EWINGS-SARCOMA OF THE PROXIMAL FEMUR

The cases of 16 patients with Ewing's sarcoma of the proximal femur tr eated in the era of multiagent chemotherapy were reviewed, with emphas is on the mechanical problem of tumor involvement in this structurally demanding site. Fourteen patients received chemotherapy and local rad iotherapy as the initial primary treatment. One patient had chemothera py and radiotherapy, followed by wide local resection. One patient had amputation, followed by chemotherapy, for pathologic fracture and ext ensive soft tissue involvement at presentation. Two local recurrences occurred. Excluding the 2 patients whose femurs were fixed prophylacti cally, the pathologic fracture rate was 79%. In addition, by excluding the 2 patients who died before fracture, the pathologic fracture rate was 92%. Nonunion occurred in 5 (71%) of the 7 pathologic fractures n ot treated by resection and required as many as 5 additional surgical procedures to obtain union, At latest followup evaluation (average, 6. 3 years), 10 patients had no evidence of disease, 1 was alive with dis ease, and 5 had died of their disease. Options for management should i nclude primary resection and reconstruction or prophylactic internal f ixation after completion of chemotherapy plus or minus radiotherapy.