Hubert Y Pan1, Ajaykumar Morani2, Wei-Lien Wang3, Kenneth R Hess4, Arnold C Paulino1, Joseph A Ludwig5, Patrick P Lin6, Najat C Daw7, Anita Mahajan8. 1. Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas. 2. Department of Radiology, The University of Texas MD Anderson Cancer Center, Houston, Texas. 3. Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas. 4. Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas. 5. Department of Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas. 6. Department of Orthopedic Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas. 7. Department of Pediatrics, The University of Texas MD Anderson Cancer Center, Houston, Texas. 8. Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas. Electronic address: amahajan@mdanderson.org.
Abstract
PURPOSE: To identify prognostic factors and patterns of relapse for patients with Ewing sarcoma who underwent chemotherapy and R0 resection without radiation therapy (RT). METHODS AND MATERIALS: We reviewed the medical records of patients who underwent surgical resection at our institution between 2000 and 2013 for an initial diagnosis of Ewing sarcoma. The associations of demographic and clinical factors with local control (LC) and patient outcome were determined by Cox regression. Time to events was measured from the time of surgery. Survival curves were estimated by the Kaplan-Meier method and compared by the log-rank test. RESULTS: A total of 66 patients (median age 19 years, range 4-55 years) met the study criteria. The median follow-up was 5.6 years for living patients. In 43 patients (65%) for whom imaging studies were available, the median tumor volume reduction was 73%, and at least partial response by Response Evaluation Criteria in Solid Tumors was achieved in 17 patients (40%). At 5 years, LC was 78%, progression-free survival (PFS) was 59%, and overall survival (OS) was 65%. Poor histologic response (necrosis ≤95%) was an independent predictor of LC (hazard ratio [HR] 6.8, P=.004), PFS (HR 5.2, P=.008), and OS (HR 5.0, P=.008). Metastasis on presentation was also an independent predictor of LC (HR 6.3, P=.011), PFS (HR 6.8, P=.002), and OS (HR 6.7, P=.002). Radiologic partial response was a predictor of PFS (HR 0.26, P=.012), and postchemotherapy tumor volume was associated with OS (HR 1.06, P=.015). All deaths were preceded by distant relapse. Of the 8 initial local-only relapses, 5 (63%) were soon followed by distant relapse. Predictors of poor postrecurrence survival were time to recurrence <1 year (HR 11.5, P=.002) and simultaneous local and distant relapse (HR 16.8, P=.001). CONCLUSIONS: Histologic and radiologic response to chemotherapy were independent predictors of outcome. Additional study is needed to determine the role of adjuvant radiation therapy for patients who have poor histologic response after R0 resection.
PURPOSE: To identify prognostic factors and patterns of relapse for patients with Ewing sarcoma who underwent chemotherapy and R0 resection without radiation therapy (RT). METHODS AND MATERIALS: We reviewed the medical records of patients who underwent surgical resection at our institution between 2000 and 2013 for an initial diagnosis of Ewing sarcoma. The associations of demographic and clinical factors with local control (LC) and patient outcome were determined by Cox regression. Time to events was measured from the time of surgery. Survival curves were estimated by the Kaplan-Meier method and compared by the log-rank test. RESULTS: A total of 66 patients (median age 19 years, range 4-55 years) met the study criteria. The median follow-up was 5.6 years for living patients. In 43 patients (65%) for whom imaging studies were available, the median tumor volume reduction was 73%, and at least partial response by Response Evaluation Criteria in Solid Tumors was achieved in 17 patients (40%). At 5 years, LC was 78%, progression-free survival (PFS) was 59%, and overall survival (OS) was 65%. Poor histologic response (necrosis ≤95%) was an independent predictor of LC (hazard ratio [HR] 6.8, P=.004), PFS (HR 5.2, P=.008), and OS (HR 5.0, P=.008). Metastasis on presentation was also an independent predictor of LC (HR 6.3, P=.011), PFS (HR 6.8, P=.002), and OS (HR 6.7, P=.002). Radiologic partial response was a predictor of PFS (HR 0.26, P=.012), and postchemotherapy tumor volume was associated with OS (HR 1.06, P=.015). All deaths were preceded by distant relapse. Of the 8 initial local-only relapses, 5 (63%) were soon followed by distant relapse. Predictors of poor postrecurrence survival were time to recurrence <1 year (HR 11.5, P=.002) and simultaneous local and distant relapse (HR 16.8, P=.001). CONCLUSIONS: Histologic and radiologic response to chemotherapy were independent predictors of outcome. Additional study is needed to determine the role of adjuvant radiation therapy for patients who have poor histologic response after R0 resection.
Authors: M Paulussen; S Ahrens; J Dunst; W Winkelmann; G U Exner; R Kotz; G Amann; B Dockhorn-Dworniczak; D Harms; S Müller-Weihrich; K Welte; B Kornhuber; G Janka-Schaub; U Göbel; J Treuner; P A Voûte; A Zoubek; H Gadner; H Jürgens Journal: J Clin Oncol Date: 2001-03-15 Impact factor: 44.544
Authors: P Therasse; S G Arbuck; E A Eisenhauer; J Wanders; R S Kaplan; L Rubinstein; J Verweij; M Van Glabbeke; A T van Oosterom; M C Christian; S G Gwyther Journal: J Natl Cancer Inst Date: 2000-02-02 Impact factor: 13.506
Authors: Carlos Rodriguez-Galindo; Catherine A Billups; Larry E Kun; Bhaskar N Rao; Charles B Pratt; Thomas E Merchant; Victor M Santana; Alberto S Pappo Journal: Cancer Date: 2002-01-15 Impact factor: 6.860
Authors: Gary K Schwartz; William D Tap; Li-Xuan Qin; Michael B Livingston; Samir D Undevia; Bartosz Chmielowski; Mark Agulnik; Scott M Schuetze; Damon R Reed; Scott H Okuno; Joseph A Ludwig; Vicki Keedy; Petra Rietschel; Andrew S Kraft; Douglas Adkins; Brian A Van Tine; Bruce Brockstein; Vincent Yim; Christiana Bitas; Abdul Abdullah; Cristina R Antonescu; Mercedes Condy; Mark A Dickson; Shyamprasad Deraje Vasudeva; Alan L Ho; L Austin Doyle; Helen X Chen; Robert G Maki Journal: Lancet Oncol Date: 2013-03-08 Impact factor: 41.316
Authors: G Bacci; S Ferrari; F Bertoni; S Rimondini; A Longhi; P Bacchini; C Forni; M Manfrini; D Donati; P Picci Journal: J Clin Oncol Date: 2000-01 Impact factor: 44.544
Authors: Steven G DuBois; Mark D Krailo; Mark C Gebhardt; Sarah S Donaldson; Karen J Marcus; John Dormans; Robert C Shamberger; Scott Sailer; Richard W Nicholas; John H Healey; Nancy J Tarbell; R Lor Randall; Meenakshi Devidas; James S Meyer; Linda Granowetter; Richard B Womer; Mark Bernstein; Neyssa Marina; Holcombe E Grier Journal: Cancer Date: 2014-09-23 Impact factor: 6.860
Authors: Richard B Womer; Daniel C West; Mark D Krailo; Paul S Dickman; Bruce R Pawel; Holcombe E Grier; Karen Marcus; Scott Sailer; John H Healey; John P Dormans; Aaron R Weiss Journal: J Clin Oncol Date: 2012-10-22 Impact factor: 44.544
Authors: Thomas E Merchant; David Hodgson; Nadia N I Laack; Suzanne Wolden; Danny J Indelicato; John A Kalapurakal Journal: Pediatr Blood Cancer Date: 2012-12-19 Impact factor: 3.167
Authors: O Oberlin; M C Deley; B N Bui; J C Gentet; T Philip; P Terrier; C Carrie; F Mechinaud; C Schmitt; A Babin-Boillettot; J Michon Journal: Br J Cancer Date: 2001-11-30 Impact factor: 7.640
Authors: Lianne M Haveman; Andreas Ranft; Henk Vd Berg; Anne Smets; Jarmila Kruseova; Ruth Ladenstein; Benedicte Brichard; Michael Paulussen; Thomas Kuehne; Heribert Juergens; Stephanie Klco-Brosius; Uta Dirksen; Johannes H M Merks Journal: Cancer Med Date: 2019-02-21 Impact factor: 4.452