Partial Pelvic Resection for Ewing’s Sarcoma

Ewing’s sarcoma is the most common malignant bone tumour of the pelvis in children and adolescents. When compared with Ewing’s sarcoma in the extremities, a primary in the pelvis has a particularly poor prognosis. Twenty such cases have been treated at this hospital during the last 25 years with only one long-term survivor; a five-year survival rate has been reported by other authors as ranging from zero to 10% (Dahlin, Coventry and Scanlon 1961 ; Falk and Alpert 1967; Phillips and Higinbotham 1967; Macintosh, Price and Jeffree 1975; Pritchard et al. 1975; Bacci, Campanacci and Pagani 1978). Historically the mainstay of treatment in Ewing’s sarcoma was radiotherapy and, although in most patients this achieved satisfactory local control, death would nonetheless occur within two years from disseminated disease. It was argued that there was, therefore, no role for surgery (Boyer, Brickner and Perry 1967), but ablative surgery has been performed in some centres and has been shown to be associated with improved survival (Pritchard et al. 1975); the overall prognosis, however, remained poor. With the advent of intensive multi-drug, multi-cycle chemotherapy to control both the primary and the systemic micrometastases, the possibility of treating peripheral lesions improved and, when combined with megavoltage radiotherapy, 60% to 70% of patients may be cured (Kinsella et al. 1984). However, less than a third of patients with primary tumours in the proximal extremity or pelvis are long-term survivors (Rosen 1978).