TREATMENT OF FEMORAL EWINGS-SARCOMA

BACKGROUND. The treatment of Ewing's sarcoma consists of chemotherapy for systemic and local disease. However, the role of radiation therapy , and/or surgical resection for definitive local treatment has yet to be determined. METHODS. A retrospective review of 32 patients (24 male s and 8 females) treated for femoral Ewing's sarcoma between 1970 and 1985 was performed. Patients were divided into 3 treatment groups: che motherapy and radiotherapy (CR) (10); chemotherapy and surgery (CS) (9 ); and chemotherapy, surgery, and radiotherapy (CSR) (13). Patients in the CR group received a mean of 5320 centigray (cGy) of radiation and patients in the CSR group received a mean of 3590 cGy. Multiagent cyc lophosphamide/doxorubicin based chemotherapy was used in all cases. Su rgery consisted of wide resection or amputation. RESULTS. Patients in the CR group had a higher risk of local recurrence than patients in th e CS and CSR groups (P = 0.02, log rank). The combination of local rec urrences and treatment complications necessitated surgery for 7 of 10 CR patients, whereas 1 of 9 and 4 of 13 in the CS and CSR groups requi red additional surgery. The median survival for the entire group was 3 9 months, Minimum followup for surviving patients was 45 months. Five- year survival consisted of 1 of 10 patients in the CR group, 2 of 9 in the CS group, and 7 of 13 in the CSR group. There were no statistical ly significant differences among the three survival curves. Tumor loca tion within the femur was a significant prognostic variable. Distal fe moral location had a survival advantage compared with proximal and mid -femur locations (P = 0.049, log rank). CONCLUSIONS. Femoral Ewing's s arcoma remains a disease with a poor prognosis. Radiation alone for lo cal treatment results in a high rate of local recurrence and complicat ions. Our current local treatment strategy for femoral Ewing's sarcoma includes surgery in all and adjuvant radiotherapy in many of the pati ents. (C) 1996 American Cancer Society.