Pelvic Ewing sarcoma: Should all patients receive pre-operative radiotherapy, or should it be delivered selectively?

Johnathan R. Lex, Vineet Kurisunkal, Yoichi Kaneuchi, Tomohiro Fujiwara, Jenny Sherriff, Catrin Wigley, Jonathan D. Stevenson, Michael C. Parry, Lee M. Jeys

Research output: Contribution to journalArticlepeer-review

5 Citations (Scopus)


Background: Locally recurrent disease following surgical resection of Ewing sarcoma (ES) confers a poor prognosis. Limited evidence is available evaluating non-selective use of pre-operative radiotherapy (RT) for patients with pelvic ES and its effect on local control and survival. Patients and methods: 49 consecutive patients with pelvic ES were identified retrospectively from a prospectively collated database. Patients either received non-selective pre-operative RT and surgery (n = 27), or selective post-operative RT (n = 22) (surgery alone (n = 11) or surgery and post-operative RT (n = 11)). Results: Patients who had non-selective pre-operative radiotherapy appeared to have a higher LRFS, 88.0% compared to 66.5% in the selective RT group (p = 0.096, Kaplan Meier; p = 0.028, Chi-squared). Administration of non-selective, pre-operative RT to all patients with pelvic ES elevates the LFRS to that of the good responder group (≥90% tumour necrosis and margins, p = 0.880). There was no difference in metastasis-free survival, 60.0% and 54.5% (p = 0.728) and overall survival (OS), 57.7% and 63.6% (p = 0.893). The majority of pre-operative RT patients had both good necrosis (≥90%) (p = 0.003) and widely excised tumours, 81.5% vs 59.1% (p = 0.080). Tumour volume ≥250 ml was associated with worse LRFS (p = 0.045) and post-operative complications (p = 0.017). There may be improved LRFS (p = 0.057) with pre-operative proton-beam RT compared to surgery and selective post-operative RT. Conclusion: Pre-operative photon or proton-beam RT to all pelvic ES may improve LRFS compared to the selective delivery of post-operative RT. Radiotherapy delivered to all patients results in a greater percentage of highly necrotic tumours at surgical excision, enabling a greater proportion of patients with wide resection margins.

Original languageEnglish
Pages (from-to)2618-2626
Number of pages9
JournalEuropean Journal of Surgical Oncology
Issue number10
Publication statusPublished - Oct 2021
Externally publishedYes


  • Ewing sarcoma
  • Orthopedic oncology
  • Pelvis
  • Proton beam
  • Radiotherapy
  • Surgery

ASJC Scopus subject areas

  • Surgery
  • Oncology


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