title: The effect of surgery with radiation on pelvic Ewing sarcoma survival.
abstract: BACKGROUND
  Pelvic Ewing sarcoma (ES) has poorer outcomes than extremity-based lesions and the method of local control is controversial.
  
  
  METHODS
  A retrospective review was performed of 40 primary pelvic or sacral ES treated by a single surgeon. All received modern chemotherapy and those that received radiation were treated with modern dosages.
  
  
  RESULTS
  Fifty-five percent were disease-free at latest follow-up (median, 83.1 mos). Sixty-one percent had ≥ 99% necrosis, which was associated with 65% disease-free survival. Larger size (P = 0.016) and the absence of metastatic disease (P = 0.005) was predictive of survival. Eighty-three percent of relapsed patients were DOD. Half of patients who received surgery alone or RT alone have NED while 57% of those who received S/RT have NED. Complication rates were 69% (S/RT), 75% (surgery alone), 10% (RT alone). Functional outcomes were similar.
  
  
  CONCLUSIONS
  Primary pelvic ES is localized at presentation in 50% and the absence of metastases is the strongest predictor for survival. Chemotherapy is key, but excellent histologic response is neither a guarantee nor a necessity for survival. More than one-third die despite an excellent histologic response and at least one-third with lung metastases survive. With chemotherapy, radiation, and surgery, reasonable control of disease can be achieved.
  
  
  METHODS
  Case-control or retrospective cohort study.
authors.affiliation: Department of Orthopaedics, University of Maryland, Baltimore, Maryland.
authors.forename: Vincent Y
authors.initials: VY
authors.lastname: Ng
authors.affiliation: Sarcoma Unit Royal Marsden Hospital, London, United Kingdom.
authors.forename: Robin
authors.initials: R
authors.lastname: Jones
authors.affiliation: Department of Orthopaedics and Sports Medicine, Seattle Children's Hospital, Seattle, Washington.
authors.forename: Viviana
authors.initials: V
authors.lastname: Bompadre
authors.affiliation: Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, Washington.
authors.forename: Philip
authors.initials: P
authors.lastname: Louie
authors.affiliation: Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, Washington.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Punt
authors.affiliation: Department of Orthopaedics and Sports Medicine, Seattle Children's Hospital, Seattle, Washington.
authors.forename: Ernest U
authors.initials: EU
authors.lastname: Conrad
mesh_terms: D000293:Adolescent; D000328:Adult; D000970:Antineoplastic Agents / Q000627:therapeutic use; D001859:Bone Neoplasms / Q000401:mortality* / Q000473:pathology / Q000628:therapy*; D002648:Child; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D010384:Pelvic Bones; D018714:Radiotherapy, Adjuvant; D012189:Retrospective Studies; D012512:Sarcoma, Ewing / Q000401:mortality* / Q000473:pathology / Q000628:therapy*; D015996:Survival Rate; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000970:Antineoplastic Agents
keywords: Ewing sarcoma; chemotherapy; quality of life; radiation; surgery; treatment modalities