Treatment of femoral Ewing's sarcoma

Cancer. 1996 Jul 1;78(1):70-8. doi: 10.1002/(SICI)1097-0142(19960701)78:1<70::AID-CNCR12>3.0.CO;2-4.


Background: The treatment of Ewing's sarcoma consists of chemotherapy for systemic and local disease. However, the role of radiation therapy, and/or surgical resection for definitive local treatment has yet to be determined.

Methods: A retrospective review of 32 patients (24 males and 8 females) treated for femoral Ewing's sarcoma between 1970 and 1985 was performed. Patients were divided into 3 treatment groups: chemotherapy and radiotherapy (CR) (10); chemotherapy and surgery (CS) (9); and chemotherapy, surgery, and radiotherapy (CSR) (13). Patients in the CR group received a mean of 5320 centigray (cGy) of radiation and patients in the CSR group received a mean of 3590 cGy. Multiagent cyclophosphamide/doxorubicin based chemotherapy was used in all cases. Surgery consisted of wide resection or amputation.

Results: Patients in the CR group had a higher risk of local recurrence than patients in the CS and CSR groups (P=0.02, log rank). The combination of local recurrences and treatment complications necessitated surgery for 7 of 10 CR patients, whereas 1 of 9 and 4 of 13 in the CS and CSR groups required additional surgery. The median survival for the entire group was 39 months. Minimum follow-up for surviving patients was 45 months. Five-year survival consisted of 1 of 10 patients in the CR group, 2 of 9 in the CS group, and 7 of 13 in the CSR group. There were no statistically significant differences among the three survival curves. Tumor location within the femur was a significant prognostic variable. Distal femoral location had a survival advantage compared with proximal and mid-femur locations (P = 0.049, log rank).

Conclusions: Femoral Ewing's sarcoma remains a disease with a poor prognosis. Radiation alone for local treatment results in a high rate of local recurrence and complications. Our current local treatment strategy for femoral Ewing's sarcoma includes surgery in all and adjuvant radiotherapy in many of the patients.

Publication types

  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adolescent
  • Adult
  • Biomarkers, Tumor / blood
  • Chemotherapy, Adjuvant
  • Child
  • Child, Preschool
  • Female
  • Femoral Neoplasms / enzymology
  • Femoral Neoplasms / therapy*
  • Humans
  • L-Lactate Dehydrogenase / blood
  • Male
  • Neoplasm Recurrence, Local
  • Radiotherapy, Adjuvant
  • Retrospective Studies
  • Salvage Therapy
  • Sarcoma, Ewing / enzymology
  • Sarcoma, Ewing / therapy*
  • Survival Analysis


  • Biomarkers, Tumor
  • L-Lactate Dehydrogenase