SURGICAL INDICATIONS FOR EWINGS-SARCOMA OF THE PELVIS

Background. Despite advances in adjuvant therapy, Ewing's sarcoma of t he pelvis remains an anatomic site with a poor prognosis. This study e valuates the role of surgery in the management of patients with pelvic Ewing's sarcoma who also received conventional radiation therapy and chemotherapy. Methods. From May 1978 to February 1994, 19 patients wit h Stage IIB Ewing's sarcoma of the pelvis were treated at the UCLA Med ical Center (Los Angeles, CA). There were eight lesions of the ilium, two of the sacrum, and nine involving two adjoining regions of pelvis. All patients received conventional medical management. The 19 patient s were divided into two groups according to treatment modality. A grou p of 12 patients (Group A) had surgical resection, and their results w ere compared with those of another group of 7 patients (Group hi who d id not have surgery, Results. The 5-year cumulative survival (Kaplan-M eier method) was 39% for all patients, 51% for Group A. and 18% for Gr oup B. The 3-year cumulative survival was 59% for all patients, 72% fo r Group A, and 36% for Group B. Although the survival rate of Group A seemed better than that of Group B. the difference was not statistical ly significant (P = 0.093, log rank method). This study also suggested that, regardless of treatment modality, the outcome of patients with lesions involving two adjoining pelvic bones was poorer than that of t hose with a single lesion, In Group A, the 3-year cumulative survival rate for patients with single bone lesions (n = 8) was 86% and for pat ients with lesions involving two adjoining pelvic bones (n = 4) was 50 % (P = 0.045, log rank method). Furthermore, the statistical analysis of the combined data of the single pelvic bone lesions in UCLA and tha t of Mayo Clinic series (n = 16 for surgery group and n = 15 for non-s urgery group) confirmed the better results for the surgical patients, which was consistent with the results from the Mayo Clinic with an eve n greater significance (P < 0.002), Conclusion, This study demonstrate s that surgery plus chemotherapy and radiation therapy is helpful for treating patients with pelvic Ewing's sarcoma so long as the tumor is limited to a single pelvic bone.