ROLE OF SURGICAL RESECTION IN PELVIC EWINGS-SARCOMA

Purpose: The improved survival in patients with Ewing's sarcoma over t he past two decades has placed increased importance on achievement of local disease control, Ewing's sarcoma that arises in the pelvis has b een recognized to have a worse prognosis than that in the appendicular skeleton, and the role of surgical resection in these cases remains c ontroversial. The current study attempts to identify a benefit to surg ical resection in these patients. Methods: We retrospectively examined 39 patients who presented with Ewing's sarcoma in a pelvic location, all of whom were treated systemically with chemotherapy, Twenty patien ts received radiation only as a means of local control, and 19 underwe nt resection with or without radiation therapy, The patients were eval uated with end points of disease-free survival and overall survival fo r a minimum of 24 months and a mean of 58 months. Results: There was a n even distribution among patients who underwent surgical resection fo r local control as compared with those who received only radiation the rapy with respect to age, site, date of treatment, and stage of diseas e, Despite uncontrolled biases including tumor size and response to ch emotherapy that would be expected to favor patients who undergo resect ion, surgery in addition to or in substitution for radiation therapy d id not result in a statistically significant increase in disease-free survival or overall survival. Local disease control was comparable bet ween those who underwent resection and those who did not: three patien ts in each group developed a local recurrence. Conclusion: Currently, morbidity of surgical resection should be weighed against the efficacy and secondary complications of radiation therapy in the decision-maki ng process for local disease control, The issue of whether overall sur vival and local disease control is improved in patients who undergo su rgical resection remains controversial and may require a prospective r andomized trial to be answered definitively. (C) 1995 by American Soci ety of Clinical Oncology.