Files of 133 children with Ewing sarcoma (median age 10 years) were reviewed. 
Frequent primary sites were extremities, trunk, pelvis, and cranium. Half of 43 
patients with metastases had disease in the lungs. Ten-year overall and 
event-free survival rates were 31% and 19%, respectively. Five-year overall 
survival rates were 42% in localized and 15% in metastatic disease (p < .0001); 
66% in cases with primary tumors < 8 cm and 29% in larger tumors (p = .013). VAC 
(vincristine, actinomycin D, and cyclophosphamide) regimens with anthracyclines 
resulted in better survival. Presence of distant metastases, large primary 
tumors, and pelvic localization were related to poor prognosis. Novel 
therapeutic approaches are needed to produce better results, especially in 
high-risk patients.