Abstract
Introduction and Aims: To assess and compare treatment of pelvic Ewing’s sarcoma, particularly extracorporeal irradiation (ECI) and re-implantation of bone segments.
Method: We reviewed all patients presenting to the New South Wales Bone Tumor Service with Ewing’s sarcoma of the pelvis from 1995 until 2003. All received chemotherapy. There were 17 patients. Resection was performed in 14 cases: 12 were reconstructed by ECI and re-implantation of the bone segment; one with autograft and THR; one with allograft and THR. Three patients with sacral lesions had chemotherapy and radiotherapy only. All margins were clear. All patients were clinically and radiologically reviewed. Three scoring systems were used: The Musculoskeletal Tumor Society score (MSTS), the Toronto Extremity Salvage Score (TESS), and the Harris Hip Score (HHS).
Results: The average age at presentation was 18 years (range six to 35). There were seven males and 10 females. One patient presented with metastatic disease. Survivor follow-up ranged from 25 to 105 months (mean 55). In those who developed metastases these were detected at a mean of 27 months (range one to 79). Deaths occurred at a mean 31 months (range eight to 65). Fourteen underwent surgery. Seven had THR as part of their reconstruction. There have been no local recurrences after surgery. Six patients have died, 11 patients are alive (65%), one with metastatic disease. Overall disease-free survival is 59%. The disease-free survival in those who underwent ECI and re-implantation is 75% (minimum two-year follow-up). Functional outcome is good. The TESS mean was 83 (range 60–100). The MSTS score mean 85 (range 60–97). The HHS mean 92 (range 67–100). Radiologically solid bony union at the osteotomy sites was the norm. Lysis existed at two periacetabular osteotomies, around the posterior iliac crest of one osteotomy, and a fibrous union occurred at one sacro-iliac joint with breakage of the sacro-iliac screws. There have been no graft fractures.
Conclusion: The best surgical management for these difficult cases is extracorporeal irradiation and re-implantation of bone segments.
These abstracts were prepared by Editorial Secretary, George Sikorski. Correspondence should be addressed to Australian Orthopaedic Association, Ground Floor, The William Bland Centre, 229 Macquarie Street, Sydney, NSW 2000, Australia.
None of the authors is receiving any financial benefit or support from any source.
