Surgical treatment for pelvic Ewing sarcoma: What is a safe and functional acetabular reconstruction when combined with modern multidisciplinary treatments?

Abstract

Purpose The purpose of this study was to clarify which local treatment is oncologically and functionally effective in pelvic Ewing sarcoma (ES). Methods A consecutive series of patients who underwent pelvic resections and acetabular reconstructions after chemotherapy between 1986 and 2016 at a supra‐regional center were evaluated. Results The cohort consisted of 35 patients. The 5‐year overall survival (OS) and local recurrence‐free survival (LRFS) was 61% and 72%, respectively. Preoperative radiotherapy (RT) and surgery provided an excellent/good histological response in 92% and achieved significantly better OS (5 years, 64%) and LRFS (5 years, 100%) than surgery alone or surgery with postoperative RT. The Musculoskeletal Tumor Society functional scores were significantly better in patients with hip transposition than those with structural reconstructions (74% vs 57%; P = .031) using custom‐made prostheses, irradiated autografts, and ice‐cream cone prostheses. These scores were significantly lower if patients had deep infection (P = .035), which was the most common complication (28%) in structural reconstructions but did not occur in hip transposition even when performed after preoperative RT. Conclusion Acetabular reconstruction with hip transposition resulted in no deep infection and superior function in patients with pelvic ES even when combined with preoperative RT, which improved tumor necrosis and rate of local control and survival.

Acetabular reconstruction with an ice‐cream cone prosthesis following resection of pelvic tumors: Does computer navigation improve surgical outcome?

“…The presence of LR was not significantly associated with survival outcome. In general, the presence of LR is associated with a very poor prognosis following pelvic tumor surgeries 47‐49 . Our results, which was discordant finding compared with previous literatures, could be attributed to the limited number of patients studied, relatively short follow‐up period, diverse tumor types included in this study.…”

Ewing Sarcoma—Diagnosis, Treatment, Clinical Challenges and Future Perspectives

“…To avoid a leg length discrepancy, hip joint transposition can be combined with endoprostheses [144]. In a recent study, acetabular reconstruction with hip transposition resulted in superior function in patients with pelvic EwS even when combined with preoperative RT, which improved tumor necrosis and rate of local control and survival [145]. Figure 6 provides a schematic workflow for local therapy decision in primary localized sacral/pelvic EwS.…”

Musculoskeletal oncology reconstructions in India – Changes in this millennium!

“…17 Recent publications from the Western world have also now recognised that hip transposition arthroplasty is a reliable option for pelvic tumors involving the acetabulum with better patient functional scores when compared to other modalities of reconstruction. 18 The use of navigation assisted surgery for complex resections, patient specific instrumentation jigs and custom plates though not very common are being utilised by some centres as Indian surgeons seek to expand the boundaries of safe oncologic resection combined with optimum functional restoration.…”