Outcome of Ewing sarcoma in children: Twenty years experience from a single center

ABSTRACT Objective: Ewing sarcoma (ES) is a significant malignancy in pediatric patients, with a notable impact on bone health. Despite advances in treatment, ES still poses challenges, particularly in cases of metastasis or relapse. This study aims to evaluate the outcomes of ES in children treated at our center over a twenty-year period. Patients and Methods: We retrospectively reviewed pediatric patients diagnosed with ES at our center between January 2004 and February 2024. Data including demographic information, tumor characteristics, treatment modalities, and survival outcomes were analyzed. Results: Among 986 pediatric solid tumor cases, 137 (13.8%) were diagnosed with ES. After excluding ineligible cases, 115 ES cases were included in the study. The most common sites of involvement were the lower extremities. Metastatic disease was observed in 35.8% of cases, with the lungs being the most common site. Advanced age, and pelvic involvement were associated with poor prognosis. Histopathological response to neoadjuvant chemotherapy, represented by tumor necrosis rate, metastatic and relapse disease significantly influenced survival outcomes. Conclusion: Despite multimodal therapies, ES in children, especially with metastatic disease or relapse, presents a challenging prognosis. Early diagnosis and the development of novel treatment strategies are imperative to improve outcomes for these patients.