Indications for surgical treatment of localized Ewing's sarcoma of bone

There has been considerable improvement in recent years i the prognosis for patients with localized Ewing's sarcoma of bone. This improvement largely stems from the use of radiation therapy to the primary lesion accompanied by aggressive adjuvant chemotherapy. With patients surviving longer, it has become evident that radiation therapy is not always successful in controlling local disease and, in addition, may be complicated by severe morbidity. In an attempt to improve local control and reduce morbidity, interest has been expressed in substituting surgical treatment for radiation therapy in certain selected situations. While precise guidelines are difficult to define, in general, surgical resection should be considered whenever the expected morbidity from this approach is less than that from the use of radiation therapy. It is anticipated that the role of surgery in the treatment of the primary lesion will change as more experience is gained. Various combinations of surgical treatment, radiation therapy, and chemotherapy are currently under investigation. As data from these therapeutic trials become available, there will undoubtedly be more precise recommendations for particular situations. In addition, the problem of post-radiation sarcoma must be closely watched; if significant numbers of survivors develop second malignancies, lower dose radiation and a more vigorous surgical approach may be necessary.