A 13-year-old boy has a large Ewing sarcoma arising from the sacrum encasing the S1 and S2 nerve roots. Chemotherapy has produced only a partial response. Wide resection would sacrifice bladder and bowel continence. What is the appropriate definitive local control measure?

• A Radical hindquarter amputation
• B External beam radiotherapy to the primary tumour as definitive local control ✓
• C Continuation of chemotherapy alone without any local therapy
• D Intralesional curettage with cryotherapy

Explanation

Ewing sarcoma is markedly radiosensitive, and radiotherapy delivering roughly 50 to 60 Gy is the accepted method of local control when resection would cause unacceptable functional loss, such as tumours of the spine, sacrum and pelvis. Chemotherapy alone leaves uncontrolled primary disease and is inadequate. Hindquarter amputation is neither feasible nor appropriate for a midline sacral tumour, and intralesional procedures have no curative role in Ewing sarcoma.

Reference: Campbell's Operative Orthopaedics, 14th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.