Hospital Infanta Cristina, Avenida Nueve de Junio, 2, 28981 Parla, Madrid, Spain.
The Royal Orthopaedic Hospital Oncology Service, Bristol Rd S, Northfield, Birmingham B31 2AP, UK.
Eur J Surg Oncol. 2014 Feb;40(2):197-201. doi: 10.1016/j.ejso.2013.09.001. Epub 2013 Sep 18.
The local treatment option for pelvic Ewing sarcoma (ES) remains uncertain and challenging as surgery is often disabling while radiotherapy alone has a higher risk of local recurrence but not necessarily a worse survival. The aim is to analyse the outcome of patients with pelvic ES after radiotherapy as the primary local treatment in combination with a temporary intrapelvic surgically placed tissue expander (TE) to reduce bowel complications.
20 patients were retrospectively analysed. All patients had neoadjuvant and adjuvant chemotherapy. We identified survival, time to develop local recurrence and metastasis, dose of radiotherapy administered, local complications related to the use of the tissue expander and bowel effects of radiotherapy.
The median follow-up was 41 months. 14 patients were stage IIb and six stage III. There were no problems after insertion of the TE and only one patient who developed mild diarrhoea. Local recurrence occurred in six patients. At the last follow-up 12 patients have died from sarcoma, five are disease free and three have had recurrent disease.
In this paper we reviewed pelvic Ewing sarcoma with all the special considerations that this entails. We think that tissue expander can be safely used when radiotherapy is chosen to treat pelvic ES. It does appear to prevent bowel problems and is a low morbidity procedure. New treatment approaches should be considered to give a chance of cure to those patients with "bad prognostic" pelvic ES.
骨盆尤文肉瘤（ES）的局部治疗选择仍然不确定且具有挑战性，因为手术往往会导致残疾，而单独放疗则有更高的局部复发风险，但不一定会降低生存率。目的是分析在放疗作为主要局部治疗的情况下，结合暂时性盆腔内置入组织扩张器（TE）以减少肠道并发症，对骨盆 ES 患者的治疗效果。
回顾性分析了 20 例患者。所有患者均接受了新辅助化疗和辅助化疗。我们评估了生存情况、局部复发和转移时间、放疗剂量、组织扩张器使用相关的局部并发症以及放疗对肠道的影响。
中位随访时间为 41 个月。14 例患者为 IIb 期，6 例为 III 期。TE 植入后无问题，仅 1 例患者出现轻度腹泻。6 例患者发生局部复发。在最后一次随访时，12 例患者死于肉瘤，5 例无病生存，3 例复发。
本文回顾了骨盆尤文肉瘤，考虑了所有特殊情况。我们认为，当选择放疗治疗骨盆 ES 时，组织扩张器可以安全使用。它似乎确实可以预防肠道问题，且是一种低发病率的手术。应该考虑新的治疗方法，为那些患有“预后不良”骨盆 ES 的患者提供治愈的机会。
