Ewing’s sarcoma Ewing’s sarcoma is the second most common malignant bone tumor in children, most often occurring in adolescents between the ages of 5 and 20, and more often in males than females. The annual incidence of Ewing’s sarcoma is approximately 0.6 per million population, with a relatively high incidence in Caucasians and a low incidence in the Chinese population. The tumor can be located in any part of any bone, with most of them located in the femur, tibia, humerus, and pelvis. Treatment with a combination of preoperative adjuvant chemotherapy, followed by local surgical resection and radiotherapy, and continued postoperative chemotherapy has led to a significant improvement in the 5-year survival rate of patients. However, some patients still die from disease progression. For patients with recurrence and metastasis after treatment, improving their survival rate is the focus of current treatment research. 1. Treatment of local lesions Treatment for localized Ewing sarcoma should include systematic chemotherapy and local surgery or radiation therapy. Currently, chemotherapy for Ewing sarcoma mainly uses adriamycin, vincristine, cyclophosphamide, actinomycin-D, and isocyclophosphamide, etoposide, etc. Adriamycin has an important place in the treatment. In the past, it was considered that the indications for surgical treatment of localized lesions were that the surgery would not lead to severe dysfunction and that no special reconstruction was required after surgery, but nowadays it is considered that surgery should be performed for all tumor lesions that can be completely resected. There are no randomized experimental studies on the exact efficacy of surgical treatment, and the available experimental results are highly biased because surgically treated patients tend to have small, peripheral tumor lesions, while non-surgically treated patients tend to have larger, deeper lesions that are difficult to operate before choosing radiotherapy. The possible advantage of surgical treatment is that it removes the primary lesion and reduces the possibility of recurrence and metastasis, but if there are still surviving tumor cells at the edge of surgical resection, their prognosis is poor. The improvement of modern imaging techniques, such as the application of 3D CT and MRI, facilitates the preoperative development of a reasonable surgical approach to remove the tumor as much as possible. The effect of surgical treatment of Ewing sarcoma is not yet certain, and the current preference is for surgery to treat lesions that can be completely removed locally, but the issue of functional reconstruction after surgery also deserves our further study. The use of adjuvant chemotherapy has significantly improved the survival rate of patients, and the problems of local recurrence, secondary sarcoma and local dysfunction after radiotherapy have also emerged one after another. 2. Treatment of patients with recurrence and metastasis Patients with recurrence of Ewing sarcoma have a poor prognosis, especially those who develop recurrence early in the disease or have multiple local and distant recurrent foci. The prognosis is better for those who relapse two years after the diagnosis of the disease, who can be treated surgically, and who are sensitive to high-dose chemotherapy. Treatment of relapsed patients should be based on recurrence and previous treatment to develop a new treatment plan. Radiation therapy is effective for localized lesions, while surgical resection is usually the treatment of choice for lesions in the lungs.