Abstract:
Objective To explore the clinical effect of limb salvage treatment on pediatric Ewing's sarcoma in the femur shaft via neoadjuvant chemotherapy and vascularized fibular graft.
Methods Twenty patients with pediatric Ewing's sarcoma in the femur shaft were classified into Stage A or B according to Enneking classification. The patients were treated via preoperative neoadjuvant chemotherapy, limb salvage surgery, and postoperative neoadjuvant chemotherapy. The postoperative chemotherapy was adjusted according to the tumor necrosis rate after surgery.
Results All patients were followed up for 6 months to 45 months (mean of 30 months). Seventeen out of the 20 patients survived without recurrence or distant metastasis until August 30, 2011. One patient developed pelvis metastasis and died of pulmonary embolism one year after surgery, and two patients died of pulmonary metastasis two years after surgery. The 3-year disease-free-survival rate was 85%. All patients were treated via limb salvage. The union between the fibula and the femur shaft was achieved within 8 weeks to 12 weeks after surgery. The results were evaluated using the Enneking evaluation system, which detected effective treatment in 20 patients.
Conclusion Neoadjuvant chemotherapy combined with vascularized fibular graft is one of the effective methods for the treatment of pediatric Ewing's sarcoma in the femur shaft.
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