We review the treatment of pelvic Ewing's sarcoma by the implantation of extracorporeallyirradiated (ECI) autografts and compare the outcome with that of other reported methods. We treated 13 patients with ECI autografts between 1994 and 2004. There were seven males and six females with a median age of 15.7 years (interquartile range (IQR) 12.2 to 21.7). At a median follow-up of five years (IQR 1.8 to 7.4), the disease-free survival was 69% overall, and 75% if one patient with local recurrence

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... fter initial treatment elsewhere was excluded. Four patients died from distant metastases at a mean of 17 months (13 to 23). There were three complications which required operative intervention; one was a deep infection which required removal of the graft. The functional results gave a mean Musculoskeletal Tumor Society score of 85% (60% to 97%), a mean Toronto extremity salvage score of 86% (69% to 100%) and a mean Harris hip score of 92 (67 to 100). We conclude that ECI grafting is a suitable form of treatment for localised and resectable pelvic Ewing's sarcoma. Ewing's sarcoma is the second most common primary malignant bone tumour in children and adolescents and the fourth most common primary malignant bone tumour overall. 1,2 The pelvis is the most common site for primary malignant bone tumours (5% to 15%), and particularly for Ewing's sarcoma in young adults. [2] [3] [4] [5] [6] [7] [8] [9] [10] [11] Advances in multimodal treatments have improved the survival rates at five years from 5% to 10% 20 years ago to 60% to 75% most recently. 2, 7, 11, 12 The prognosis for Ewing's sarcoma is poorest in the pelvis, 2-5,7,13 with a survival rate at five years of approximately 50%. 7, 14, 15 The pelvis is a deep organ with poor compartmentalisation for the restriction of tumour growth, and a complicated anatomy with major neurovascular and visceral structures. It is difficult to achieve local control, limb salvage and preservation of function.