Spontaneous conception and pregnancy outcomes after multi-agent chemotherapy and high-dose radiotherapy for pelvic Ewing sarcoma: Case report and literature review

Ewing sarcoma is an aggressive, rare bone and soft tissue malignancy, often affecting the long bones and pelvis. A woman was diagnosed with Ewing sarcoma of the left pelvis at 18 years of age. She underwent left paravesical lesion resection with ipsilateral ureteral reimplantation and received combined multi-agent chemotherapy and high-dose pelvic radiotherapy. A gonadotropin-releasing hormone analog was administered to preserve ovarian function. The patient received oral contraceptives as hormone replacement therapy due to secondary amenorrhea. She spontaneously conceived after the withdrawal of oral contraceptives at 24 years. The pregnancy was complicated by early third-trimester impaired fetal growth and preterm premature rupture of membranes at 32 weeks of pregnancy. Spontaneous preterm labor started and the patient delivered vaginally at 34 weeks, without any complications. Including our report, only 10 cases of pregnancy after pelvic Ewing sarcoma are reported in the literature. Pregnancy and delivery can be achieved after combined pelvic treatment for Ewing sarcoma, taking into account possible obstetric risks and complications. Complex bone surgery is associated with cesarean delivery, but previous high-dose pelvic irradiation does not seem to affect mode of delivery. Our report provides further information on perinatal management, given the cases previously described.