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Article Open Access

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

  • Authors:
    • Noriko Kato
    • Takashi Yanagawa
    • Masahiko Okamoto
    • Tatsuya Ohno
    • Hirotaka Chikuda
  • View Affiliations / Copyright

    Affiliations: Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, Maebashi, Gunma 371‑8511, Japan, Gunma University Heavy Ion Medical Center, Gunma University, Maebashi, Gunma 371‑8511, Japan
    Copyright: © Kato et al. This is an open access article distributed under the terms of Creative Commons Attribution License.
  • Article Number: 424
    |
    Published online on: July 23, 2026
       https://doi.org/10.3892/ol.2026.15779
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Abstract

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.
View Figures

Figure 1

A 75-year-old man with Ewing sarcoma
of the right shoulder (case 1). MRI showed (A) a scapular lesion
invading the scapulothoracic joint (arrows) and infraspinatus
muscle in the axial plane on T2-weighted images and (B) extending
into the subacromial space (an arrow) in the coronal plane on short
tau inversion recovery sequences. There were no local recurrences
on (C) contrast-enhanced MRI and (D) positron emission
tomography-computed tomography at 2 years post-treatment. MRI,
magnetic resonance imaging.

Figure 2

A 40-year-old man with Ewing sarcoma
of the left scapula (case 2). (A) MRI and (B) positron emission
tomography-computed tomography revealed a tumor that invaded both
the ventral (arrows) and dorsal (arrowheads) aspects of the left
scapula. (C) Contrast-enhanced MRI showed no local recurrence 2
years after the treatment. MRI, magnetic resonance imaging.

Figure 3

A 32-year-old woman with Ewing sarcoma
of the right scapula (case 3). (A) The tumor with unclear borders
presented invasion into the dorsal cortex of the scapula on
magnetic resonance imaging. (B) Positron emission
tomography-computed tomography showed high accumulation of the
tracer in the tumor of the scapula. (C) Lateral elevation of the
shoulder was preserved 2 years after the radiotherapy.

Figure 4

Pathological findings of case 3. (A)
The pathological findings on hematoxylin and eosin staining were
compatible with Ewing sarcoma showing diffuse proliferation of
small round tumor cells with rosette like formation (scale bar, 50
µm). Immunohistochemical staining demonstrated a diffuse membranous
expression of (B) CD99 and (C) Cyclin D1 (scale bars, 100 µm).
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Copy and paste a formatted citation
Spandidos Publications style
Kato N, Yanagawa T, Okamoto M, Ohno T and Chikuda H: Evaluation of limb function after treatment with chemotherapy and carbon ion radiotherapy for Ewing sarcoma of the scapula: A report of three cases . Oncol Lett 32: 424, 2026.
APA
Kato, N., Yanagawa, T., Okamoto, M., Ohno, T., & Chikuda, H. (2026). Evaluation of limb function after treatment with chemotherapy and carbon ion radiotherapy for Ewing sarcoma of the scapula: A report of three cases . Oncology Letters, 32, 424. https://doi.org/10.3892/ol.2026.15779
MLA
Kato, N., Yanagawa, T., Okamoto, M., Ohno, T., Chikuda, H."Evaluation of limb function after treatment with chemotherapy and carbon ion radiotherapy for Ewing sarcoma of the scapula: A report of three cases ". Oncology Letters 32.4 (2026): 424.
Chicago
Kato, N., Yanagawa, T., Okamoto, M., Ohno, T., Chikuda, H."Evaluation of limb function after treatment with chemotherapy and carbon ion radiotherapy for Ewing sarcoma of the scapula: A report of three cases ". Oncology Letters 32, no. 4 (2026): 424. https://doi.org/10.3892/ol.2026.15779
Copy and paste a formatted citation
x
Spandidos Publications style
Kato N, Yanagawa T, Okamoto M, Ohno T and Chikuda H: Evaluation of limb function after treatment with chemotherapy and carbon ion radiotherapy for Ewing sarcoma of the scapula: A report of three cases . Oncol Lett 32: 424, 2026.
APA
Kato, N., Yanagawa, T., Okamoto, M., Ohno, T., & Chikuda, H. (2026). Evaluation of limb function after treatment with chemotherapy and carbon ion radiotherapy for Ewing sarcoma of the scapula: A report of three cases . Oncology Letters, 32, 424. https://doi.org/10.3892/ol.2026.15779
MLA
Kato, N., Yanagawa, T., Okamoto, M., Ohno, T., Chikuda, H."Evaluation of limb function after treatment with chemotherapy and carbon ion radiotherapy for Ewing sarcoma of the scapula: A report of three cases ". Oncology Letters 32.4 (2026): 424.
Chicago
Kato, N., Yanagawa, T., Okamoto, M., Ohno, T., Chikuda, H."Evaluation of limb function after treatment with chemotherapy and carbon ion radiotherapy for Ewing sarcoma of the scapula: A report of three cases ". Oncology Letters 32, no. 4 (2026): 424. https://doi.org/10.3892/ol.2026.15779
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