Introduction and Aims: Multimodal treatment has dramatically improved the outcome of patients with Ewing’s sarcoma. However, little is known about treatment-related complications in patients who are long-term survivors.

Method: Forty-one patients with Ewing’s sarcoma treated at the authors’ institution between 1963 and 1980 and who survived by at least 20 years were included in this study. This patient group comprises 17 men and 24 women. The mean age at presentation was 16.8 (range five to 51) years. Three patients presented with metastatic disease. The location included 14 axial, and 27 appendicular lesions. All but nine patients had chemotherapy as part of their multimodality treatment.

Results: The overall follow-up averaged 297 (range 240–430) months. All except one patient were alive at final follow-up, the latter dying of radiotherapy-induced secondary malignancy after 33 years. Five patients survived, despite developing local recurrence or metastatic disease. Only 16 (39%) patients were free of any complication. These included metastases (12%), local recurrence (7%), secondary malignancies (7%), pathologic fractures (20%), and radiation (32%), and chemotherapy-associated morbidities (20%). The complication rate in this series of long-term survivors treated prior to 1980 is surprisingly high. Current treatment advances should result in improved long-term results.

Conclusion: Even when patients with Ewing’s sarcoma survive the primary cancer, only a minority of them remain without treatment-associated morbidities.

Introduction and Aims: Sacrococcygeal chordoma presents a difficult diagnostic and therapeutic problem with a high incidence of local recurrence. The report aims to define the importance of adequate surgical treatment on outcome and survival.

Method: Fifty-eight patients underwent surgical treatment for sacrococcygeal chordoma between 1979 and 2001. The series included 19 women and 39 men with an average age of 56.2 (range 13–76) years at diagnosis. Depending on the level and extent of the lesion, a posterior approach was performed in 25 patients, and a combined antero-posterior approach in 33 patients. A wide surgical margin was achieved in 22 patients, 14 marginal and 22 intralesional.

Results: At average follow-up of 92.2 (range 18–276) months. Thirty-three patients were alive with no evidence of disease. Twenty-one patients had local recurrence. Recurrence-free survival at five years was 67% and at 10 years 57%. The overall survival was 74%, 51%, 42% at five years, 10 years, and 15 years, respectively. All patients with wide margins survived (100%), which was significantly different from patients who had either marginal or intralesional excision (p=0.0001). The type of surgical approach (p=0.138) does not influence the likelihood to obtain a good margin, although patients with wide margins were also more likely to have small tumors. A wide margin was achieved in 48% using a combined antero-posterior approach, whereas this was the case only in 29% using a posterior approach. Tumor volume univariately assessed, however, does not seem to compromise the possibility of obtaining a wide margin (p=0.21). Multivariate analysis identified – in contrast to tumor volume (p=0.13) – margin (p=0.0001) and age (p=0.04) as predictors of survival. Whereas survival is independent of age in the case with wide margins, patients with marginal or intralesional margins and an age above 60 years have a better survival (43% at 10 years) than patients younger than 60 years with those parameters (20% at 10 years; p=0.0776).

Conclusion: A wide margin is the most important predictor of survival in patients with sacrococcygeal chordoma. Tumor volume per se has no negative impact on survival as long as a wide margin is obtained. Therefore, for large tumors and tumors above S3 we prefer combined antero-posterior approach. If a wide margin cannot be obtained, then young patients have a worse prognosis than older patients.