The treatment of localized Ewing's sarcoma: the experience at the Istituto Ortopedico Rizzoli in 163 cases treated with and without adjuvant chemotherapy.

Eighty consecutive patients with localized Ewing's tumor treated with adjuvant chemotherapy for two years plus local tumor control were retrospectively reviewed. Adjuvant chemotherapy protocol was constant for all patients, but local treatment consisted of amputation, resection (complete or incomplete) plus radiotherapy, or radiotherapy alone. The follow-up ranged from 21--101 months (mean = 50 months). The mortality rate and incidence of metastasis were significantly lower than in a comparable group of 83 patients previously treated by radiotherapy, or surgery plus radiotherapy but without chemotherapy. The percentage of local recurrence was not significantly different between the two groups. Of the patients treated with adjuvant chemotherapy, the percentage of local recurrence and metastases was much lower when the primary lesion was located in the extremities and when this lesion was treated by conservative surgery followed by irradiation. This was also true when the resection was not complete. Little discrepancy in functional results was observed using either resection plus radiotherapy or radiotherapy alone. The above data suggest that in treating Ewing's sarcoma, conservative surgery, even incomplete, can play an important role when associated with radiotherapy and adjuvant chemotherapy.