A bstractIntroduction and pur pose. Primary Ewing's sarcoma arising from the bones of the head and neck region is extremely rare representing only 1± 4% of all Ewing's sarcoma cases. Previous reports suggest a better prognosis for that particular anatomic site. The purpose of this study was to analyze the clinico-epidemiologic characteristics of that rare clinical presentation, as well as its patterns of failure and prognosis following treatment. M ater ials and methods. This study included a retrospective review of the medical records of patients with the diagnosis of Ewing's sarcoma of the head and neck region treated at King Faisal Specialist Hospital and Research Center between 1975 and Results . Out of a total number of 24 cases analyzed, there were 17 males and 7 fem ales with a ratio of 2.4:1. The m edian age at diagnosis was 16.5 years. A painful swelling was the m ost comm on clinical presentation. The m axilla was the m ost common site of presentation (9/24 cases). There were 3/24 cases who presented with metastatic disease at diagnosis. The m ajority of patients (16/24 cases) had a tum or size >10 cm . M ost patients were treated with systemic chem otherapy plus localized irradiation following an initial biopsy. W ith a m ean follow up of 3.4 years, the 5-year actuarial overall survival (OS) for the whole group was 53% , while the 5-year actuarial disease-free survival (DFS) was 30% . These ® gures were higher than those reported from our institution for young patients (£ 14 years treated for Ewing' s sarcom a in other anatom ic locations (30 % v 15% ). The response to chem otherapy was the only prognostic factor that affected both the OS and DFS. C onclusio n. The prognosis of Ewing's sarcoma of the head and neck region is slightly better than that of other anatomic sites. The response to systemic chem otherapy is one of the m ost important prognostic factors affecting both DFS and OS of Ewing's sarcoma of the head and neck. M ultimodality therapy consisting of an initial biopsy, aggressive combination chem otherapy and localized radiotherapy is the treatment of choice for Ewing's sarcoma of the head and neck region and m ay result in long-term survival.

These findings may help clinicians understand the effects of HFNC at different settings and may inform management guidelines for patients with respiratory failure.

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The impression is that patients here cope better with terminal illness at home than do patients elsewhere. The extended family, with its strong ties, and the strong Islamic faith that encourages its members to provide for parents and children in case of need mean that any input by health professionals is magnified by the family in the care of the patient. At first, it was uncertain if foreign health professionals would be accepted into Saudi homes (which are intensely private and protected for the family) for the purpose of caring for patients. This has proved unfounded. Hospitality is a very important part of Saudi society; nurses and doctors are welcomed and respected. Much of this success is due to the use of Saudi men as drivers and translators. These people provide 24-hour service, act as social workers assessing the needs of the family, and are the link between the patient and family, the nurse, and the doctor. 2. "CURE" OR "PALLIATION": The emphasis for cancer patients in Saudi Arabia is still on "curative treatment," even after any realistic hope of a cure is gone. The problem this causes is compounded by many patients being excluded from the decision-making process. Decisions made by the family may not always reflect the patient's wishes. Greater communication is needed to guide treatment decisions. 3. TRUTH-TELLING: Denying information of the patient's illness is probably more a historical than a cultural phenomenon. Similar attitudes prevailed until very recently in practically all other countries. In this very conservative country, people are committed to preserving Islamic culture in the face of Western technology. As medicine continues to demonstrate its effectiveness as well as its limitations, people will come to realize that the right of patients to know and understand their illness allows them to cope much better, and is compatible with the responsibility of the family to care for them. 4. WORK FORCE: The government employs 14,500 doctors, but only 12% are Saudi nationals. Nearly all the 33,000 nursing work force are expatriates. There is a constant turnover of expatriate staff. The commitment to continuing care with proper communication that is required for the whole of medicine is likely to be fully realized only when the majority of the workforce are Saudi nationals. 5. PRIMARY, SECONDARY, AND TERTIARY CARE SERVICES: The Kingdom is well served by a system of 174 public hospitals and numerous private clinics. However, for a patient with a chronic or terminal illness, continuing care, even in the community, tends to be provided by the hospital service; whereas the polyclinics and health centers seem to provide mainly crisis management. The aim should be to develop community care for chronic illness as part of the primary health care system. The impact of Western medicine on Saudi society has been dramatic and sudden, as evidenced by the high growth rate of the population. There is now widespread interest in matching the culture to the technology. Much of the drive to change the attitudes of bot...

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