?t=7)
- "The study examined patients less than 22 years old with initially localized Ewing sarcoma who developed first pulmonary relapse between 2007 and 2020 across 19 different centers" — Sophia Schermerhorn (clinical) [Ep 2 · 0:20](https://library.globalcastmd.com/watch/current-management-of-pulmonary-relapse-in-ewing-sarcoma-a-report-from-the-pediatric-surgical-oncology-research-collaborative-11335?t=20)
- "Among 33 patients studied, about 2/3 had relapse limited to the lungs" — Sophia Schermerhorn (epidemiological) [Ep 2 · 0:32](https://library.globalcastmd.com/watch/current-management-of-pulmonary-relapse-in-ewing-sarcoma-a-report-from-the-pediatric-surgical-oncology-research-collaborative-11335?t=32)
- "Nearly half of patients with lung-limited relapse had just a solitary pulmonary nodule" — Sophia Schermerhorn (epidemiological) [Ep 2 · 0:32](https://library.globalcastmd.com/watch/current-management-of-pulmonary-relapse-in-ewing-sarcoma-a-report-from-the-pediatric-surgical-oncology-research-collaborative-11335?t=32)
- "Patients with solitary pulmonary nodule were more likely to undergo metastasectomy and whole lung radiation" — Sophia Schermerhorn (clinical) [Ep 2 · 0:39](https://library.globalcastmd.com/watch/current-management-of-pulmonary-relapse-in-ewing-sarcoma-a-report-from-the-pediatric-surgical-oncology-research-collaborative-11335?t=39)
- "Patients with solitary pulmonary nodule had the highest overall three-year survival at 73%" — Sophia Schermerhorn (epidemiological) [Ep 2 · 0:39](https://library.globalcastmd.com/watch/current-management-of-pulmonary-relapse-in-ewing-sarcoma-a-report-from-the-pediatric-surgical-oncology-research-collaborative-11335?t=39)
- "Three-year survival for patients with multiple nodules was 40%" — Sophia Schermerhorn (epidemiological) [Ep 2 · 0:50](https://library.globalcastmd.com/watch/current-management-of-pulmonary-relapse-in-ewing-sarcoma-a-report-from-the-pediatric-surgical-oncology-research-collaborative-11335?t=50)
- "Three-year survival for patients with extrapulmonary disease was 23%" — Sophia Schermerhorn (epidemiological) [Ep 2 · 0:50](https://library.globalcastmd.com/watch/current-management-of-pulmonary-relapse-in-ewing-sarcoma-a-report-from-the-pediatric-surgical-oncology-research-collaborative-11335?t=50)
- "Solitary pulmonary relapse may represent a biologically more favorable type of recurrence" — Sophia Schermerhorn (opinion) [Ep 2 · 0:57](https://library.globalcastmd.com/watch/current-management-of-pulmonary-relapse-in-ewing-sarcoma-a-report-from-the-pediatric-surgical-oncology-research-collaborative-11335?t=57)
- "Solitary pulmonary relapse is more amenable to achieving meaningful local control" — Sophia Schermerhorn (opinion) [Ep 2 · 0:57](https://library.globalcastmd.com/watch/current-management-of-pulmonary-relapse-in-ewing-sarcoma-a-report-from-the-pediatric-surgical-oncology-research-collaborative-11335?t=57)
- "Metastasectomy plays an important role as part of multimodal therapy for solitary pulmonary relapse in Ewing sarcoma" — Sophia Schermerhorn (opinion) [Ep 2 · 0:57](https://library.globalcastmd.com/watch/current-management-of-pulmonary-relapse-in-ewing-sarcoma-a-report-from-the-pediatric-surgical-oncology-research-collaborative-11335?t=57)
- "Primary chest wall tumors are a rare entity in pediatric population with Ewing sarcoma being the most common one." — Chiara Oreglio (epidemiological) [Ep 1 · 0:00](https://library.globalcastmd.com/watch/dr-chiara-oreglio-best-of-the-best-in-pediatric-surgery-2025-10042?t=0)
- "Surgery remains the mainstay of treatment for primary chest wall tumors, composed of a demolitive phase and a reconstructive phase." — Chiara Oreglio (guideline) [Ep 1 · 0:00](https://library.globalcastmd.com/watch/dr-chiara-oreglio-best-of-the-best-in-pediatric-surgery-2025-10042?t=0)
- "The material of choice for chest wall reconstruction must encompass features of both stiffness and malleability while being biologically compatible." — Chiara Oreglio (clinical) [Ep 1 · 0:00](https://library.globalcastmd.com/watch/dr-chiara-oreglio-best-of-the-best-in-pediatric-surgery-2025-10042?t=0)
- "The reconstructive material must be able to physiologically integrate with tissues and cope with the ongoing growing process in pediatric patients." — Chiara Oreglio (clinical) [Ep 1 · 0:00](https://library.globalcastmd.com/watch/dr-chiara-oreglio-best-of-the-best-in-pediatric-surgery-2025-10042?t=0)
- "The series includes the youngest patient affected by chest wall Ewing sarcoma reported in literature, an 18-month-old female." — Chiara Oreglio (epidemiological) [Ep 1 · 0:00](https://library.globalcastmd.com/watch/dr-chiara-oreglio-best-of-the-best-in-pediatric-surgery-2025-10042?t=0)
- "The institution used porcine acellular dermal collagen (Permacol) for chest wall reconstruction." — Chiara Oreglio (clinical) [Ep 1 · 0:00](https://library.globalcastmd.com/watch/dr-chiara-oreglio-best-of-the-best-in-pediatric-surgery-2025-10042?t=0)
- "Three patients were treated: two males and one female (18 months old at diagnosis)." — Chiara Oreglio (clinical) [Ep 1 · 0:00](https://library.globalcastmd.com/watch/dr-chiara-oreglio-best-of-the-best-in-pediatric-surgery-2025-10042?t=0)
- "The surgical technique aims for 'drum-like tension'—tension strong enough to guarantee internal organ protection while accommodating chest wall growth." — Chiara Oreglio (clinical) [Ep 1 · 0:00](https://library.globalcastmd.com/watch/dr-chiara-oreglio-best-of-the-best-in-pediatric-surgery-2025-10042?t=0)
- "A latissimus dorsi muscular flap is created, rotated, and fixated over the prosthesis with sparing of the thoracodorsal artery." — Chiara Oreglio (clinical) [Ep 1 · 0:00](https://library.globalcastmd.com/watch/dr-chiara-oreglio-best-of-the-best-in-pediatric-surgery-2025-10042?t=0)
- "In all patients, at least three ribs were removed in accordance with oncological guidelines." — Chiara Oreglio (clinical) [Ep 1 · 0:00](https://library.globalcastmd.com/watch/dr-chiara-oreglio-best-of-the-best-in-pediatric-surgery-2025-10042?t=0)
- "In two cases, there was diaphragmatic involvement that was removed and reconstructed with Permacol." — Chiara Oreglio (clinical) [Ep 1 · 0:00](https://library.globalcastmd.com/watch/dr-chiara-oreglio-best-of-the-best-in-pediatric-surgery-2025-10042?t=0)
- "In one case with a large defect, two Stratos bars (rigid material) were used in addition to Permacol, instead of the usual four bars." — Chiara Oreglio (clinical) [Ep 1 · 0:00](https://library.globalcastmd.com/watch/dr-chiara-oreglio-best-of-the-best-in-pediatric-surgery-2025-10042?t=0)
- "None of the patients reported any perioperative complications according to the Clavien classification." — Chiara Oreglio (clinical) [Ep 1 · 0:00](https://library.globalcastmd.com/watch/dr-chiara-oreglio-best-of-the-best-in-pediatric-surgery-2025-10042?t=0)
- "R0 resection was reached in all cases." — Chiara Oreglio (clinical) [Ep 1 · 0:00](https://library.globalcastmd.com/watch/dr-chiara-oreglio-best-of-the-best-in-pediatric-surgery-2025-10042?t=0)
- "All patients were able to restart chemotherapy within two months from surgery." — Chiara Oreglio (clinical) [Ep 1 · 0:00](https://library.globalcastmd.com/watch/dr-chiara-oreglio-best-of-the-best-in-pediatric-surgery-2025-10042?t=0)
- "No limitations of movement are reported by any of the patients." — Chiara Oreglio (clinical) [Ep 1 · 0:00](https://library.globalcastmd.com/watch/dr-chiara-oreglio-best-of-the-best-in-pediatric-surgery-2025-10042?t=0)
- "The youngest case shows no paradoxical chest wall movement at follow-up and is disease-free." — Chiara Oreglio (clinical) [Ep 1 · 0:00](https://library.globalcastmd.com/watch/dr-chiara-oreglio-best-of-the-best-in-pediatric-surgery-2025-10042?t=0)
- "Permacol mesh presents good adaptability to the growing process with a reduced risk of rejection and infection." — Chiara Oreglio (opinion) [Ep 1 · 0:00](https://library.globalcastmd.com/watch/dr-chiara-oreglio-best-of-the-best-in-pediatric-surgery-2025-10042?t=0)
- "Permacol is highly versatile for reconstruction of highly mobile tissues such as the diaphragm." — Chiara Oreglio (clinical) [Ep 1 · 0:00](https://library.globalcastmd.com/watch/dr-chiara-oreglio-best-of-the-best-in-pediatric-surgery-2025-10042?t=0)
- "The thickness of the Permacol mesh can be adjusted according to age, region to be reconstructed, and defect size, making it feasible even in very young children." — Chiara Oreglio (clinical) [Ep 1 · 0:00](https://library.globalcastmd.com/watch/dr-chiara-oreglio-best-of-the-best-in-pediatric-surgery-2025-10042?t=0)
- "Permacol can be associated with other synthetic materials in hybrid reconstruction." — Chiara Oreglio (clinical) [Ep 1 · 0:00](https://library.globalcastmd.com/watch/dr-chiara-oreglio-best-of-the-best-in-pediatric-surgery-2025-10042?t=0)
- "Compared to rigid structures like titanium bars or Stratos bars, bioprosthesis integrates with tissue and grows with surrounding tissue as the patient grows." — Chiara Oreglio (clinical) [Ep 1 · 6:48](https://library.globalcastmd.com/watch/dr-chiara-oreglio-best-of-the-best-in-pediatric-surgery-2025-10042?t=408)
- "Rigid bars like Stratos bars oblige surrounding ribs to remain fixed, modifying chest wall shape and leading to scoliosis or chest wall deformation as the most common complication." — Chiara Oreglio (clinical) [Ep 1 · 6:48](https://library.globalcastmd.com/watch/dr-chiara-oreglio-best-of-the-best-in-pediatric-surgery-2025-10042?t=408)
- "With bioprosthesis, tissues are free to grow in their own way without chest wall deformity." — Chiara Oreglio (clinical) [Ep 1 · 6:48](https://library.globalcastmd.com/watch/dr-chiara-oreglio-best-of-the-best-in-pediatric-surgery-2025-10042?t=408)
- "The oldest patient treated with Permacol did not develop any difficulty in movement, and imaging shows the rib cage is not deformed." — Chiara Oreglio (clinical) [Ep 1 · 6:48](https://library.globalcastmd.com/watch/dr-chiara-oreglio-best-of-the-best-in-pediatric-surgery-2025-10042?t=408)
- "The histological integration of the bioprosthesis with surrounding tissue does not prevent growth or movement of the tissue." — Laura Galganski (host_summary) [Ep 1 · 8:23](https://library.globalcastmd.com/watch/dr-chiara-oreglio-best-of-the-best-in-pediatric-surgery-2025-10042?t=503)
- "Compressed-interval VDC/IE chemotherapy given every 2 weeks is now well proven to be of benefit over 3-week schedule for Ewing sarcoma" — Joseph Pressey (clinical) [Ep 3 · 9:23](https://library.globalcastmd.com/watch/clinical-research-update-sarcoma-w-drs-roshni-dasgupta-joseph-pressey-arthur-meyer-luke-pater-14017?t=563)
- "For chest wall sarcomas, the old adage of needing a rib above and a rib below for margins is not the case anymore; the goal is just to get negative margins if possible" — Roshni Dasgupta (clinical) [Ep 3 · 11:23](https://library.globalcastmd.com/watch/clinical-research-update-sarcoma-w-drs-roshni-dasgupta-joseph-pressey-arthur-meyer-luke-pater-14017?t=683)
- "When tumor is adherent to diaphragm or pericardium, you should not dissect these structures off the tumor because you don't know where the margin is; instead take a portion of the adherent structure with the tumor" — Roshni Dasgupta (clinical) [Ep 3 · 12:18](https://library.globalcastmd.com/watch/clinical-research-update-sarcoma-w-drs-roshni-dasgupta-joseph-pressey-arthur-meyer-luke-pater-14017?t=738)
- "Titanium rib reconstruction systems may need revision as the child grows, particularly during puberty with significant growth spurts" — Roshni Dasgupta (clinical) [Ep 3 · 14:05](https://library.globalcastmd.com/watch/clinical-research-update-sarcoma-w-drs-roshni-dasgupta-joseph-pressey-arthur-meyer-luke-pater-14017?t=845)
- "For Ewing sarcoma radiotherapy, treatment typically involves two phases: disease presentation volume and then more specific targeting of gross disease or positive margins" — Luke Pater (clinical) [Ep 3 · 15:29](https://library.globalcastmd.com/watch/clinical-research-update-sarcoma-w-drs-roshni-dasgupta-joseph-pressey-arthur-meyer-luke-pater-14017?t=929)
- "Protons are preferred over photons for focused boost volumes because they reduce low-dose exposure to non-target tissue beyond the target, though in lungs the benefit is compromised due to low-density tissue causing scatter" — Luke Pater (clinical) [Ep 3 · 20:12](https://library.globalcastmd.com/watch/clinical-research-update-sarcoma-w-drs-roshni-dasgupta-joseph-pressey-arthur-meyer-luke-pater-14017?t=1212)
- "Small cell carcinoma of the ovary hypercalcemic type (SCCOHT) was originally described around 1980 in young adult women presenting with ovarian tumors with nondescript morphology, often associated with hypercalcemia" — Joseph Pressey (epidemiological) [Ep 3 · 23:23](https://library.globalcastmd.com/watch/clinical-research-update-sarcoma-w-drs-roshni-dasgupta-joseph-pressey-arthur-meyer-luke-pater-14017?t=1403)
- "SCCOHT tumors are actually malignant rhabdoid tumors; some have postulated they should be called malignant rhabdoid tumor of the ovary" — Joseph Pressey (clinical) [Ep 3 · 23:47](https://library.globalcastmd.com/watch/clinical-research-update-sarcoma-w-drs-roshni-dasgupta-joseph-pressey-arthur-meyer-luke-pater-14017?t=1427)
- "In 2014, three labs simultaneously identified SMARCA4 mutation (usually single nucleotide variant) as the underlying genetic defect in SCCOHT" — Joseph Pressey (clinical) [Ep 3 · 24:06](https://library.globalcastmd.com/watch/clinical-research-update-sarcoma-w-drs-roshni-dasgupta-joseph-pressey-arthur-meyer-luke-pater-14017?t=1446)
- "SMARCA4 encodes BRG1 and its loss unifies all SCCOHT tumors; like Ewing sarcoma, these tumors have very low tumor mutational burden with SMARCA4 usually the only mutation found" — Joseph Pressey (clinical) [Ep 3 · 24:40](https://library.globalcastmd.com/watch/clinical-research-update-sarcoma-w-drs-roshni-dasgupta-joseph-pressey-arthur-meyer-luke-pater-14017?t=1480)
- "Many SCCOHT patients enter the OR without this diagnosis in the differential; they are usually thought to be germ cell tumors, resulting in incomplete initial surgery" — Joseph Pressey (clinical) [Ep 3 · 26:39](https://library.globalcastmd.com/watch/clinical-research-update-sarcoma-w-drs-roshni-dasgupta-joseph-pressey-arthur-meyer-luke-pater-14017?t=1599)
- "SCCOHT is a chemo-sensitive tumor but only transiently so; it is very important to start intensive systemic chemotherapy quickly rather than sending patients back for immediate second-look operation" — Joseph Pressey (clinical) [Ep 3 · 27:00](https://library.globalcastmd.com/watch/clinical-research-update-sarcoma-w-drs-roshni-dasgupta-joseph-pressey-arthur-meyer-luke-pater-14017?t=1620)
- "The VPCBAE regimen (vinorelbine, cisplatin, cyclophosphamide, bleomycin, doxorubicin, etoposide) with all six agents given every 21-day cycle is very intensive toxic therapy requiring meticulous supportive care" — Joseph Pressey (clinical) [Ep 3 · 27:20](https://library.globalcastmd.com/watch/clinical-research-update-sarcoma-w-drs-roshni-dasgupta-joseph-pressey-arthur-meyer-luke-pater-14017?t=1640)
- "Four cycles of VPCBAE induction chemotherapy are given prior to second-look operation for SCCOHT; patients with measurable disease after initial surgery often respond well even by RECIST criteria" — Joseph Pressey (clinical) [Ep 3 · 27:43](https://library.globalcastmd.com/watch/clinical-research-update-sarcoma-w-drs-roshni-dasgupta-joseph-pressey-arthur-meyer-luke-pater-14017?t=1663)
- "The 12-month-old SCCOHT patient is the youngest ever described with this tumor; the average age for diagnosis is 24 years" — Joseph Pressey (epidemiological) [Ep 3 · 28:25](https://library.globalcastmd.com/watch/clinical-research-update-sarcoma-w-drs-roshni-dasgupta-joseph-pressey-arthur-meyer-luke-pater-14017?t=1705)
- "MRIs and PET scans are not great for detecting peritoneal disease and very small nodules (1mm); second-look surgery is necessary to identify disease that imaging cannot detect" — Roshni Dasgupta (clinical) [Ep 3 · 29:18](https://library.globalcastmd.com/watch/clinical-research-update-sarcoma-w-drs-roshni-dasgupta-joseph-pressey-arthur-meyer-luke-pater-14017?t=1758)
- "For SCCOHT second-look surgery, laparoscopy is used initially to understand extent of disease and determine size of laparotomy incision needed; the operation is never done with laparoscopy alone" — Roshni Dasgupta (clinical) [Ep 3 · 29:44](https://library.globalcastmd.com/watch/clinical-research-update-sarcoma-w-drs-roshni-dasgupta-joseph-pressey-arthur-meyer-luke-pater-14017?t=1784)
- "Complete cytoreduction for SCCOHT includes removing all visible disease, with particular attention to peritoneal reflection in pouch of Douglas and surface of rectum where tumor can hide after spill" — Roshni Dasgupta (clinical) [Ep 3 · 30:40](https://library.globalcastmd.com/watch/clinical-research-update-sarcoma-w-drs-roshni-dasgupta-joseph-pressey-arthur-meyer-luke-pater-14017?t=1840)
- "HIPEC in pediatric patients requires a multidisciplinary team experienced in this procedure; it is not the same as adult HIPEC" — Roshni Dasgupta (clinical) [Ep 3 · 32:25](https://library.globalcastmd.com/watch/clinical-research-update-sarcoma-w-drs-roshni-dasgupta-joseph-pressey-arthur-meyer-luke-pater-14017?t=1945)
- "HIPEC protocol includes preoperative hyperhydration (1-2x maintenance fluids), warming abdomen to 42°C, cisplatin given in 2/3 dose initially and 1/3 at 45 minutes, continuous shaking for 90-minute dwell time, sodium thiosulfate infusion at 30 minutes to scavenge cisplatin, and 4-5L washout" — Roshni Dasgupta (clinical) [Ep 3 · 32:59](https://library.globalcastmd.com/watch/clinical-research-update-sarcoma-w-drs-roshni-dasgupta-joseph-pressey-arthur-meyer-luke-pater-14017?t=1979)
- "Post-HIPEC patients receive 24 hours of hyperhydration in ICU; main counseled toxicities are ileus and kidney function issues, though the Cincinnati protocol has not seen significant renal toxicity" — Roshni Dasgupta (clinical) [Ep 3 · 34:49](https://library.globalcastmd.com/watch/clinical-research-update-sarcoma-w-drs-roshni-dasgupta-joseph-pressey-arthur-meyer-luke-pater-14017?t=2089)
- "SCCOHT patients can resume next cycle of chemotherapy 4-7 days postoperatively after HIPEC once bowel function recovers" — Roshni Dasgupta (clinical) [Ep 3 · 35:50](https://library.globalcastmd.com/watch/clinical-research-update-sarcoma-w-drs-roshni-dasgupta-joseph-pressey-arthur-meyer-luke-pater-14017?t=2150)
- "Maintaining interval compression as dense as possible (7-8 days to resume chemotherapy post-HIPEC) is very important to continue killing residual tumor cells" — Joseph Pressey (clinical) [Ep 3 · 36:06](https://library.globalcastmd.com/watch/clinical-research-update-sarcoma-w-drs-roshni-dasgupta-joseph-pressey-arthur-meyer-luke-pater-14017?t=2166)
- "SCCOHT treatment uses 6 cycles of VPCBAE (usually 4 induction, 2 adjuvant); some stage 1 patients or those with considerable toxicity (especially renal) have stopped after 5 cycles to get to transplant in good health" — Joseph Pressey (clinical) [Ep 3 · 36:39](https://library.globalcastmd.com/watch/clinical-research-update-sarcoma-w-drs-roshni-dasgupta-joseph-pressey-arthur-meyer-luke-pater-14017?t=2199)
- "Cincinnati uses busulfan-thiotepa conditioning for autologous stem cell transplant in SCCOHT, which is more toxic than the carboplatin-based regimen used by the French consortium but complements VPCBAE better with heavy alkylator exposure" — Joseph Pressey (clinical) [Ep 3 · 37:08](https://library.globalcastmd.com/watch/clinical-research-update-sarcoma-w-drs-roshni-dasgupta-joseph-pressey-arthur-meyer-luke-pater-14017?t=2228)
- "Approximately 43% of SCCOHT patients carry germline SMARCA4 mutations; in Cincinnati's last 20 patients, 8 had germline SMARCA4 (40%)" — Joseph Pressey (epidemiological) [Ep 3 · 37:56](https://library.globalcastmd.com/watch/clinical-research-update-sarcoma-w-drs-roshni-dasgupta-joseph-pressey-arthur-meyer-luke-pater-14017?t=2276)
- "For SCCOHT patients with germline SMARCA4, contralateral salpingo-oophorectomy should be performed at second-look operation because it would be nearly impossible to treat a metachronous SCCOHT tumor a second time with intensive therapy" — Joseph Pressey (clinical) [Ep 3 · 38:21](https://library.globalcastmd.com/watch/clinical-research-update-sarcoma-w-drs-roshni-dasgupta-joseph-pressey-arthur-meyer-luke-pater-14017?t=2301)
- "Germline SMARCA4 mutations have been found in older SCCOHT patients in their late 30s with no prior personal or family history of cancer; all patients should be tested regardless of family history" — Joseph Pressey (clinical) [Ep 3 · 38:55](https://library.globalcastmd.com/watch/clinical-research-update-sarcoma-w-drs-roshni-dasgupta-joseph-pressey-arthur-meyer-luke-pater-14017?t=2335)
- "Hysterectomy should be considered for germline SMARCA4 carriers due to risk of SMARCA4-deficient uterine sarcoma, which peaks around age 50 (later than SCCOHT which peaks at 23-24 years)" — Joseph Pressey (clinical) [Ep 3 · 39:16](https://library.globalcastmd.com/watch/clinical-research-update-sarcoma-w-drs-roshni-dasgupta-joseph-pressey-arthur-meyer-luke-pater-14017?t=2356)
- "Two patients who survived SCCOHT developed metachronous SCCOHT tumors in the contralateral ovary and subsequently died, demonstrating this is a real risk not worth taking" — Joseph Pressey (clinical) [Ep 3 · 39:37](https://library.globalcastmd.com/watch/clinical-research-update-sarcoma-w-drs-roshni-dasgupta-joseph-pressey-arthur-meyer-luke-pater-14017?t=2377)
- "Penetrance of germline SMARCA4 is estimated at 62% based on UK Biobank study comparing males vs females over age 40, assuming the deficit of females was explained by SCCOHT deaths" — Joseph Pressey (epidemiological) [Ep 3 · 40:10](https://library.globalcastmd.com/watch/clinical-research-update-sarcoma-w-drs-roshni-dasgupta-joseph-pressey-arthur-meyer-luke-pater-14017?t=2410)
- "Cincinnati's methodology estimates SMARCA4 penetrance closer to 20% studying family members of SCCOHT patients; even at 20% this is considered considerable risk for otherwise healthy female carriers" — Joseph Pressey (epidemiological) [Ep 3 · 41:08](https://library.globalcastmd.com/watch/clinical-research-update-sarcoma-w-drs-roshni-dasgupta-joseph-pressey-arthur-meyer-luke-pater-14017?t=2468)
- "About 20% of SCCOHT patients have de novo SMARCA4 mutations with neither parent carrying the mutation" — Joseph Pressey (epidemiological) [Ep 3 · 41:35](https://library.globalcastmd.com/watch/clinical-research-update-sarcoma-w-drs-roshni-dasgupta-joseph-pressey-arthur-meyer-luke-pater-14017?t=2495)
- "Major long-term toxicity from SCCOHT treatment is ototoxicity requiring hearing aids; otherwise patients grow and develop well" — Joseph Pressey (clinical) [Ep 3 · 42:11](https://library.globalcastmd.com/watch/clinical-research-update-sarcoma-w-drs-roshni-dasgupta-joseph-pressey-arthur-meyer-luke-pater-14017?t=2531)
- "Whole abdomen radiation for SCCOHT was used historically but is excessively toxic in patients who receive autologous stem cell transplant and HIPEC; Cincinnati has walked away from this approach" — Luke Pater (clinical) [Ep 3 · 43:16](https://library.globalcastmd.com/watch/clinical-research-update-sarcoma-w-drs-roshni-dasgupta-joseph-pressey-arthur-meyer-luke-pater-14017?t=2596)
- "Whole abdomen radiation could still be considered for SCCOHT patients who do not get HIPEC or autologous bone marrow transplant" — Luke Pater (opinion) [Ep 3 · 43:46](https://library.globalcastmd.com/watch/clinical-research-update-sarcoma-w-drs-roshni-dasgupta-joseph-pressey-arthur-meyer-luke-pater-14017?t=2626)
- "Protons are ideal for SCCOHT lymph node radiation to minimize bowel, liver, kidney exposure and in similar scenarios to minimize dose to uterus, ovaries, pancreas, and spleen (low-dose pancreatic/splenic exposure is problematic long-term for metabolic syndrome and immune function)" — Luke Pater (clinical) [Ep 3 · 44:30](https://library.globalcastmd.com/watch/clinical-research-update-sarcoma-w-drs-roshni-dasgupta-joseph-pressey-arthur-meyer-luke-pater-14017?t=2670)
- "Cincinnati's SCCOHT series of 20 consecutive patients (2018-2024) with median follow-up of 58 months shows 60% overall survival, about 20 percentage points higher than the French study published in 2020" — Joseph Pressey (epidemiological) [Ep 3 · 50:21](https://library.globalcastmd.com/watch/clinical-research-update-sarcoma-w-drs-roshni-dasgupta-joseph-pressey-arthur-meyer-luke-pater-14017?t=3021)
- "For rhabdomyosarcoma, surgery should only be attempted if negative margins are achievable; if only debulking is possible, local control should be done with radiation only" — Roshni Dasgupta (clinical) [Ep 3 · 55:18](https://library.globalcastmd.com/watch/clinical-research-update-sarcoma-w-drs-roshni-dasgupta-joseph-pressey-arthur-meyer-luke-pater-14017?t=3318)
- "The goal of delayed primary excision (DPE) for rhabdomyosarcoma is to achieve at least R1 disease (microscopic residual only)" — Roshni Dasgupta (clinical) [Ep 3 · 55:41](https://library.globalcastmd.com/watch/clinical-research-update-sarcoma-w-drs-roshni-dasgupta-joseph-pressey-arthur-meyer-luke-pater-14017?t=3341)
- "Scapular disarticulation provides excellent access for high chest wall tumors, allowing the chest to be opened like a book" — Roshni Dasgupta (clinical) [Ep 3 · 56:33](https://library.globalcastmd.com/watch/clinical-research-update-sarcoma-w-drs-roshni-dasgupta-joseph-pressey-arthur-meyer-luke-pater-14017?t=3393)
- "For tumors near subclavian vessels and brachial plexus, a neck incision (similar to first rib operation for thoracic outlet syndrome) allows isolation of these structures from above before thoracotomy" — Roshni Dasgupta (clinical) [Ep 3 · 56:47](https://library.globalcastmd.com/watch/clinical-research-update-sarcoma-w-drs-roshni-dasgupta-joseph-pressey-arthur-meyer-luke-pater-14017?t=3407)
- "For high chest wall defects covered by scapula, bony reconstruction is not needed; Gore-Tex mesh with trapezius flap rotation provides adequate coverage" — Roshni Dasgupta (clinical) [Ep 3 · 57:34](https://library.globalcastmd.com/watch/clinical-research-update-sarcoma-w-drs-roshni-dasgupta-joseph-pressey-arthur-meyer-luke-pater-14017?t=3454)
- "After delayed primary excision for presenting R3/group 3 rhabdomyosarcoma, radiotherapy is typically recommended" — Luke Pater (clinical) [Ep 3 · 59:48](https://library.globalcastmd.com/watch/clinical-research-update-sarcoma-w-drs-roshni-dasgupta-joseph-pressey-arthur-meyer-luke-pater-14017?t=3588)
- "In the rhabdomyosarcoma case with germline TP53 mutation, radiation was deferred due to the mutation combined with excellent chemotherapy response and complete surgical resection, despite this being non-standard for group 3 disease" — Luke Pater (clinical) [Ep 3 · 60:13](https://library.globalcastmd.com/watch/clinical-research-update-sarcoma-w-drs-roshni-dasgupta-joseph-pressey-arthur-meyer-luke-pater-14017?t=3613)
- "Radiation-induced sarcomas in Li-Fraumeni patients are typically more aggressive and less chemosensitive than primary sarcomas" — Joseph Pressey (clinical) [Ep 3 · 60:53](https://library.globalcastmd.com/watch/clinical-research-update-sarcoma-w-drs-roshni-dasgupta-joseph-pressey-arthur-meyer-luke-pater-14017?t=3653)
- "The incidence of secondary malignancy from radiation is assumed to be higher the younger the patient, both because of more years to develop it and an inherent increased risk with young age" — Luke Pater (clinical) [Ep 3 · 61:31](https://library.globalcastmd.com/watch/clinical-research-update-sarcoma-w-drs-roshni-dasgupta-joseph-pressey-arthur-meyer-luke-pater-14017?t=3691)
- "Radiation decisions in young children involve nuanced discussions of toxicities including pulmonary function, cardiac exposure, wound healing, and chest wall development, individualized case by case" — Luke Pater (opinion) [Ep 3 · 61:48](https://library.globalcastmd.com/watch/clinical-research-update-sarcoma-w-drs-roshni-dasgupta-joseph-pressey-arthur-meyer-luke-pater-14017?t=3708)
- "The risk of hereditary predisposition among all sarcoma patients may be as high as 15%" — Joseph Pressey (epidemiological) [Ep 3 · 64:17](https://library.globalcastmd.com/watch/clinical-research-update-sarcoma-w-drs-roshni-dasgupta-joseph-pressey-arthur-meyer-luke-pater-14017?t=3857)
- "Cincinnati now performs universal germline testing for all newly diagnosed solid tumor patients and many benign tumors like desmoid tumors (with FAP testing)" — Joseph Pressey (clinical) [Ep 3 · 64:27](https://library.globalcastmd.com/watch/clinical-research-update-sarcoma-w-drs-roshni-dasgupta-joseph-pressey-arthur-meyer-luke-pater-14017?t=3867)

## Changelog
- Sep 26: 3 items added automatically

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