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Neoadjuvant radiotherapy, marginal surgical resection, adjuvant chemotherapy
3%
77/2321
Neoadjuvant chemotherapy, marginal surgical resection, adjuvant radiotherapy
6%
135/2321
Neoadjuvant chemotherapy, wide surgical resection, adjuvant chemotherapy
84%
1939/2321
Wide surgical excision and reconstruction
5%
118/2321
Radiotherapy and chemotherapy without surgery
2%
38/2321
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The treatment for a 17-year-old male with Ewing's sarcoma in his proximal tibia is neoadjuvant chemotherapy, wide surgical resection, and adjuvant chemotherapy. While non-resectable Ewing's sarcoma may be treated with radiotherapy and chemotherapy alone (answer 5), the proximal tibia is considered resectable and as such wide excision and reconstruction with chemotherapy is the treatment of choice. Sluga et al review their series of patients with Ewing's sarcoma which suggest that neoadjuvant chemotherapy followed by wide surgical resection is the treatment which affords the best long term survival. With appropriate treatment, including adjuvant therapy and negative margin resection, the 5-year overall survival for Ewing's sarcoma approaches 60%. In a similiar fashion, Toni et al review their series of patients treated for Ewing's sarcoma. Of their cohort, they treated almost half (47%) with radiotherapy alone and saw a significantly higher rate of local recurrence (24%). Whether this is due to the tumor biology, difficulty of achieving adequate radiation doses, or some other factor, they suggest that Ewing's sarcoma should be treated with surgical excision when at all possible. Illustration A displays the MSTS (Enneking) Staging System.
3.7
(18)
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