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Ewing’s Sarcoma of Bone

  • Drew D. Moore
  • Rex C. HaydonEmail author
Chapter
Part of the Cancer Treatment and Research book series (CTAR, volume 162)

Abstract

Ewing's sarcoma of bone is a primary bone sarcoma found predominantly in patients during their second decade of life. It is a high-grade aggressive small round blue cell tumor that is part of the Ewing's family of tumors. Its exact eitiology is unknown but it commonly demonstrates reproducible staining of CD99 and translocations of the EWS gene. Historically, this diagnosis was associated with near certain metastasis and subsequent mortality. However, current management consists of extensive chemotherapy in addition to local control with surgical resection and/or radiation. As a result, survival has improved to the 55–75% range in those patients who present without known metastases. Current research aims to continue this improvement by looking further into the assocated gene abnormalities and possibly targeted therapies.

Keywords

Ewing's sarcoma Ewing Sarcoma Limb salvage Bone 

References

  1. 1.
    Ewing J (1921) Diffuse endothelioma of bone. Proc NY Pathol Soc. 21:17–24Google Scholar
  2. 2.
    Codman E (1925) Bone sarcoma: an interpretation of the nomenclature used by the committee on the Registry of Bone Sarcomas of the American College of Surgeons. Paul B. Hoeber, Inc., New YorkGoogle Scholar
  3. 3.
    Codman EA (2009) The Classic: The Registry of Bone Sarcomas as an example of the End-Result Idea in Hospital Organization. Clin Orthop Relat Res 467(11):2766–2770. doi: 10.1007/s11999-009-1048-7 PubMedCentralPubMedCrossRefGoogle Scholar
  4. 4.
    Codman E (1909) The use of the x-ray and radiation in surgery. In: Keen WB (ed) Surgery. Its principles and practice by various authors, vol 1909. WB Saunders, Philadelphia, p. 1170Google Scholar
  5. 5.
    Esiashvili N, Goodman M, Marcus RB Jr (2008) Changes in incidence and survival of Ewing sarcoma patients over the past 3 decades: Surveillance Epidemiology and End Results data. J Pediatr Hematol Oncol 30(6):425–430. doi: 10.1097/MPH.0b013e31816e22f3 PubMedCrossRefGoogle Scholar
  6. 6.
    Dorfman HD, Czerniak B (1995) Bone cancers. Cancer 75(1 Suppl):203–210PubMedCrossRefGoogle Scholar
  7. 7.
    Stiller CA, Desandes E, Danon SE et al (2006) Cancer incidence and survival in European adolescents (1978–1997). Report from the Automated Childhood Cancer Information System project. Eur J Cancer Oxf Engl 1990 2(13):2006–2018. doi: 10.1016/j.ejca.2006.06.002
  8. 8.
    Patricio MB, Vilhena M, Neves M et al (1991) Ewing’s sarcoma in children: twenty-five years of experience at the Instituto Portugês de Oncologia de Francisco Gentil (I.P.O.F.G.). J Surg Oncol 47(1):37–40PubMedCrossRefGoogle Scholar
  9. 9.
    Widhe B, Widhe T (2000) Initial symptoms and clinical features in osteosarcoma and Ewing sarcoma. J Bone Joint Surg Am 82(5):667–674PubMedGoogle Scholar
  10. 10.
    Bacci G, Balladelli A, Forni C et al (2007) Ewing’s sarcoma family tumours. Differences in clinicopathological characteristics at presentation between localised and metastatic tumours. J Bone Joint Surg Br 89(9):1229–1233. doi: 10.1302/0301-620X.89B9.19422 PubMedCrossRefGoogle Scholar
  11. 11.
    Rutkowski P, Kamińska J, Kowalska M, Ruka W, Steffen J (2003) Cytokine and cytokine receptor serum levels in adult bone sarcoma patients: correlations with local tumor extent and prognosis. J Surg Oncol 84(3):151–159. doi: 10.1002/jso.10305 PubMedCrossRefGoogle Scholar
  12. 12.
    Nakamura T, Grimer RJ, Gaston CL, Watanuki M, Sudo A, Jeys L (2013) The prognostic value of the serum level of C-reactive protein for the survival of patients with a primary sarcoma of bone. Bone Jt J 95-B(3):411–418. doi: 10.1302/0301-620X.95B3.30344
  13. 13.
    Ilić I, Manojlović S, Cepulić M, Orlić D, Seiwerth S (2004) Osteosarcoma and Ewing’s sarcoma in children and adolescents: retrospective clinicopathological study. Croat Med J 45(6):740–745PubMedGoogle Scholar
  14. 14.
    Biermann JS, Adkins DR, Agulnik M et al (2013) Bone cancer. J Natl Compr Cancer Netw JNCCN 11(6):688–723Google Scholar
  15. 15.
    Suh C-H, Ordóñez NG, Hicks J, Mackay B (2002) Ultrastructure of the Ewing’s sarcoma family of tumors. Ultrastruct Pathol 26(2):67–76. doi: 10.1080/01913120252959236 PubMedCrossRefGoogle Scholar
  16. 16.
    Fellinger EJ, Garin-Chesa P, Triche TJ, Huvos AG, Rettig WJ (1991) Immunohistochemical analysis of Ewing’s sarcoma cell surface antigen p30/32MIC2. Am J Pathol 139(2):317–325PubMedCentralPubMedGoogle Scholar
  17. 17.
    Folpe AL, Goldblum JR, Rubin BP et al (2005) Morphologic and immunophenotypic diversity in Ewing family tumors: a study of 66 genetically confirmed cases. Am J Surg Pathol 29(8):1025–1033PubMedGoogle Scholar
  18. 18.
    Delattre O, Zucman J, Plougastel B et al (1992) Gene fusion with an ETS DNA-binding domain caused by chromosome translocation in human tumours. Nature 359(6391):162–165. doi: 10.1038/359162a0 PubMedCrossRefGoogle Scholar
  19. 19.
    Delattre O, Zucman J, Melot T et al (1994) The Ewing family of tumors—a subgroup of small-round-cell tumors defined by specific chimeric transcripts. N Engl J Med 331(5):294–299. doi: 10.1056/NEJM199408043310503 PubMedCrossRefGoogle Scholar
  20. 20.
    Peter M, Mugneret F, Aurias A, Thomas G, Magdelenat H, Delattre O (1996) An EWS/ERG fusion with a truncated N-terminal domain of EWS in a Ewing’s tumor. Int J Cancer J Int Cancer 67(3):339–342. doi: 10.1002/(SICI)1097-0215(19960729)67:3<339:AID-IJC6>3.0.CO;2-S CrossRefGoogle Scholar
  21. 21.
    Wang L, Bhargava R, Zheng T et al (2007) Undifferentiated small round cell sarcomas with rare EWS gene fusions: identification of a novel EWS-SP3 fusion and of additional cases with the EWS-ETV1 and EWS-FEV fusions. J Mol Diagn JMD 9(4):498–509. doi: 10.2353/jmoldx.2007.070053 CrossRefGoogle Scholar
  22. 22.
    Shulman SC, Katzenstein H, Bridge J et al (2012) Ewing sarcoma with 7;22 translocation: three new cases and clinicopathological characterization. Fetal Pediatr Pathol 31(6):341–348. doi: 10.3109/15513815.2012.659397 PubMedCrossRefGoogle Scholar
  23. 23.
    De Alava E, Kawai A, Healey JH et al (1998) EWS-FLI1 fusion transcript structure is an independent determinant of prognosis in Ewing’s sarcoma. J Clin Oncol Off J Am Soc Clin Oncol 16(4):1248–1255Google Scholar
  24. 24.
    Ginsberg JP, Alava E de, Ladanyi M et al (1999) EWS-FLI1 and EWS-ERG gene fusions are associated with similar clinical phenotypes in Ewing’s Sarcoma. J Clin Oncol 17(6):1809Google Scholar
  25. 25.
    Le Deley M-C, Delattre O, Schaefer K-L et al (2010) Impact of EWS-ETS fusion type on disease progression in Ewing’s sarcoma/peripheral primitive neuroectodermal tumor: prospective results from the cooperative Euro-E.W.I.N.G. 99 trial. J Clin Oncol Off J Am Soc Clin Oncol 28(12):1982–1988. doi: 10.1200/JCO.2009.23.3585 CrossRefGoogle Scholar
  26. 26.
    Wagner LM, Smolarek TA, Sumegi J, Marmer D (2012) Assessment of minimal residual disease in Ewing sarcoma. Sarcoma 2012:780129. doi: 10.1155/2012/780129 PubMedCentralPubMedCrossRefGoogle Scholar
  27. 27.
    Dubois SG, Epling CL, Teague J, Matthay KK, Sinclair E (2010) Flow cytometric detection of Ewing sarcoma cells in peripheral blood and bone marrow. Pediatr Blood Cancer 54(1):13–18. doi: 10.1002/pbc.22245 PubMedCentralPubMedCrossRefGoogle Scholar
  28. 28.
    Bridge RS, Rajaram V, Dehner LP, Pfeifer JD, Perry A (2006) Molecular diagnosis of Ewing sarcoma/primitive neuroectodermal tumor in routinely processed tissue: a comparison of two FISH strategies and RT-PCR in malignant round cell tumors. Mod Pathol Off J U S Can Acad Pathol Inc 19(1):1–8. doi: 10.1038/modpathol.3800486 Google Scholar
  29. 29.
    Thorner P, Squire J, Chilton-MacNeil S et al (1996) Is the EWS/FLI-1 fusion transcript specific for Ewing sarcoma and peripheral primitive neuroectodermal tumor? A report of four cases showing this transcript in a wider range of tumor types. Am J Pathol 148(4):1125–1138PubMedCentralPubMedGoogle Scholar
  30. 30.
    Kuleta-Bosak E, Kluczewska E, Machnik-Broncel J et al (2010) Suitability of imaging methods (X-ray, CT, MRI) in the diagnostics of Ewing’s sarcoma in children—analysis of own material. Pol J Radiol Pol Med Soc Radiol 75(1):18–28Google Scholar
  31. 31.
    Peersman B, Vanhoenacker FM, Heyman S et al (2007) Ewing’s sarcoma: imaging features. JBR-BTR Organe Société R Belge Radiol SRBR Orgaan Van K Belg Ver Voor Radiol KBVR 90(5):368–376Google Scholar
  32. 32.
    Van der Woude HJ, Bloem JL, Hogendoorn PC (1998) Preoperative evaluation and monitoring chemotherapy in patients with high-grade osteogenic and Ewing’s sarcoma: review of current imaging modalities. Skeletal Radiol 27(2):57–71PubMedCrossRefGoogle Scholar
  33. 33.
    Eary JF, Mankoff DA (1998) Tumor metabolic rates in sarcoma using FDG PET. J Nucl Med Off Publ Soc Nucl Med 39(2):250–254Google Scholar
  34. 34.
    Eary JF, O’Sullivan F, Powitan Y et al (2002) Sarcoma tumor FDG uptake measured by PET and patient outcome: a retrospective analysis. Eur J Nucl Med Mol Imaging 29(9):1149–1154. doi: 10.1007/s00259-002-0859-5 PubMedCrossRefGoogle Scholar
  35. 35.
    Sharma P, Khangembam BC, Suman KCS et al (2013) Diagnostic accuracy of 18F-FDG PET/CT for detecting recurrence in patients with primary skeletal Ewing sarcoma. Eur J Nucl Med Mol Imaging 40(7):1036–1043. doi: 10.1007/s00259-013-2388-9 PubMedCrossRefGoogle Scholar
  36. 36.
    Newman EN, Jones RL, Hawkins DS (2013) An evaluation of [F-18]-fluorodeoxy-D-glucose positron emission tomography, bone scan, and bone marrow aspiration/biopsy as staging investigations in Ewing sarcoma. Pediatr Blood Cancer 60(7):1113–1117. doi: 10.1002/pbc.24406 PubMedCrossRefGoogle Scholar
  37. 37.
    Treglia G, Salsano M, Stefanelli A, Mattoli MV, Giordano A, Bonomo L (2012) Diagnostic accuracy of 18F-FDG-PET and PET/CT in patients with Ewing sarcoma family tumours: a systematic review and a meta-analysis. Skeletal Radiol 41(3):249–256. doi: 10.1007/s00256-011-1298-9 PubMedCrossRefGoogle Scholar
  38. 38.
    Kumar J, Seith A, Kumar A et al (2008) Whole-body MR imaging with the use of parallel imaging for detection of skeletal metastases in pediatric patients with small-cell neoplasms: comparison with skeletal scintigraphy and FDG PET/CT. Pediatr Radiol 38(9):953–962. doi: 10.1007/s00247-008-0921-y PubMedCrossRefGoogle Scholar
  39. 39.
    Franzius C, Sciuk J, Daldrup-Link HE, Jürgens H, Schober O (2000) FDG-PET for detection of osseous metastases from malignant primary bone tumours: comparison with bone scintigraphy. Eur J Nucl Med 27(9):1305–1311PubMedCrossRefGoogle Scholar
  40. 40.
    Chan RC, Sutow WW, Lindberg RD, Samuels ML, Murray JA, Johnston DA (1979) Management and results of localized Ewing’s sarcoma. Cancer 43(3):1001–1006PubMedCrossRefGoogle Scholar
  41. 41.
    Enneking WF, Spanier SS, Goodman MA (1980) A system for the surgical staging of musculoskeletal sarcoma. Clin Orthop 153:106–120PubMedGoogle Scholar
  42. 42.
    American Joint Committee on Cancer (2010) AJCC cancer staging manual, 7th edn. Springer, New YorkGoogle Scholar
  43. 43.
    Sutow WW, Sullivan MP (1962) Cyclophosphamide therapy in children with Ewing’s sarcoma. Cancer Chemother Rep 23:55–60PubMedGoogle Scholar
  44. 44.
    Pinkel D (1962) Cyclophosphamide in children with cancer. Cancer 15:42–49PubMedCrossRefGoogle Scholar
  45. 45.
    Donaldson SS, Torrey M, Link MP et al (1998) A multidisciplinary study investigating radiotherapy in Ewing’s sarcoma: end results of POG #8346. Pediatric Oncology Group. Int J Radiat Oncol Biol Phys 42(1):125–135PubMedCrossRefGoogle Scholar
  46. 46.
    Bacci G, Toni A, Avella M et al (1989) Long-term results in 144 localized Ewing’s sarcoma patients treated with combined therapy. Cancer 63(8):1477–1486PubMedCrossRefGoogle Scholar
  47. 47.
    Bacci G, Ferrari S, Avella M et al (1991) Non-metastatic Ewing’s sarcoma: results in 98 patients treated with neoadjuvant chemotherapy. Ital J Orthop Traumatol 17(4):449–465PubMedGoogle Scholar
  48. 48.
    Nesbit ME Jr, Gehan EA, Burgert EO Jr et al (1990) Multimodal therapy for the management of primary, nonmetastatic Ewing’s sarcoma of bone: a long-term follow-up of the First Intergroup study. J Clin Oncol Off J Am Soc Clin Oncol. 8(10):1664–1674Google Scholar
  49. 49.
    Grier HE, Krailo MD, Tarbell NJ et al (2003) Addition of ifosfamide and etoposide to standard chemotherapy for Ewing’s sarcoma and primitive neuroectodermal tumor of bone. N Engl J Med 348(8):694–701. doi: 10.1056/NEJMoa020890 PubMedCrossRefGoogle Scholar
  50. 50.
    Miser JS, Krailo MD, Tarbell NJ et al (2004) Treatment of metastatic Ewing’s sarcoma or primitive neuroectodermal tumor of bone: evaluation of combination ifosfamide and etoposide—a Children’s Cancer Group and Pediatric Oncology Group study. J Clin Oncol Off J Am Soc Clin Oncol. 22(14):2873–2876. doi: 10.1200/JCO.2004.01.041 CrossRefGoogle Scholar
  51. 51.
    Laurence V, Pierga J-Y, Barthier S et al (2005) Long-term follow up of high-dose chemotherapy with autologous stem cell rescue in adults with Ewing tumor. Am J Clin Oncol 28(3):301–309PubMedCrossRefGoogle Scholar
  52. 52.
    Kushner BH, Meyers PA (2001) How effective is dose-intensive/myeloablative therapy against Ewing’s sarcoma/primitive neuroectodermal tumor metastatic to bone or bone marrow? The Memorial Sloan-Kettering experience and a literature review. J Clin Oncol Off J Am Soc Clin Oncol 19(3):870–880Google Scholar
  53. 53.
    Navid F, Santana VM, Billups CA et al (2006) Concomitant administration of vincristine, doxorubicin, cyclophosphamide, ifosfamide, and etoposide for high-risk sarcomas: the St Jude Children’s Research Hospital experience. Cancer 106(8):1846–1856. doi: 10.1002/cncr.21810 PubMedCrossRefGoogle Scholar
  54. 54.
    Womer RB, Daller RT, Fenton JG, Miser JS (2000) Granulocyte colony stimulating factor permits dose intensification by interval compression in the treatment of Ewing’s sarcomas and soft tissue sarcomas in children. Eur J Cancer Oxf Engl 1990 36(1):87–94Google Scholar
  55. 55.
    Ludwig JA (2008) Ewing sarcoma: historical perspectives, current state-of-the-art, and opportunities for targeted therapy in the future. Curr Opin Oncol 20(4):412–418. doi: 10.1097/CCO.0b013e328303ba1d PubMedCrossRefGoogle Scholar
  56. 56.
    Lissat A, Chao MM, Kontny U (2012) Targeted therapy in Ewing sarcoma. ISRN Oncol 2012:609439. doi: 10.5402/2012/609439 PubMedCentralPubMedGoogle Scholar
  57. 57.
    Olmos D, Postel-Vinay S, Molife LR et al (2010) Safety, pharmacokinetics, and preliminary activity of the anti-IGF-1R antibody figitumumab (CP-751, 871) in patients with sarcoma and Ewing’s sarcoma: a phase 1 expansion cohort study. Lancet Oncol 11(2):129–135. doi: 10.1016/S1470-2045(09)70354-7 PubMedCentralPubMedCrossRefGoogle Scholar
  58. 58.
    Bond M, Bernstein ML, Pappo A et al (2008) A phase II study of imatinib mesylate in children with refractory or relapsed solid tumors: a Children’s Oncology Group study. Pediatr Blood Cancer 50(2):254–258. doi: 10.1002/pbc.21132 PubMedCrossRefGoogle Scholar
  59. 59.
    Donaldson SS (2004) Ewing sarcoma: radiation dose and target volume. Pediatr Blood Cancer 42(5):471–476. doi: 10.1002/pbc.10472 PubMedCrossRefGoogle Scholar
  60. 60.
    Dalinka MK, Edeiken J, Finkelstein JB (1974) Complications of radiation therapy: adult bone. Semin Roentgenol 9(1):29–40PubMedCrossRefGoogle Scholar
  61. 61.
    Cotterill SJ, Ahrens S, Paulussen M et al (2000) Prognostic factors in Ewing’s tumor of bone: analysis of 975 patients from the European Intergroup Cooperative Ewing’s Sarcoma Study Group. J Clin Oncol Off J Am Soc Clin Oncol 18(17):3108–3114Google Scholar
  62. 62.
    Yang RS, Eckardt JJ, Eilber FR et al (1995) Surgical indications for Ewing’s sarcoma of the pelvis. Cancer 76(8):1388–1397PubMedCrossRefGoogle Scholar
  63. 63.
    Frassica FJ, Frassica DA, Pritchard DJ, Schomberg PJ, Wold LE, Sim FH (1993) Ewing sarcoma of the pelvis. Clinicopathological features and treatment. J Bone Joint Surg Am 75(10):1457–1465PubMedGoogle Scholar
  64. 64.
    Thorpe SW, Weiss KR, Goodman MA, Heyl AE, McGough RL (2012) Should aggressive surgical local control be attempted in all patients with metastatic or pelvic Ewing’s sarcoma? Sarcoma 2012:953602. doi: 10.1155/2012/953602 PubMedCentralPubMedCrossRefGoogle Scholar
  65. 65.
    Puri A, Gulia A, Jambhekar NA, Laskar S (2012) Results of surgical resection in pelvic Ewing’s sarcoma. J Surg Oncol 106(4):417–422. doi: 10.1002/jso.23107 PubMedCrossRefGoogle Scholar
  66. 66.
    Donati D, Yin J, Di Bella C et al (2007) Local and distant control in non-metastatic pelvic Ewing’s sarcoma patients. J Surg Oncol 96(1):19–25. doi: 10.1002/jso.20752 PubMedCrossRefGoogle Scholar
  67. 67.
    Sucato DJ, Rougraff B, McGrath BE et al (2000) Ewing’s sarcoma of the pelvis. Long-term survival and functional outcome. Clin Orthop 373:193–201PubMedCrossRefGoogle Scholar
  68. 68.
    Bacci G, Ferrari S, Longhi A et al (2004) Role of surgery in local treatment of Ewing’s sarcoma of the extremities in patients undergoing adjuvant and neoadjuvant chemotherapy. Oncol Rep 11(1):111–120PubMedGoogle Scholar
  69. 69.
    Sluga M, Windhager R, Lang S et al (2001) The role of surgery and resection margins in the treatment of Ewing’s sarcoma. Clin Orthop 392:394–399PubMedCrossRefGoogle Scholar
  70. 70.
    Henderson ER, Groundland JS, Pala E et al (2011) Failure mode classification for tumor endoprostheses: retrospective review of five institutions and a literature review. J Bone Joint Surg Am 93(5):418–429. doi: 10.2106/JBJS.J.00834 PubMedCrossRefGoogle Scholar
  71. 71.
    Horowitz SM, Glasser DB, Lane JM, Healey JH (1993) Prosthetic and extremity survivorship after limb salvage for sarcoma. How long do the reconstructions last? Clin Orthop 293:280–286PubMedGoogle Scholar
  72. 72.
    Malawer MM, Chou LB (1995) Prosthetic survival and clinical results with use of large-segment replacements in the treatment of high-grade bone sarcomas. J Bone Joint Surg Am 77(8):1154–1165PubMedGoogle Scholar
  73. 73.
    Mankin HJ, Gebhardt MC, Jennings LC, Springfield DS, Tomford WW (1996) Long-term results of allograft replacement in the management of bone tumors. Clin Orthop 324:86–97PubMedCrossRefGoogle Scholar
  74. 74.
    Berrey BH Jr, Lord CF, Gebhardt MC, Mankin HJ (1990) Fractures of allografts. Frequency, treatment, and end-results. J Bone Joint Surg Am 72(6):825–833Google Scholar
  75. 75.
    Getty PJ, Peabody TD (1999) Complications and functional outcomes of reconstruction with an osteoarticular allograft after intra-articular resection of the proximal aspect of the humerus. J Bone Joint Surg Am 81(8):1138–1146PubMedGoogle Scholar
  76. 76.
    Hong AM, Millington S, Ahern V et al (2013) Limb preservation surgery with extracorporeal irradiation in the management of malignant bone tumor: the oncological outcomes of 101 patients. Ann Oncol Off J Eur Soc Med Oncol ESMO 24(10):2676–2680. doi: 10.1093/annonc/mdt252 CrossRefGoogle Scholar
  77. 77.
    Benedetti MG, Bonatti E, Malfitano C, Donati D (2013) Comparison of allograft-prosthetic composite reconstruction and modular prosthetic replacement in proximal femur bone tumors: functional assessment by gait analysis in 20 patients. Acta Orthop 84(2):218–223. doi: 10.3109/17453674.2013.773119 PubMedCentralPubMedCrossRefGoogle Scholar
  78. 78.
    Donati D, Di Bella C, Frisoni T, Cevolani L, DeGroot H (2011) Alloprosthetic composite is a suitable reconstruction after periacetabular tumor resection. Clin Orthop 469(5):1450–1458. doi: 10.1007/s11999-011-1799-9 PubMedCentralPubMedCrossRefGoogle Scholar
  79. 79.
    Bölling T, Schuck A, Paulussen M et al (2008) Whole lung irradiation in patients with exclusively pulmonary metastases of Ewing tumors. Toxicity analysis and treatment results of the EICESS-92 trial. Strahlenther Onkol Organ Dtsch Röntgenges Al 4(4):193–197. doi: 10.1007/s00066-008-1810-x
  80. 80.
    Rodríguez-Galindo C, Navid F, Liu T, Billups CA, Rao BN, Krasin MJ (2008) Prognostic factors for local and distant control in Ewing sarcoma family of tumors. Ann Oncol Off J Eur Soc Med Oncol ESMO 19(4):814–820. doi: 10.1093/annonc/mdm521 CrossRefGoogle Scholar
  81. 81.
    Ahrens S, Hoffmann C, Jabar S et al (1999) Evaluation of prognostic factors in a tumor volume-adapted treatment strategy for localized Ewing sarcoma of bone: the CESS 86 experience. Cooperative Ewing Sarcoma Study. Med Pediatr Oncol 32(3):186–195PubMedCrossRefGoogle Scholar
  82. 82.
    Lee J, Hoang BH, Ziogas A, Zell JA (2010) Analysis of prognostic factors in Ewing sarcoma using a population-based cancer registry. Cancer 116(8):1964–1973. doi: 10.1002/cncr.24937 PubMedCrossRefGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2014

Authors and Affiliations

  1. 1.Department of Orthopedic Surgery and Rehabilitation MedicineThe University of ChicagoChicagoUSA

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