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

Sep 28, 2026

Ewing’s sarcoma is an uncommon, aggressive malignancy of bone and soft tissue that mainly affects adolescents and young adults. Chest wall involvement is rare but creates distinctive surgical and oncologic challenges. The report describes a 17-year-old male with thoracic pain and swelling; imaging showed a posterior chest wall mass consistent with Ewing’s sarcoma. He received extensive multi-line chemotherapy after rib-involving surgical resection, yet developed rapid progression with spinal canal involvement and pleural metastases, followed by systemic decline, recurrent infections, and death in August 2024.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages6

Reading Time15 min

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Abstract

Introduction

Case Presentation

Initial presentation and diagnostic workup

Review began 11/16/2025 Review ended 11/25/2025 Published 11/30/2025 © Copyright 2025 AlRefaie et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CCBY 4.0. , which permits unrestricted use , distribution , and reproduction in any medium , provided the original author and source are credited. DOI: 10.7759/cureus.98192 Open Access Case Report Recurrent Ewing’s Sarcoma of the Chest Wall inan Adolescent Male Patient: A Complex Multimodal Management and Progressive Disease Course Asmaa M. AlRefaie 1, 2, Salma Almarwani 2, Renad Alshaikh 2 , Muḥammad Alfattani 3 1. Department of Family Medicine, National Guard Hospital, Jeddah, SAU 2. College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU 3. Department of Pediatrics, Maternity and Children 's Hospital, Makkah, SAU Corresponding author: Salma Almarwani, [salmaaalmarwani@gmail.com](salmaaalmarwani@gmail.com) Abstract 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. Categories: Family/General Practice, Radiation Oncology Keywords: adolescent oncology, chemotherapy resistance, recurrence, supportive and palliative care, thoracic ewing 's sarcoma Introduction Ewing’s sarcoma is a highly malignant small round-cell tumor characterized by aggressive local invasion and early metastatic potential. It primarily affects long bones and the pelvis but may also arise in the chest wall, where the entity is specifically termed Askin’s tumor [1] . The disease predominantly affects adolescents and young adults, with most cases occurring before the age of 20, and it accounts for approximately 4% of pediatric malignancies. Despite its rarity, Ewing’s sarcoma carries substantial clinical impact due to its rapid progression, high recurrence rate, and the intensive multimodal therapy required for management [2] . Standard treatment consists of neoadjuvant chemotherapy, wide surgical resection, and adjuvant radiotherapy, an approach that has significantly improved outcomes over recent decades [1,2] . However, recurrence remains a major therapeutic challenge. Patients with chest wall primaries face particularly poor prognoses because complete margin-negative resection is often difficult due to the proximity of tumors to vital mediastinal structures [1,3] . In addition, data from the Euro-EWING trials and subsequent multicenter analyses have shown that recurrent or refractory disease is associated with markedly inferior survival, reflecting both biological aggressiveness and therapeutic resistance [4,5] . Recent studies demonstrate that relapsed Ewing’s sarcoma often exhibits chemoresistance and follows heterogeneous relapse patterns, especially when the initial disease presents with

FAQs

Why is chest wall involvement in Ewing’s sarcoma clinically challenging?

Although uncommon, chest wall involvement presents unique surgical and oncologic challenges, particularly because complete margin-negative resection can be difficult near vital mediastinal structures.

What treatment sequence was used in this case?

The patient underwent surgical resection with rib removal, followed by multiple chemotherapy regimens across many cycles, including VAC/IE, cyclophosphamide/topotecan, EVAIA, and gemcitabine/docetaxel.

How did the disease progress despite multimodal therapy?

Despite aggressive treatment, the disease showed rapid progression with extensive local invasion, spinal canal involvement, and pleural metastases, later leading to systemic progression, recurrent infections, and death in August 2024.

Sep 28, 2026

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