Abstract
In previous reports, patients with Ewing's sarcoma received radiation therapy (XRT) for definitive local control because metastatic disease and pelvic location were thought to preclude aggressive local treatment. We sought to determine if single-site metastatic disease should be treated differently from multicentric-metastatic disease. We also wanted to reinvestigate the impact of XRT, pelvic location, and local recurrence on outcomes. Our results demonstrated a significant difference in overall survival (OS) between patients with either localized disease or a single-metastatic site and patients with multicentric-metastatic disease (P = 0.004). Local control was also found to be an independent predictor of outcomes as demonstrated by a significant difference in OS between those with and without local recurrence (P = 0.001). Axial and pelvic location did not predict a decreased OS. Based on these results, we concluded that pelvic location and the diagnosis of metastatic disease at diagnosis should not preclude aggressive local control, except in cases of multicentric-metastatic disease.
Highlights
Ewing’s sarcoma (EWS) is the second most common primary bone tumor in children and adolescents [1,2,3,4,5,6], representing 3% of all pediatric malignancies [2, 5, 7]
We reviewed patients’ medical records for surgical reports, radiographic studies, and pathological results in order to determine primary location, AJCC stage at diagnosis, neoadjuvant treatment, primary local treatment, adjuvant treatments, local recurrence, late-metastatic disease, and late complications
Metastatic disease at the time of diagnosis was found in 13/42 (31%) of patients (AJCC stage at diagnosis was unknown for five patients), and 7/42 (17%) of patients presented with multicentric disease
Summary
Ewing’s sarcoma (EWS) is the second most common primary bone tumor in children and adolescents [1,2,3,4,5,6], representing 3% of all pediatric malignancies [2, 5, 7]. With improvement in treatment protocols and chemotherapy regimens, these factors deserve reinvestigation [2]. Despite advances in chemotherapy protocols, survival rates are consistently in the 54–68% range [8, 9, 12, 14, 15] This plateau in the improvement of outcomes has been frustrating despite chemotherapy trials, new regimens, and dose intensification [5, 7, 14, 16]. Many patients received XRT for local control because metastatic disease and pelvic location were thought to preclude aggressive local treatment [7, 14, 18,19,20]
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