Evaluation of limb function after treatment with chemotherapy and carbon ion radiotherapy for Ewing sarcoma of the scapula: A report of three cases.

Ewing sarcoma is a rare malignant tumor that tends to occur in children and adolescents; it usually arises from the pelvis and extremities, whereas it rarely originates from the scapula. The present study describes the treatment of three patients with Ewing sarcoma of the scapula using chemotherapy and carbon ion radiotherapy (CIRT), evaluating their oncological outcome and shoulder function. Three patients with Ewing sarcoma of the scapula were treated at the Gunma Prefectural Cancer Center (Ota, Japan) and Gunma University Heavy Ion Medical Center (Maebashi, Japan) with chemotherapy and CIRT. Case 1 was a 75-year-old man who presented with a scapular lesion infiltrating the anterior, posterior and superior aspects. A total of 2 years and 6 months after treatment, the patient showed no evidence of the disease, although they had a limited range of motion in their shoulder and a Musculoskeletal Tumor Society (MSTS) score of 70%. Case 2 was a 40-year-old man who presented with a scapular tumor invading the anterior and posterior aspects, while sparing the subacromial space and glenohumeral joints. A total of 2 years and 6 months after treatment, the patient remained disease-free with an MSTS score of 87%. Case 3 was a 32-year-old woman who presented with a scapular lesion that extended into the infraspinatus and latissimus dorsi muscles, and with multiple lung metastases. During treatment, the patient experienced radiation recall dermatitis, which was treated with opioids and steroids. A total of 3 years after treatment, the patient had an excellent range of motion in the shoulder joint, with an MSTS score of 87%, although lung metastases persisted. In conclusion, CIRT may be considered an acceptable treatment modality for Ewing sarcoma of the scapula and may possibly be used as an alternative to surgery.