Ewing's sarcoma of the foot

The results of treatment were reviewed in 16 patients (10 male and six female) who had Ewing's sarcoma of the foot from 1954 through 1992. Mean age was 17 years (range, 10-42 years). The tumor involved the metatarsals (six patients), phalanges (four), calcaneus (three), navicular (one), talus (one), and calcaneus and phalanx (one). Seven patients had metastatic disease at the time of diagnosis, and only one of these patients survived. None of the patients with pulmonary metastasis at presentation survived. Nine patients had localized disease at the time of diagnosis, and eight survived. In the overall series, nine of the 16 patients were alive at followup (eight survived at least 5 years). Diagnosis was established at an average of 14 months from the onset of symptoms: 7 months in forefoot tumors and 22 months in hindfoot tumors. None of the six patients who had a resection had local failure. Seven of the 10 patients with forefoot lesions survived, and two of the six patients with hindfoot lesions survived. Treatment of Ewing's sarcoma of the foot by local control with radiation or operation and systemic control with chemotherapy is recommended. Survival appears to be better in patients who present with localized disease and forefoot lesions. Survival is worse in patients who present with metastatic disease. Surgical treatment appears to have an important role in local control and survival.