Intraoperative radiotherapy in the local control of chest wall Ewing sarcoma.

Abstract

Introduction: Ewing sarcoma is a rare malignant tumor with an incidence of 3 cases per 1 million inhabitants annually. Cross-disciplinary management is key to improve survival rates. The role played by intraoperative radiotherapy in terms of treatment is still to be defined.

Material and methods: A retrospective study of pediatric patients (up to 16 years of age) with chest wall Ewing sarcoma undergoing tumor resection surgery, intraoperative radiotherapy, and chest wall reconstruction in our institution from 2011 to 2024 was carried out. Variables such as age at surgery, sex, neoadjuvant treatment, resection type, characteristics of intraoperative radiotherapy, reconstruction type, complications, local control rate, relapses, survival, and reconstruction's functional result were collected.

Results: 8 patients were included. Mean age at diagnosis was 12.5 years. Full tumor mass removal with free margins (R0) was achieved in 100% of the cases. Reconstructive techniques with flexible patches, titanium plates, and muscle flaps were used. None of the flaps was lost. Overall survival was 87.5%, with a mean follow-up period of 6 years. 3- and 5-year overall survival rates were 100% and 80%, respectively. Local control of the disease was achieved in 100% of the cases.

Conclusions: This paper discusses the role of intraoperative radiotherapy as a good treatment alternative to achieve the local control of Ewing sarcoma associated with large surgical resections.