Recurrent Ewing's Sarcoma of the Chest Wall in an Adolescent Male Patient: A Complex Multimodal Management and Progressive Disease Course.

Ewing's sarcoma is a rare, aggressive malignant tumor of bone and soft tissue that predominantly affects adolescents and young adults. Chest wall involvement, though uncommon, presents unique surgical and oncologic challenges. We report a 17-year-old male patient who initially presented with thoracic pain and swelling. Imaging revealed a posterior chest wall mass consistent with Ewing's sarcoma. He underwent surgical resection with rib removal, followed by multiple lines of chemotherapy (vincristine, adriamycin (doxorubicin), and cyclophosphamide/ifosfamide and etoposide (VAC/IE) ×15 cycles; cyclophosphamide/topotecan ×4 cycles; etoposide, vincristine, adriamycin (doxorubicin), ifosfamide, and actinomycin D (EVAIA) ×2 cycles; and gemcitabine/docetaxel ×3 cycles). Despite aggressive multimodal therapy, the disease demonstrated rapid progression with extensive local invasion, spinal canal involvement, and pleural metastases. The patient ultimately developed systemic progression with recurrent infections and succumbed to his disease in August 2024. This case highlights the aggressive nature and chemoresistance of recurrent Ewing's sarcoma, emphasizing the importance of multidisciplinary care and early palliative involvement in advanced stages.