CORR Insights®: Which Factors Are Associated with Local Control and Survival of Patients with Localized Pelvic Ewing’s Sarcoma? A Retrospective Analysis of Data from the Euro-EWING99 Trial

摘要

Effective chemotherapy and local therapy (which may include radiation alone, surgery alone, or the two in combination) have dramatically improved survival for patients with Ewing’s sarcoma during the last four decades [8, 12, 24]. However, some controversy remains about whether surgical resection adds an important incremental benefit to radiation alone, particularly when the tumor is in the pelvis involving the hip joint [15-17, 20], although in my opinion, the best evidence suggests that surgery plus radiation is superior to surgery or radiation alone. The best study in support of my viewpoint is the 2017 report from the Mayo Clinic, which found local recurrence in 26% of patients treated with radiation alone, 13% in those treated with surgery alone, and 0% for those who received both surgery and radiation [1]. But another small study found no difference in the frequency of recurrence whether treated with radiation alone, surgery or a combination [16], and so we have to keep an open mind on this. The only variable linked in that report for improved survival was tumor response to chemotherapy. Chemotherapy for Ewing’s sarcoma is not controversial and routinely used in all patients regardless of anatomic site. It will necrose and volumetrically diminish the size of the tumor. Chemotherapy combined with local treatment, radiation, surgery, or a combination is the standard treatment for Ewing’s sarcoma of the extremities.