Surgical Trend in Ewing’s sarcoma: from the Limb Amputation to the Extended Curettage

Ewing’s sarcoma (ES) is the second most common malignant bone tumor in childhood and adolescence, with a survival rate of 70-80% for patients with localized disease and nearly 30% for those with metastatic disease(1).For several decades, prior to the introduction of chemotherapy, amputation of the affected limb was the only surgical method for the treatment of ES patients and the survival rate was as low as 10%(2).With the introduction of chemotherapy in the late 1970s and the early 1980s,the survival rate of ES patients was increaseddramatically to nearly 75% (3). Currently, the standard treatment for nonexpendable bone ESinvolves neoadjuvant chemotherapy followed by wide excision, radiotherapy, or a combination of both (4).Nevertheless, the tumor margin should still be defined when deciding on the treatment approach. In this respect, when a wide surgical margin can be achieved in the preoperative imaging studies, wide resection without radiotherapy is the procedure of choice. However, if the prospect of obtaining an adequate surgical margin is uncertain based on preoperative imaging, neoadjuvant radiotherapy should be added. When the preoperative imaging indicates that surgical margins are insufficient, amputation could be regarded as the only available surgical option. Therefore, it is imperative to define the surgical margin appropriately for the accurate selection of the surgical approach (2, 5).