Are Pathological Fractures in Patients with Ewing Sarcoma Associated with Worse Survival Outcomes?

Objectives Pathological fractures occur in 5–10% of patients with Ewing sarcoma and may disseminate tumor cells from the fractured bone, potentially affecting the treatment strategy. This study analyzed the clinical course of patients with pathological fractures of Ewing sarcoma using propensity score matching to minimize selection bias. Methods This retrospective study assessed the outcomes from 2003 to 2020. Among the 437 patients with Ewing sarcoma, 12 had pathological fractures of the extremities. For comparison with patients without pathological fractures, a 1:3 propensity score-matched control group (n = 36, adjusted group) was used. Results Among the 12 patients, limb-sparing surgery was performed in 11 patients (91.7%), and limb salvage was achieved in 10 patients (83.3%). Three-year overall survivals were 75.0% in patients with pathological fractures and 66.4% in the adjusted group (p = 0.29). Local recurrence was observed in two patients (16.7%) in the pathological fracture group; both had a poor histologic response (25% and 40%). Conclusion Pathological fractures in Ewing sarcoma were not associated with worse oncological outcomes, even after propensity score matching. Limb-sparing surgery may be a reasonable treatment option when preoperative chemotherapy is effective in patients with pathological fractures.