[Ewing's sarcoma. New clinico-pathological aspects]

Ewing's sarcoma is a rare, but highly malignant bone tumor. During the years 1966-1983 we diagnosed and treated this tumor in 84 patients. Diagnosis of the tumor in an early stage is a prerequisite for successful therapy. Clinical and radiological findings contribute to the diagnosis, but histologic confirmation is indispensible. In addition to histomorphology we regard electron microscopy and the demonstration of glycogen as essential for the final diagnosis. The differential diagnosis includes haematogeneous osteomyelitis, malignant lymphoma, metastases from neuroblastomas, rhabdomyosarcoma and some benign bone tumors. New observations concerning the histogenesis of Ewing's sarcoma are discussed. The introduction of chemotherapy as part of a multimodality approach to treatment has substantially improved the prognosis in comparison to the previous results with surgery and radiation therapy. The role of surgery and radiation independently and in combination is discussed. We propose an approach to treatment based on our experience which involves surgical removal of the primary tumor after preoperative chemotherapy. The overall survival rate among our 84 patients was 40%. Among those who were diagnosed early and treated according to the recommended protocol 54% are alive.