• Lida Mirzaei, Suzanne E J Kaal, Hendrik W B Schreuder, and Ronald H M A Bartels.
• *Radboud University Nijmegen, Medical Faculty, Nijmegen, The Netherlands; ‡Radboud University Medical Center, Department of Medical Oncology, Nijmegen, The Netherlands; §Radboud University Medical Center, Department of Orthopedics, Nijmegen, The Netherlands; ‖Radboud University Medical Center, Department of Neurosurgery, Nijmegen, The Netherlands.
• Neurosurgery. 2015 Nov 1; 77 (5): 718-24; discussion 724-5.

BackgroundThe vertebral column is an infrequent site of primary involvement in Ewing sarcoma. Yet when Ewing sarcoma is found in the spine, the urge for decompression is high because of the often symptomatic compression of neural structures. It is unclear in alleviating a neurological deficit whether chemotherapy is preferred over decompressive laminectomy.ObjectiveTo underline, in this case series, the efficiency of initial chemotherapy before upfront surgery in the setting of high-grade spinal cord or cauda equina compression of primary Ewing sarcoma.MethodsFifteen patients with Ewing sarcoma primarily located in the spine were treated at our institution between 1983 and 2015. Localization, neurological deficit expressed as Frankel grade, and outcome expressed as Rankin scale before and after initial chemotherapy, the recurrence rate, and overall survival were evaluated. The multidisciplinary approach of 1 case will be discussed in detail.ResultsNine patients (60%) were female. The age at presentation was 15.0 ± 5.5 years (range: 0.9-22.8 years). Ten patients (67%) were initially treated with chemotherapy, and 1 patient (7%) was treated primarily with radiotherapy followed by chemotherapy. The remaining 4 patients (27%) were initially treated with decompressive surgery. All patients treated primarily nonsurgically improved neurologically at follow-up, showing the importance of chemotherapy as an effective initial treatment option.ConclusionAdequate and quick decompression of neural structures with similar results can be achieved by chemotherapy and radiotherapy, avoiding the local spill of malignant cells.

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