Pelvic Ewing sarcoma: a retrospective outcome analysis of 104 patients who underwent pelvic tumor resection at a single supra-regional center

Abstract

Background Local treatment in pelvic Ewing sarcoma (ES) consists of operation, radiation therapy, or a combination of both. Reported outcomes vary depending on the treatment modality performed. It is the objective of this study to analyze surgical outcome and complications as well as oncological outcome and complications of chemo- and radiation therapy in this patient cohort and evaluate prognostic factors. Methods Retrospective review of 104 patients who underwent tumor resection for pelvic ES from 1988 to 2014. Results All patients underwent pelvic resection and radiation therapy was administered in 77.9%. Margins were clear in 94.2%. The response to chemotherapy was good in 78.8%. Local recurrence occurred in 7.7%. The presence of distant metastases at the time of operation was the most important negative predictor for overall survival (p = 0.003). The cumulative 5- and 10-year survival rates were 82.7% and 80.1% for non-metastasized and 61.4% and 41.6% for metastasized pelvic ES at operation. In the presence of a single-distant metastatic site at operation compared to multiple metastatic sites, the cumulative survival rates were 64.3% versus 50% at five and 50.7% versus 16.7% at 10 years. Conclusions A combined treatment approach of tumor resection and radiation therapy leads to a local control and overall survival rates comparable with those of extremity locations in this study’s patient cohort with localized pelvic ES. Therefore, surgical tumor resection (combined with (neo-)adjuvant radiation therapy) in non-metastatic pelvic ES seems feasible. In metastatic patients, however, the significance of tumor resection as a part of local treatment remains less certain and improved outcomes of combined local treatment approaches need to be weighed against these patients’ prognosis and quality of life.

Ewing Sarcoma—Diagnosis, Treatment, Clinical Challenges and Future Perspectives

“…Tumors which cross the midline in the sacrum or sacral tumors involving the S1 nerve route are not considered resectable because of the morbidity associated with surgery [ 17 ]. Current studies even refute the role of surgery for local therapy of pelvic EwS, favoring definitive RT for most sacral EwS [ 127 , 137 , 139 ]. Technical operability per se does not necessarily improve survival but may significantly limit the patient’s quality of life.…”

Late Distal Ureteral Stricture in Internal Hemipelvectomy Without Bone Reconstruction: A Case Report

“…Guder et al recommended a combined treatment approach for pelvic Ewing sarcoma by tumor resection, and radiation therapy led to local control and overall survival rates compared with those of extremity locations. 22 The postoperative management and rehabilitation program of the patient was uneventful. The patient could participate in the class with good recovery and graduated with her bachelor’s later.…”

Custom Massive Allograft in a Case of Pelvic Bone Tumour: Simulation of Processing with Computerised Numerical Control vs. Robotic Machining

“…Up to the present, regarding bone allograft reconstructions, allograft shaping is usually performed intraoperatively [ 2 , 9 , 38 ], although having a pre-shaped allograft certainly allows to save surgical time. Unfortunately, although musculoskeletal tissue banks are available worldwide, few of them have the facilities, the expertise, and the know-how to process tissues in a cleanroom environment.…”