Treatment of pelvic Ewing’s sarcoma: Pros and cons of chemotherapy plus definitive radiotherapy versus surgery

Objective: The aim of this study was to compare the results of chemotherapy or combined chemotherapy-radiation therapy with surgical intervention following neodjuvant therapy in pelvic Ewing’s sarcoma patients. Methods: The study population consisted of 39 patients with pelvic Ewing’s sarcoma treated in our clinic between 1994 and 2014. Of these patients, 28 patients (11 boys and 17 girls; mean age: 19.57±6.8 years) were treated with chemotherapy and radiation therapy and the remaining 11 patients (9 boys and 2 girls; mean age: 18.64±8.1 years) patients underwent surgical intervention after neoadjuvant chemotherapy or chemotherapy plus radiation therapy. Internal hemipelvectomy was performed in 10 patients, and external hemipelvectomy was performed in one patient. Survival rates were compared between the surgical and non-surgical treatment groups. Predictive factors, such as treatment protocol (surgery, neoadjuvant chemotherapy, definitive radiotherapy), mass localisation, mass size, presence of metastasis at the time of diagnosis, and presence of late metastases were compared between the groups. T he effects of each variable on survival were also examined. Results: The overall 3- and 5-year survival rates of the 28 non-surgical patients were 41.4% and 26.1%, respectively, while those of the surgical patients were 53% and 35.4%, respectively (p=0.777). Large mass size, presence of metastasis at the time of diagnosis, and presence of late metastases were significantly associated with lower survival rates. Conclusion: The survival rates of the patients who underwent surgery were higher than those of non-surgical patients, although the difference was not statistically significant. Definitive radiation and chemotherapy would be preferable in selected cases, such as patients with sacral localisation, without surgical intervention.


Cotterill SJ, Ahrens S, Paulussen M, et al. Prognostic factors in Ewing’s tumor of bone: Analysis of 975 patients from the European Intergroup Cooperative Ewing’s Sarcoma Study Group. J Clin Oncol 2000; 18: 3108-14. [CrossRef]

Bacci G, Longhi A, Ferrari S, Mercuri M, Versari M, Bertoni F. Prognostic factors in non-metastatic Ewing’s sarcoma tumor of bone: an analysis of 579 patients treated at a single institution with adjuvant or neoadjuvant chemotherapy between 1972 and 1998. Acta Oncologica 2006; 45: 469-75. [CrossRef]

Rodriguez-Galindo C, Liu T, Krasin MJ, et al. Analysis of prognostic factors in Ewing sarcoma family of tumors: Review of St. Jude Children’s Research Hospital studies. Cancer 2007; 110: 375-84. [CrossRef]

Karski EE, McIlvaine E, Segal MR, et al. Identification of discrete prognostic groups in Ewing sarcoma. Pediatr Blood Cancer 2016; 63: 47-53. [CrossRef]

Craft AW, Cotterill SJ, Bullimore JA, Pearson D. Long-term results from the first UKCCSG Ewing’s Tumour Study (ET-1). United Kingdom Children’s Cancer Study Group (UKCCSG) and the Medical Research Council Bone Sarcoma Working Party. Eur J Cancer 1997; 33: 1061-9. [CrossRef]

Donaldson SS, Torrey M, Link MP, et al. A multidisciplinary study investigating radiotherapy in Ewing’s sarcoma: End results of POG #8346. Pediatric Oncology Group. Int J Radiat Oncol Biol Phys 1998; 42: 125-35. [CrossRef]

Granowetter L, Womer R, Devidas M, et al. Dose-intensified compared with standard chemotherapy for nonmetastatic Ewing sarcoma family of tumors: A Children’s Oncology Group Study. J Clin Oncol 2009; 27: 2536-41. [CrossRef]

Krasin MJ, Rodriguez-Galindo C, Davidoff AM, et al. Efficacy of combined surgery and irradiation for localized Ewings sarcoma family of tumors. Pediatr Blood Cancer 2004; 43: 229-36. [CrossRef]

DuBois SG, Krailo MD, Gebhardt MC, et al. Comparative evaluation of local control strategies in localized Ewing sarcoma of bone: A report from the Children’s Oncology Group. Cancer 2015; 121: 467-75. [CrossRef]

10. Schuck A, Rübe C, Könemann S, et al. Postoperative radiotherapy in the treatment of Ewing tumors: influence of the interval between surgery and radiotherapy. Strahlenther Onkol 2002; 178: 25-31. [CrossRef]

11. Hardes J, von Eiff C, Streitbuerger A, et al. Reduction of periprosthetic infection with silver-coated megaprostheses in patients with bone sarcoma. J Surg Oncol 2010; 101: 389-95. [CrossRef]

12. Germain MA, Mascard E, Dubousset J, Nguefack M. Free vascularized fibula and reconstruction of long bones in the child: Our evolution. Microsurgery 2007; 27: 415-9. [CrossRef]

13. Paulussen M, Craft AW, Lewis I, et al. Results of the EICESS-92 Study: Two randomized trials of Ewing’s sarcoma treatment - cyclophosphamide compared with ifosfamide in standard-risk patients and assessment of benefit of etoposide added to standard treatment in high-risk patients. J Clin Oncol 2008; 26: 4385-93. [CrossRef]

14. Paulussen M, Ahrens S, Dunst J, et al. Localized Ewing tumor of bone: Final results of the Cooperative Ewing’s Sarcoma Study CESS 86. J Clin Oncol 2001; 19: 1818-29. [CrossRef]

15. Yock TI, Krailo M, Fryer CJ, et al. Local control in pelvic Ewing sarcoma: Analysis from INT-0091 - a report from the Children’s Oncology Group. J Clin Oncol 2006; 24: 3838-43. [CrossRef]

16. Dramis A. Pelvic Ewing’s Sarcoma: Oncologic outcomes and evaluation of prognostic factors. Acta Orthop Belg 2016; 82: 216-21.

17. Serlo J, Helenius I, Vettenranta K, et al. Surgically treated patients with axial and peripheral Ewing’s sarcoma family of tumours: A population based study in Finland during 1990-2009. Eur J Surg Oncol 2015; 41: 893-8. [CrossRef]

18. Sucato DJ, Rougraff B, McGrath BE, et al. Ewing’s sarcoma of the pelvis. Long-term survival and functional outcome. Clin Orthop Relat Res 2000: 193-201. [CrossRef]

19. Ahmed SK, Robinson SI, Arndt CAS, et al. Pelvis Ewing sarcoma: Local control and survival in the modern era. Pediatr Blood Cancer 2017 Feb 28. doi: 10.1002/pbc.26504. [Epub ahead of print]. [CrossRef]

20. Hoffmann C, Ahrens S, Dunst J, et al. Pelvic Ewing sarcoma: A retrospective analysis of 241 cases. Cancer 1999; 85: 869-77.

21. Ng VY, Jones R, Bompadre V, Louie P, Punt S, Conrad EU 3rd. The effect of surgery with radiation on pelvic Ewing sarcoma survival. J Surg Oncol 2015; 112: 861-5. [CrossRef]

22. Lee J, Hoang BH, Ziogas A, Zell JA. Analysis of prognostic factors in Ewing sarcoma using a population-based cancer registry. Cancer 2010; 116: 1964-73. [CrossRef]

23. Donati D, Yin J, Di Bella C, et al. Local and distant control in non-metastatic pelvic Ewing’s sarcoma patients. J Surg Oncol 2007; 96: 19-25. [CrossRef]

24. Raciborska A, Bilska K, Rychlowska-Pruszynska M, et al. Internal hemipelvectomy in the management of pelvic Ewing sarcoma: are outcomes better than with radiation therapy? J Pediatr Surg 2014; 49: 1500-4. [CrossRef]

25. Yang RS, Eckardt JJ, Eilber FR, et al. Surgical indications for Ewing’s sarcoma of the pelvis. Cancer 1995; 76: 1388-97.

26. Fan H, Guo Z, Fu J, Li X, Li J, Wang Z. Surgical management of pelvic Ewing’s sarcoma in children and adolescents. Oncology Lett 2017; 14: 3917-26. [CrossRef]

27. Akagunduz OO, Kamer SA, Kececi B, et al. The role of radiotherapy in local control of nonextremity Ewing sarcomas. Tumori 2016; 102: 162-7. [CrossRef]

28. Hesla AC, Tsagozis P, Jebsen N, Zaikova O, Bauer H, Brosjo O. Improved prognosis for patients with ewing sarcoma in the sacrum compared with the innominate bones: The Scandinavian Sarcoma Group Experience. J Bone Joint Surg Am 2016; 98: 199-210. [CrossRef]

Kaynak Göster

360 144

Sayıdaki Diğer Makaleler

Center-edge angle values in healthy children between 5 and 14 years old in Turkey

Ali İhsan TUĞRUL, Yılmaz GÜNEY, Bahattin Kerem AYDIN, İbrahim AKEL, Fatih DURGUT, Hakan ŞENARAN

Biomechanical comparison of Bunnell, modified Kessler, and Tsuge tendon repair techniques using two suture types


Efficacy and safety of tranexamic acid for reducing blood loss in elderly patients with intertrochanteric fracture treated with intramedullary fixation surgery: A meta-analysis of randomized controlled trials

Xiangping LUO, Hangqing HUANG, Xiong TANG

Knotless anchors offer better prevention of meniscal excursion than knotted anchors: An experimental study of the bovine knee

Mehmet Burtaç EREN, Murat AŞÇI, ERGİN TÖNÜK, Orhan BALTA, Recep Kurnaz

Treatment of pelvic Ewing’s sarcoma: Pros and cons of chemotherapy plus definitive radiotherapy versus surgery

İsmail Eralp KAÇMAZ, Burçin KEÇECİ, Can Doruk BASA, Dündar SABAH

Cemented versus uncemented hemiarthroplasty for displaced femoral neck fractures: A randomized controlled trial with two years follow-up


Comment on: “Turkish version of the modified ConstantMurley score and standardized test protocol: Reliability and validity”


T he effect of previous pelvic or proximal femoral osteotomy on the outcomes of total hip arthroplasty in patients with dysplastic coxarthrosis


Minimally invasive medial plate osteosynthesis in tibial pilon fractures: Longterm functional and radiological outcomes

Alican Barış, Esra ÇİRCİ, Ziya DEMİRCİ, Yusuf ÖZTÜRKMEN

Clinical and radiological outcomes of high tibial osteotomy with combined fixator-assisted nailing and subtubercle tibial osteotomy

LEVENT BAYAM, Mehmet ERDEM, Deniz GÜLABİ, Ahmet Can ERDEM, Ahmet Çağrı UYAR, Alauddin KOCHAİ