Optimizing Ewing Sarcoma and Osteosarcoma Biopsy Acquisition: A Children’s Oncology Group Bone Tumor Committee Consensus Statement

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Matthew S. Dietz University of Utah and Primary Children’s Hospital, Salt Lake City, UT

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Alyaa Al-Ibraheemi Boston Children’s Hospital, Boston, MA

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Jessica L. Davis Indiana University, Indianapolis, IN

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C. Matthew Hawkins Emory University School of Medicine, Department of Radiology and Imaging Sciences, Children’s Healthcare of Atlanta, Atlanta, GA

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Brian T. Craig Children’s Wisconsin, Medical College of Wisconsin, Milwaukee, WI

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Roshni Dasgupta University of Cincinnati, Department of Surgery, Cincinnati Children’s, Cincinnati, OH

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David S. Geller Children’s Hospital at Montefiore, Montefiore Medical Center, The University Hospital for Albert Einstein College of Medicine, Bronx, NY

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David S. Shulman Dana-Farber/Boston Children’s Cancer and Blood Disorders Center, Boston, MA

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Sarah Cohen-Gogo The Hospital for Sick Children, Toronto, Ontario, Canada

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Ajay Gupta Division of Pediatric Oncology, Department of Pediatrics, Roswell Park Comprehensive Cancer Center, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY

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Susan L. Whiteway Walter Reed National Military Medical Center, Bethesda, MD

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Emily K. Slotkin Memorial Sloan Kettering Cancer Center, New York, NY

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Christine M. Heske Pediatric Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD

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Safia K. Ahmed Department of Radiation Oncology, Mayo Clinic Arizona, Phoenix, AZ

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Daniel J. Indelicato Department of Radiation Oncology, University of Florida, Gainesville, FL

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Catherine M. Albert Ben Towne Center for Childhood Cancer Research, Seattle Children’s Hospital, Seattle, WA
Department of Pediatrics, University of Washington, Seattle, WA

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Nicole Montgomery Texas Children’s Hospital, Baylor College of Medicine, Houston, TX

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Jesse K. Sandberg Department of Pediatric Radiology, Lucile Packard Children’s Hospital, Stanford University, Stanford, CA

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Holcombe E. Grier Dana-Farber/Boston Children’s Cancer and Blood Disorders Center, Boston, MA

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Mark Krailo Department of Population and Public Health Sciences, Keck School of Medicine of the University of Southern California, Los Angeles, CA

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Michael S. Isakoff Center for Cancer and Blood Disorders, Connecticut Children’s Medical Center, Hartford, CT

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Elyssa Rubin Children’s Hospital of Orange County, Orange, CA

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Elizabeth R. Lawlor Ben Towne Center for Childhood Cancer Research, Seattle Children’s Hospital, Seattle, WA
Department of Pediatrics, University of Washington, Seattle, WA

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Steven G. DuBois Dana-Farber/Boston Children’s Cancer and Blood Disorders Center, Boston, MA

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Leo Mascarenhas Cedars-Sinai Medical Center, Los Angeles, CA

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Patrick J. Grohar Center for Childhood Cancer Research, Children’s Hospital of Philadelphia, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA

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Odion Binitie Moffitt Cancer Center, Tampa, FL

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Damon Reed Memorial Sloan Kettering Cancer Center, New York, NY

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Katherine Janeway Dana-Farber/Boston Children’s Cancer and Blood Disorders Center, Boston, MA

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Ryan D. Roberts Nationwide Children’s Hospital, Columbus, OH

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Kelly M. Bailey University of Pittsburgh School of Medicine, UPMC Children’s Hospital of Pittsburgh, Pittsburgh, PA

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Trends in diagnostic biopsy sample collection approaches for primary bone sarcomas have shifted in the past 2 decades. Although open/incisional biopsies used to be the predominant approach to obtain diagnostic material for Ewing sarcoma and osteosarcoma, image-guided core needle biopsies have increased in frequency and are safe for patients. These procedures are less invasive and reduce recovery times but have potential limitations. The quantity and quality of tissue obtained through these procedures vary between institutions. Acquired viable tissue volumes can be low, limiting the conduct of downstream expanded clinical workup, molecular analyses, and research. Patients with advanced Ewing sarcoma and osteosarcoma continue to have overall poor outcomes despite dose-intensive cytotoxic chemotherapy. The biology of treatment resistance is not currently well understood, partly due to limited availability of relevant tissue to study. There is a need for access to quality tumor specimens for molecular and other analyses to identify high-risk tumor subsets and drive discovery to improve patient outcomes. Given broad variability in bone tumor tissue procurement and processing across member institutions, the Children’s Oncology Group Bone Tumor Committee convened a multidisciplinary group of experts to outline the current and near-future tissue needs for optimal clinical care and access to research platforms. The goal of this working group was to provide high-level guidance on biopsy practices that safely meet these evolving needs. Harmonizing tissue collection practices is paramount to improving the care of children, adolescents, and young adults diagnosed with Ewing sarcoma and osteosarcoma.

Submitted November 20, 2023; final revision received July 24, 2024; accepted for publication August 2, 2024. Published online December 27, 2024.

R.D. Roberts and K.M. Bailey are co–senior authors.

Disclosures: The authors have disclosed that they have not received any financial considerations from any person or organization to support the preparation, analysis, results, or discussion of this article.

Funding: This research was supported by funding from the National Clinical Trials Network (NCTN) Operations Center (grant number U10CA180886) and NCTN Statistics & Data Center (grant number U10CA180899) from the National Cancer Institute of the National Institutes of Health.

Disclaimer: The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Correspondence: Kelly M. Bailey, MD, PhD, University of Pittsburgh School of Medicine, UPMC Children’s Hospital of Pittsburgh, Rangos Research Building, 4401 Penn Avenue, Pittsburgh, PA 15224. Email: Kelly.Bailey@chp.edu
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