Long-term outcome of patients with lower extremity Ewing sarcoma.

Abstract

117 Background: With improved survival rates of patients with Ewing sarcoma the quality of long-term survivorship needs to be addressed. In this study, general recovery and restitution of function following intensive bone tumor treatment were analyzed by assessing the clinico-functional outcome and physical activity using self-reporting and objective measurement tools. Methods: Long-term outcome of 224 former patients with lower extremity Ewing sarcoma, registered between 1980 and 2009 in consecutive clinical trials of the GPOH, were assessed using the TESS, SF-36, BSI, and RSES questionnaire scales, and the accelerometric StepWatch Activity Monitor (SAM). To compare results with healthy subjects, 111 non-random peer controls were selected. Median observation time was 13.8 years from primary diagnosis (range 4.1-31.2). Results: Absolute values from the questionnaire scores indicated no major clinical findings in former patients. Compared to controls, unfavorable outcomes were however seen on physical TESS (d=-0.85), PCS (SF-36) (d=-1.08) and BSI-S scores (d=0.65) (P<0.001), in contrast to mental MCS (SF-36), BSI-A, BSI-D, RSES scores (d<0.40). Former patients were less active than the control group (10067 vs. 12430 steps per day; d=-0.56; P<0.001), but on average did reach the recommended level for an active life-style (>10000 steps). Comparing local therapy modality, physical scores for SAM, TESS, PCS were 10978, 91.2, T=50.2 for patients treated with surgery (N=101), 11097, 90.0, T=48.6 in patients with combined modality treatment (N=108), and 10093, 92.8, T=50.0 for patients with definite radiotherapy (N=15) (P=0.648; P=0.580; P=0.368). Conclusions: Survivors of primary lower extremity Ewing sarcoma exhibited moderately reduced self-reported and objectively measured physical outcome scores. Continuous long-term observation will be important in order to identify disease-specific prognostic factors for these patient-oriented outcomes.