Local and distant control in non-metastatic pelvic Ewing's sarcoma patients.
OBJECTIVE
Due to possible complication and loss of function, surgery is not often indicated in pelvic Ewing's sarcoma (ES). The purpose of this study was to review our experience and evaluate the role of different local treatment in non-metastatic pelvic ES patients.


METHODS
One hundred twenty-nine patients with pelvic ES were treated at our institution between 1975 and 1999. We excluded patients presenting metastases, patients who had died of other causes, or those with incomplete clinical documentation. Among the 73 eligible patients, 17 (23%) with progression of tumor growth during induction chemotherapy eventually died. The analysis was focused on the remaining 56 patients with good or stable clinical response to the chemotherapy.


RESULTS
Patients treated with surgery, with or without radiation therapy, had a better local control (82.6% vs. 66.7%) and a significantly higher rate of 5-year EFS (73.9% vs. 30.3%, P = 0.036) than those who were only treated with local radiation therapy.


CONCLUSIONS
Chemotherapy is the key factor in the treatment of pelvic ES. In our series, surgical treatment was associated with good prognosis for pelvic ES. The use of radiotherapy alone was less effective and should be only used in non-operable patients. Radiotherapy after surgery as a rescue method might not act effectively, while preoperative radiotherapy was associated with good clinical response and should be recommended.
Donati
Davide
D
Orthopaedic Surgery, Department of Musculoskeletal Oncology, Istituto Ortopedico Rizzoli, Bologna, Italy. davide.donati@ior.it
Yin
Junqiang
J
Di Bella
Claudia
C
Colangeli
Marco
M
Bacci
Gaetano
G
Ferrari
Stefano
S
Bertoni
Franco
F
Barbieri
Enza
E
Mercuri
Mario
M
D000293:Adolescent; D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001859:Bone Neoplasms / Q000188:drug therapy / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery*; D002648:Child; D003131:Combined Modality Therapy; D003520:Cyclophosphamide / Q000008:administration & dosage; D003609:Dactinomycin / Q000008:administration & dosage; D004317:Doxorubicin / Q000008:administration & dosage; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D007085:Ilium; D008297:Male; D008875:Middle Aged; D010384:Pelvic Bones; D012512:Sarcoma, Ewing / Q000188:drug therapy* / Q000532:radiotherapy / Q000556:secondary / Q000601:surgery*; D016019:Survival Analysis; D014750:Vincristine / Q000008:administration & dosage
D003609:Dactinomycin; D014750:Vincristine; D004317:Doxorubicin; D003520:Cyclophosphamide