# Surgical resection with neoadjuvant chemotherapy for iliac Ewing's sarcoma in adult females: A rare case report highlighting multidisciplinary approaches and promising outcomes

## TL;DR

This paper reports a rare case of Ewing's sarcoma in an adult woman's pelvis, showing that combining surgery with neoadjuvant chemotherapy and radiotherapy can lead to positive outcomes.

## Contribution

The novelty lies in demonstrating a successful multidisciplinary treatment approach for a rare and aggressive pelvic tumor in an adult.

## Key findings

- The patient showed no recurrence after 6 months of follow-up following a combined treatment plan.
- Neoadjuvant chemotherapy and precise radiotherapy, along with surgical resection, improved outcomes in this rare case.
- Early detection remains challenging due to nonspecific symptoms and subtle radiographic changes.

## Abstract

The iliac origin Ewing's sarcoma is a highly malignant primitive bone tumor. Its occurrence in adults is very rare. The prognosis for this tumor in adult patients is unfavorable and has a high rate of local recurrence. The main treatment goals include preventing local recurrences and distant metastases. A secondary objective is to maintain the quality of life by avoiding major amputative surgery. The primary aim of this report is to underscore the rarity and significance of the combination of surgery with neoadjuvant chemotherapy for better outcomes.

We present a rare case of Ewing's sarcoma of the right ilium without metastasis in a 50-year-old woman, treated with initial chemotherapy followed by extensive local marginal resection of the pelvic lesion, complemented by perimeter radiotherapy, and concluded with additional chemotherapy. The patient's progress has been satisfactory, with no recurrence observed during a 6-month follow-up period.

The Ewing's sarcoma of the pelvis, being more aggressive than in other locations, presents an unfavorable prognosis, especially in cases of delayed diagnosis associated with large tumors and micrometastases. Therapeutic advancements, such as neoadjuvant chemotherapy, precise radiotherapy, and sophisticated preoperative planning, contribute to improving survival rates.

Early diagnosis of Ewing's sarcoma of the ilium remains a challenge due to subtle changes difficult to detect on radiographs and nonspecific clinical symptoms. Ewing's sarcoma of the pelvis has an unfavorable prognosis due to the lack of a major anatomical barrier to tumor spread in this region. The treatment of this disease requires a multidisciplinary approach involving oncologists, radiation oncologists, surgeons, and radiologists. The effectiveness of surgery depends on the possibility of complete resection without excessive morbidity. The clarity of surgical margins influences the prognosis, although the presence of distant metastases remains the worst prognostic factor, with a limited long-term survival of 20 % despite aggressive treatment. Histological grades do not determine the prognosis, and long-term survival is generally reported between 60 % and 70 %, emphasizing the crucial importance of early detection and appropriate therapeutic intervention.

In summary, the case of Ewing's sarcoma in the right ilium highlights the rarity and challenges associated with this highly malignant bone tumor. Despite the unfavorable prognosis often linked to delayed diagnosis in the pelvic region, a multidisciplinary approach, including surgical resection along with neoadjuvant chemotherapy and precise radiotherapy, shows promise in improving outcomes. The satisfactory progress of the patient over 6 months underscores the potential effectiveness of this treatment plan.

•Uncommon Adult Presentation: This case underscores the rarity of Ewing's sarcoma originating from the iliac crest in a 50-year-old woman, emphasizing the unique challenges posed by this malignancy in adults.•Holistic Treatment Approach: Successful management involved a comprehensive strategy, integrating neoadjuvant chemotherapy, surgical resection, and targeted radiotherapy, highlighting the significance of a multidisciplinary approach in addressing pelvic Ewing's sarcoma.•Diagnostic Complexity: Early detection remains elusive due to subtle symptoms and nonspecific radiographic changes, emphasizing the critical need for precise diagnostics and collaborative efforts among medical specialties to overcome diagnostic challenges.•Advancements in Therapy: The case showcases evolving therapeutic options, including limb-sparing surgeries and neoadjuvant chemotherapy, contributing to improved outcomes and raising hope for better quality of life for patients with aggressive pelvic bone tumors.•Positive Progress: Despite the typically unfavorable prognosis associated with pelvic Ewing's sarcoma, the patient's encouraging progress over a 6-month follow-up period highlights the potential efficacy of the selected treatment plan, offering optimism for enhanced clinical outcomes.

Uncommon Adult Presentation: This case underscores the rarity of Ewing's sarcoma originating from the iliac crest in a 50-year-old woman, emphasizing the unique challenges posed by this malignancy in adults.

Holistic Treatment Approach: Successful management involved a comprehensive strategy, integrating neoadjuvant chemotherapy, surgical resection, and targeted radiotherapy, highlighting the significance of a multidisciplinary approach in addressing pelvic Ewing's sarcoma.

Diagnostic Complexity: Early detection remains elusive due to subtle symptoms and nonspecific radiographic changes, emphasizing the critical need for precise diagnostics and collaborative efforts among medical specialties to overcome diagnostic challenges.

Advancements in Therapy: The case showcases evolving therapeutic options, including limb-sparing surgeries and neoadjuvant chemotherapy, contributing to improved outcomes and raising hope for better quality of life for patients with aggressive pelvic bone tumors.

Positive Progress: Despite the typically unfavorable prognosis associated with pelvic Ewing's sarcoma, the patient's encouraging progress over a 6-month follow-up period highlights the potential efficacy of the selected treatment plan, offering optimism for enhanced clinical outcomes.