Review Question - QID 176

This patients history, radiograph, and biopsy are consistent with Ewing’s sarcoma. Specifically the radiograph shows an infiltrative, non-geographic lesion with periosteal reaction and "onion-skinning." The pathology slide shows a diffuse sheet of small round blue cells lining the bone trabeculae-diagnostic of Ewing's sarcoma. Current treatment for Ewing's sarcoma include neoadjuvant chemotherapy, surgical resection, and adjuvant chemotherapy. Only in "unresectable" tumors, or situations where resection would be associated with poor functional outcome would Ewing's be treated with chemotherapy and radiotherapy without surgical excision. While Ewing's sarcoma is very radiation sensitive, the worry with radiation therapy in young patients is the increased lifetime risk of radiation induced sarcomas and the other complications of radiotherapy including fibrosis, fracture, and wound problems.

The article by Krasin et al looked at 79 patients who received different chemotherapy protocols and received either low dose <40Gy or high dose >40Gy radiotherapy. Local failure at 10yrs was 19% when tumors <8cm were treated with <40Gy and no failures were seen with >40Gy.