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. 2010 Oct;44(4):397-401.
doi: 10.4103/0019-5413.69312.

Surgical management of pelvic Ewing's sarcoma

Mayil Vahanan Natarajan  1 , M Mohamed Sameer, Jagdish Chandra Bose, Kunal Dheep
Affiliations

Surgical management of pelvic Ewing's sarcoma

Mayil Vahanan Natarajan et al. Indian J Orthop. 2010 Oct.

Abstract

Background: Despite advances in adjuvant therapy, Ewing's sarcoma of the pelvis remains an anatomic site with a poor prognosis due to its relative inaccessibility, complex anatomy, and limited reconstructive options available. This study evaluates the role of surgery in the management of patients with pelvic Ewing's sarcoma who also have received conventional radiation therapy and chemotherapy.

Materials and methods: From July 1990 to July 2006, we received 10 patients with Ewing's sarcoma of pelvis at our center. Nine patients were in stage II B and one in Stage III at the time of presentation to us. All patients underwent surgical resection after preoperative chemotherapy with or without radiotherapy, which was given at the discretion of the referral center. Reconstruction was attempted using plate osteosynthesis in four patients, SS wires and screws in three patients, free fibular strut graft in one patient, and none was done in two patients.

Results: Functional outcome assessed by Enneking's criteria revealed excellent outcome in two patients, good outcome in five patients, and poor outcome in two patients. At a mean followup of 10.3 years, seven patients remained free from the disease, and three patients died. The 5- and 10-year cumulative survival (Kaplan Meier method) was 63% and 34%, respectively.

Conclusion: This study demonstrates that surgery plus chemotherapy and radiation therapy is helpful for treating patients with pelvic Ewing's sarcoma, particularly in achieving local control.

Keywords: Adjuvant chemotherapy; Ewing’s sarcoma; pelvic neoplasms; pelvic resections; reconstruction.

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Conflict of interest statement

Conflict of Interest: None.

Figures

Figure 1
Figure 1
A line diagram showing types of pelvic resection
Figure 2
Figure 2
(a) Preoperative X-ray (anteroposterior view) of a patient showing Ewing’s sarcoma involving right ischium (thick black arrow) and soft tissue extent (thin black arrows). (b) Intraoperative clinical picture of same patient showing Type I+II pelvic resection. (c) Postoperative X-ray (anteroposterior view) after Type I + II resection and attempted iliofemoral fusion with plate osteosynthesis after 3 years. (d) Clinical followup after 3 years with good functional outcome
See this image and copyright information in PMC

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