PHYSIOTHERAP TRAETMENT IN EWING'S SARCOMA

Ewingov sarkom treći je po učestalosti primarni zloćudni tumor kostiju, iza osteosarkoma i hondrosarkoma, te je drugi najčešći zloćudni tumor kostiju kod djece i adolescenata, a čini otprilike 10 do 15 % svih primarnih tumora kostiju. Najčešće je lokaliziran na donjim ekstremitetima (45 %). Slijede zdjelica (20 %), gornji ekstremiteti (13 %), aksijalni skelet i rebra (13 %) te kosti lica, gdje se najrjeđe javlja, u svega 2 % slučajeva. Tipični su simptomi bol, oteklina, venski crtež, neuroispadi, ograničena pokretljivost, slabost, umor i vrućica. Dijagnostika uključuje rendgensko snimanje, CT, MR, scintigrafiju te biopsiju za postavljanje konačne dijagnoze. Liječenje se sastoji primarno od ciklusa polikemoterapija u trajanju od 12 do 24 tjedana. Nakon toga slijede operacija, radioterapija, kemoradioterapija ili amputacija. Prognoze su za petogodišnje preživljavanje pacijenata s lokaliziranim tumorom oko 70 %, a pacijenata s metastazirajućim tumorom oko 20 do 30 %. U današnje doba javlja se sve veća potreba za fizioterapijom i rehabilitacijom onkoloških bolesnika, kako bi pacijenti ostvarili što veću kvalitetu života. Fizioterapija u tretmanu onkoloških pacijenata započinje već u jedinici intenzivnog liječenja. Kod Ewingova sarkoma fizioterapija ima značajnu ulogu u prijeoperacijskom razdoblju, kao i nakon operacije ili amputacije.Ewing’s sarcoma is the third most common primary malignant bone tumor, following osteosarcoma and chondrosarcoma, it is also the second most common malignant bone tumor in children and adolescents, and makes up about 10 to 15% of all primary bone tumors. In most cases, it is localized in the lower extremities (45%), followed by the pelvic region (20%), the upper extremities (13%), the axial skeleton and the ribs (13%) and the face skeleton (2%). The tumor arises in the medullary cavity and spreads through the bone and periosteum to soft tissues. It can be localized or metastatic. Typical simptoms are pain, swelling, telangiectasias, neurological deficits, limited mobility, weakness, tiredness and fever. Diagnostics includes Xray scanning, CT, MRI, scintigraphy and, for the final diagnosis, biopsy. The treatment consists primarily of polychemotherapy cycles lasting 12-24 weeks, followed by surgery, radiotherapy, chemoradiotherapy or amputation. The 5-year survival rate of patients with localized tumor is about 70% and with metastatic tumor it is about 20-30%. The prognosis is poor for patients with tumor relapse which occurs in 30-40% of the patients. About 30% of the patients with tumor relapse have less than 20% chance of survival. Nowadays, there is a growing need for physiotherapy and rehabilitation in the treatment of oncological patients, to help them to achieve the highest possible quality of life. Physiotherapy in the treatment of oncological patients starts in the intensive care unit. Physiotherapy in Ewing’s sarcoma treatment plays an important role in the preoperative, postoperative and postamputation period