Muratori Francesco, Totti Francesca, Cuomo Pierluigi, Beltrami Giovanni, Matera Davide, Tamburrini Angela, Capanna Rodolfo, Roselli Giuliana, Campanacci Domenico Andrea
Department of Orthopaedic Oncology and Reconstructive Surgery, University of Florence, Azienda Ospedaliera Universitaria Careggi, Florence, Italy.
Myer Hospital, Florence, Italy.
Surg Technol Int. 2019 May 15;34:489-496.
Although multidisciplinary therapies have improved local control and overall survival in Ewing sarcoma (ES), the prognosis of pelvic lesions remains markedly worse than that of limb ES.
We retrospectively evaluated the influence of the type of local treatment, margins, necrosis and sacrum involvement on overall survival (OS) and disease-free survival (DFS) in a series of 21 non-metastatic pelvic ES.
The average follow-up was 46.3 months (range 3-156). Only one patient had recurrence, at 11 months after surgery. Eight patients showed pulmonary metastasis and five showed bone metastases. Necrosis was the only significant prognostic factor for overall survival at 5 years (p=0.0132) and disease-free survival (p=0.0086). Overall survival at 5 years was 40.1%.
Local control in pelvic Ewing sarcoma is comparable for patients treated with surgery (S), surgery plus radiotherapy (S/RT), or definitive radiotherapy (RT). The combination of surgery plus radiotherapy could be indicated in cases of large tumor, a poor necrosis response (< 90%), or an inadequate margin with involvement of the sacrum. A poor response to neoadjuvant therapy is a significant risk factor for both local control and overall survival.
尽管多学科治疗已改善了尤因肉瘤（ES）的局部控制和总生存率，但盆腔病变的预后仍明显差于肢体ES。
我们回顾性评估了局部治疗类型、切缘、坏死及骶骨受累情况对21例非转移性盆腔ES患者总生存（OS）和无病生存（DFS）的影响。
平均随访46.3个月（范围3 - 156个月）。仅1例患者术后11个月复发。8例出现肺转移，5例出现骨转移。坏死是5年总生存（p = 0.0132）和无病生存（p = 0.0086）的唯一显著预后因素。5年总生存率为40.1%。
对于接受手术（S）、手术加放疗（S/RT）或根治性放疗（RT）的盆腔尤因肉瘤患者，局部控制效果相当。对于肿瘤较大、坏死反应差（< 90%）或切缘不足且累及骶骨的病例，可考虑手术加放疗联合治疗。新辅助治疗反应不佳是局部控制和总生存的重要危险因素。
