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Ewing Limb Salvage — SCE Medical Oncology MCQ

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HardSarcomaEwing Limb SalvageSCE Medical Oncology

A 55-year-old man with Ewing sarcoma achieves a good histological response (>90% necrosis) after neoadjuvant VDC/IE chemotherapy. His tumour is in the proximal tibia. What local treatment is preferred?

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Correct answer: A — Wide-margin limb-sparing resection after systemic induction chemotherapy

For a resectable proximal-tibial Ewing sarcoma with good induction response, wide-margin limb-sparing surgery is the preferred definitive local treatment. Wide-margin limb-sparing resection followed by routine adjuvant radiotherapy: clear-margin surgery after good response does not make radiotherapy universally necessary. Wide-margin limb-sparing resection followed by maintenance VDC chemotherapy: systemic protocol completion is appropriate, but there is no maintenance VDC concept. Definitive radiotherapy followed by consolidation high-dose chemotherapy: a safely resectable extremity Ewing tumour is preferentially controlled surgically. Rotationplasty followed by consolidation radiotherapy to the operative field: rotationplasty is reserved for selected anatomical situations rather than this default.

Reference: ESMO-EURACAN-GENTURIS-ERN PaedCan bone sarcoma clinical practice guideline (Published October 2021): https://pubmed.ncbi.nlm.nih.gov/34500044/