Curettage, phenolization, and cementation in paediatric Ewing's sarcoma with a complete radiological response to neoadjuvant chemotherapy.

PURPOSE

Although wide resection is the standard treatment for Ewing's sarcoma (ES), it has complications especially in children. In this study, we compared the oncologic and functional outcomes of wide resection with extended curettage and local adjuvant therapy (phenolization and cementation), as a less extensive surgery for paediatric ES with a complete radiologic response to neoadjuvant chemotherapy.

METHODS

Children aged ≤ ten years, with ES of non-expendable long-bones and complete radiologic response to neoadjuvant chemotherapy, were included in this case-control study. Twenty-six patients were treated with extended curettage and local adjuvant therapy (case group) and 17 were managed with wide resection (control group). The average follow-up period was 60.1 ± 28.7 months (range 30-168 months). Functional outcome was assessed with the Musculoskeletal Tumor Society (MSTS) scoring system.

RESULTS

Three local recurrences (11.5%) and three distant metastases (11.5%) were observed in the case group. Two local recurrences (11.7%) and two metastases (11.7%) were recorded in the control group. The rate of local recurrence was not statistically different between the two study groups (p = 0.668). The rate of metastasis was not statistically different between the two study groups as well (p = 0.668). The complication rates were 15% in the case group and 53% in the control group (p = 0.005). The mean MSTS score was 98.3% and 74% in the case and control group, respectively (p < 0.001).

CONCLUSION

The oncologic outcome of extended curettage and local adjuvant therapy in paediatric ES with complete radiological response to neoadjuvant chemotherapy is comparable to wide resection, yet it offers considerably better functional results.