Post-Radiotherapy Complications in Ewing Sarcoma: A Case Report and Literature Review

Abstract

Ewing's sarcoma (ES), the second most prevalent malignant osseous tumor in children and adolescents, primarily affects the extremities' long bones and pelvic region. Characterized by its aggressive growth, ES often presents with symptoms like swelling, pain, and neurological deficits, impacting various skeletal sites. ES involving the spine, particularly the sacral region, poses a significant challenge due to its rarity, aggressive nature, and limited sensitivity to treatments. We report the case of an 18-year-old male with recurrent metastatic ES presenting with fever, cough, and a lesion in the right humerus. Despite prior treatments and complications including spinal metastasis and cord compression, the patient's condition deteriorated, resulting in an unfortunate outcome. This case highlights the complexities in managing recurrent metastatic ES, emphasizing the need for tailored multidisciplinary approaches and early detection strategies.

Keywords: chemotherapy; ewing's sarcoma (es); immunohistochemistry; metastatic es; radiation therapy.

Figure 1. Magnetic resonance imaging (MRI) scan revealed a lytic necrotic lesion characterized by hyperintense signal intensity on T2-weighted images in the right humerus (arrow). Sagittal (A) and axial views ( B).

Figure 2. Computed tomography (CT) scan showing lung metastasis (A) and x-ray (B) and CT scan showing bone metastasis in the ischial tuberosity from ES (C).

Figure 3. Positron Emission Tomography (PET) scan (A) pinpoints the presence of an aggressive ES lesion within the right humerus, illuminated by hypermetabolic activity, and (B) reveals additional areas of concern with metastasis to ischial tuberosity.

Figure 4. Magnetic resonance imaging (MRI) scan showing metastatic spinal cord compression.

Figure 5. Chest X-ray showed pneumonitis most likely due to radiation.