Internal hemipelvectomy in the management of pelvic Ewing sarcoma – are outcomes better than with radiation therapy?

BackgroundPelvic Ewing sarcoma (ES) is commonly associated with a worse prognosis. Large size and location limit local control options to radiation therapy, and local recurrences are common. We evaluated the impact of hemipelvectomy and radiation on outcomes, including function.Materials and methodsThirty-nine patients (median age 13.5 years) with ES of the pelvis and sacral bones were treated during the period 2000–2012. Fifteen were treated with definitive radiotherapy (RT), 9 patients underwent hemipelvectomy alone, and 15 were treated with combined hemipelvectomy and RT.ResultsTwenty patients (51.2%) are alive with a median follow-up 3.2 years from diagnosis. Median time from diagnosis to relapse was 1.3 years. Three-year estimates of EFS and OS were 47% and 61%, respectively. Patients treated with surgery or surgery with RT had better outcome than patients treated with RT only (3-year OS 78% or 81% vs. 36%, respectively, p = 0.00083). The outcome of patients with pelvic ES treated with hemipelvectomy was not significantly different from the outcome of all patients with Ewing sarcoma treated on the national Polish protocol.ConclusionsInternal hemipelvectomy offers good chances of cure for patients with pelvic ES, with a reasonable rate of complications and good function.