Long-Term Outcomes of Ewing Sarcoma of the Foot and Ankle

Ewing sarcoma (ES) is a rare tumor, but one of the most common primary bone tumors of the foot and ankle. The aim of this study was to review long-term outcomes of ES of the foot or ankle.

We reviewed 21 patients (16 male, 5 female, mean age 20±14 years) treated for ES of the foot or ankle. Local control consisted of surgical resection alone (n=16), surgery with radiotherapy (n=1), or definitive radiotherapy (n=4). Of the patients who underwent surgical resection, 11 underwent amputation and 6 underwent limb salvage.

The 5-, and 10-year disease-specific survival rates were 65%, and 46%, respectively. Patients who presented with metastatic disease were not at increased risk of death due to disease [hazard ratio (HR)=2.45, p=0.14] but were more likely to be treated with definitive radiotherapy [odds ratio (OR)=22.5, p=0.01]. Patients with tumors arising in the hind-foot had the worst 5-year overall survival (16%, p=0.003). There was no difference in the 5-year Musculoskeletal Tumor Society Score comparing patients who underwent a primary amputation or limb salvage (79% vs. 78%, p=0.14).

Ewing sarcoma of the foot and ankle demonstrates poor survival in patients with tumors arising in the hindfoot. The results of this study indicate that decision between surgery and radiotherapy is based on the patient's status. In patients who undergo primary limb salvage, the majority retain their limb at long-term follow-up.