Matthew S Ning1, Stephanie M Perkins2, Scott C Borinstein3, Ginger E Holt4, Mark J Stavas1, Eric T Shinohara1. 1. Department of Radiation Oncology, Vanderbilt University School of Medicine, Nashville, Tennessee, USA. 2. Department of Radiation Oncology, Washington University School of Medicine, Saint Louis, Missouri, USA. 3. Department of Pediatrics, Division of Pediatric Hematology/Oncology, Vanderbilt University School of Medicine, Nashville, Tennessee, USA. 4. Department of Orthopedics, Vanderbilt University School of Medicine, Nashville, Tennessee, USA.
Abstract
INTRODUCTION: Local control, either with surgery, radiation (RT) or both, is essential in the management of localised Ewing sarcoma; however, the relative role of RT remains controversial. METHODS: Using the Surveillance, Epidemiology, and End Results database, 612 patients treated for non-metastatic skeletal Ewing sarcoma between the years 1988 and 2010 were identified. RESULTS: Median age and follow-up were 13 years (range: 0-21) and 56 months (range: 0-287), respectively. Five-year overall survival (OS) for the cohort was 74.4 ± 2.0%. Patients received surgery alone (51.3%), RT alone (21.6%) or both (27.1%). Patients with skeletal Ewing sarcoma had improved OS with surgery alone compared with other treatments. However, in subset analyses, RT was not inferior to surgery alone for appendicular (5-year OS: 80.0% vs. 79.3%), non-pelvic (84.3% vs. 79.9%) or localised disease (confined to cortex or periosteum; 79.7% vs. 80.6%). After controlling for stage and site, no increase in mortality was observed with RT versus surgery alone (hazard ratio = 0.77 (95% confidence interval: 0.49-1.19)). CONCLUSIONS: In regard to survival, RT did not appear to be inferior to surgery alone for most patients, particularly those with disease at favourable sites (localised, appendicular, non-pelvic). In select patients with Ewing sarcoma, RT may be an appropriate strategy for local control that does not necessarily compromise survival outcomes.
INTRODUCTION: Local control, either with surgery, radiation (RT) or both, is essential in the management of localised Ewing sarcoma; however, the relative role of RT remains controversial. METHODS: Using the Surveillance, Epidemiology, and End Results database, 612 patients treated for non-metastatic skeletal Ewing sarcoma between the years 1988 and 2010 were identified. RESULTS: Median age and follow-up were 13 years (range: 0-21) and 56 months (range: 0-287), respectively. Five-year overall survival (OS) for the cohort was 74.4 ± 2.0%. Patients received surgery alone (51.3%), RT alone (21.6%) or both (27.1%). Patients with skeletal Ewing sarcoma had improved OS with surgery alone compared with other treatments. However, in subset analyses, RT was not inferior to surgery alone for appendicular (5-year OS: 80.0% vs. 79.3%), non-pelvic (84.3% vs. 79.9%) or localised disease (confined to cortex or periosteum; 79.7% vs. 80.6%). After controlling for stage and site, no increase in mortality was observed with RT versus surgery alone (hazard ratio = 0.77 (95% confidence interval: 0.49-1.19)). CONCLUSIONS: In regard to survival, RT did not appear to be inferior to surgery alone for most patients, particularly those with disease at favourable sites (localised, appendicular, non-pelvic). In select patients with Ewing sarcoma, RT may be an appropriate strategy for local control that does not necessarily compromise survival outcomes.
Authors: Jeremy Whelan; Allan Hackshaw; Anne McTiernan; Robert Grimer; David Spooner; Jessica Bate; Andreas Ranft; Michael Paulussen; Herbert Juergens; Alan Craft; Ian Lewis Journal: Clin Sarcoma Res Date: 2018-03-30