Melina Heinemann1,2, Andreas Ranft1,3, Thorsten Langer4, Herbert Jürgens5, Justus Kreyer6, Volker Vieth7, Michael Schäfers8, Matthias Weckesser8, Thorsten Simon9, Wolf Hassenpflug10, Selim Corbacioglu11, Stefan Bielack12, Regina Mayer-Steinacker13, Thomas Kühne14, Henk van den Berg15, Hans Gelderblom16, Sebastian Bauer17,18, Lars Stegger8, Uta Dirksen1,3,17,18. 1. University Hospital Muenster, Westphalian-Wilhelms University, Muenster, Germany. 2. Department of Internal Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany. 3. Paediatrics III, West German Cancer Centre, University Hospital of Essen, Essen, Germany. 4. Paediatric Oncology and Haematology, University Hospital Schleswig-Holstein, Campus Luebeck, Luebeck, Germany. 5. Paediatric Haematology and Oncology, University Hospital Muenster, Muenster, Germany. 6. Department of Orthopaedic and Trauma Surgery, University Hospital of Essen, University of Duisburg-Essen, Essen, Germany. 7. Department of Clinical Radiology, University Hospital Muenster, Muenster, Germany. 8. Department of Nuclear Medicine, University Hospital Muenster, Muenster, Germany. 9. Department of Paediatric Oncology and Haematology, University Children's Hospital of Cologne, Cologne, Germany. 10. Department of Paediatric Haematology and Oncology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany. 11. Department of Paediatric Haematology, Oncology, and Stem Cell Transplantation, Children's Hospital Regensburg, University of Regensburg, Regensburg, Germany. 12. Paediatrics 5 (Oncology, Haematology, and Immunology), Klinikum Stuttgart, Olgahospital, Stuttgart, Germany. 13. Department of Internal Medicine, University Hospital of Ulm, Ulm, Germany. 14. Department of Oncology and Haematology, University Children's Hospital Basel, Basel, Switzerland. 15. Paediatric Oncology, Emma Children's Hospital, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands. 16. Clinical Oncology, Leiden University Medical Centre, Leiden, The Netherlands. 17. Sarcoma Centre, West German Cancer Centre, University Hospital of Essen, Essen, Germany. 18. German Cancer Research Centre, Essen, Germany.
Abstract
BACKGROUND: The Cooperative Ewing Sarcoma Study and the Late Effects Surveillance System of the Society for Paediatric Oncology and Haematology recommend a structured follow-up imaging protocol (FUIP) for patients with Ewing sarcoma (EwS) with decreasing frequency of imaging over the first 5 years. The present study aims to assess the effectiveness of the FUIP for EwS patients regarding survival after relapse. PATIENTS AND METHODS: A retrospective multicenter analysis on 160 eligible patients with EwS recurrence was performed. Potential survival differences following recurrence diagnosis between patients with protocol-detected and symptomatic relapse were investigated using the Kaplan-Meier method. Additional subgroup analyses were performed on the relapse type. Overall survival (OS) was calculated from diagnosis of relapse to last follow-up or death. RESULTS: In the multicenter analysis, recurrence was detected by FUIP in 77 of 160 patients (48%) and due to symptoms in 83 patients (52%). Regarding the entire study population, OS was significantly superior in patients with protocol-detected relapse compared to patients with symptomatic relapse (median, 2.4 vs. 1.2 years; P < 0.001). In the subgroup analyses, patients whose lung recurrences were detected by the FUIP experienced longer survival after recurrence than those whose recurrences were detected symptomatically (P = 0.023). In the 83 symptomatic patients, pain was the most prevalent symptom of relapse (72%). CONCLUSION: FUIP may benefit survival in EwS relapse, especially in lung recurrence. Pain was the leading symptom of relapse.
BACKGROUND: The Cooperative Ewing Sarcoma Study and the Late Effects Surveillance System of the Society for Paediatric Oncology and Haematology recommend a structured follow-up imaging protocol (FUIP) for patients with Ewing sarcoma (EwS) with decreasing frequency of imaging over the first 5 years. The present study aims to assess the effectiveness of the FUIP for EwSpatients regarding survival after relapse. PATIENTS AND METHODS: A retrospective multicenter analysis on 160 eligible patients with EwS recurrence was performed. Potential survival differences following recurrence diagnosis between patients with protocol-detected and symptomatic relapse were investigated using the Kaplan-Meier method. Additional subgroup analyses were performed on the relapse type. Overall survival (OS) was calculated from diagnosis of relapse to last follow-up or death. RESULTS: In the multicenter analysis, recurrence was detected by FUIP in 77 of 160 patients (48%) and due to symptoms in 83 patients (52%). Regarding the entire study population, OS was significantly superior in patients with protocol-detected relapse compared to patients with symptomatic relapse (median, 2.4 vs. 1.2 years; P < 0.001). In the subgroup analyses, patients whose lung recurrences were detected by the FUIP experienced longer survival after recurrence than those whose recurrences were detected symptomatically (P = 0.023). In the 83 symptomatic patients, pain was the most prevalent symptom of relapse (72%). CONCLUSION: FUIP may benefit survival in EwS relapse, especially in lung recurrence. Pain was the leading symptom of relapse.
Authors: Bas Vaarwerk; Coralie Mallebranche; Maria C Affinita; Johanna H van der Lee; Andrea Ferrari; Julia C Chisholm; Anne-Sophie Defachelles; Gian Luca De Salvo; Nadège Corradini; Veronique Minard-Colin; Carlo Morosi; Hervé J Brisse; Kieran McHugh; Gianni Bisogno; Rick R van Rijn; Daniel Orbach; Johannes H M Merks Journal: Cancer Date: 2019-11-21 Impact factor: 6.860