Limb Salvage in Ewing's Sarcoma of the Distal Lower Extremity

Background: Ewing's sarcoma (ES) of the foot and ankle is a rare condition whose treatment is controversial. There are no large series covering this issue. Some authors advise amputation as the “gold standard” treatment. The authors here prsent their experience in limb salvage of fourteen cases of ES in distal lower extremities. Methods: The clinical records of fourteen patients affected by ES in ankle or foot were reviewed. Particular attention was paid to followup, functional status, type of treatment, survivorship and histological response to treatment. Results: Straightforward amputation was employed in just 3 cases of toe location, and another case located in the calcaneum was considered unresectable. Limb salvage was achieved in most patients with tumors in tarsal and metatarsal bones, as well as distal tibia and distal fibula locations. There were no local recurrences of the tumor. All but on patient survived after a minimum follow-up of four years (4 to 22). The function at the last follow-up was excellent or good in 80% of cases of limb salvage, mainly in non-irradiated patients. Conclusions: Chemotherapy and resection with reconstruction of the foot yielded excellent results in ES cases. Survivorship of ES in distal locations seems to be better than for proximal ones. High doses of radiotherapy and amputation can be avoided in the treatment of these tumors.