Timing of Local Therapy Affects Survival in Ewing Sarcoma

Abstract

We aimed to investigate the relationship between survival and time to local therapy after initiation of up-front chemotherapy in the treatment of patients with localized Ewing sarcoma. The National Cancer Database was queried for patients with localized Ewing sarcoma treated with primary chemotherapy and subsequent local therapy. Kaplan-Meier survival curves were generated for patients initiating local therapy 6 to 15weeks and ≥16weeks after chemotherapy initiation. Multivariable binomial logistic regression was used to identify factors associated with prolonged time to local therapy. A multivariable Cox proportional hazards model was used to identify factors associated with overall survival (OS). The final cohort included 1318 patients. A higher proportion of patients initiating local therapy 6 to 15weeks after chemotherapy initiation versus ≥16weeks after chemotherapy initiation were ≤21years old (79.5% vs 72.0%; P=.004). Age >21years (P<.001; hazard ratio, 1.65; 95% confidence interval, 1.28-2.12), tumor size >8cm(P=.016), and time to local therapy ≥16weeks (P=.005; hazard ratio, 1.41; 95% confidence interval, 1.11-1.80) were associated with reduced OS; after review of margin status, negative margins were associated with improved OS compared with gross disease (P=.029). Patients initiating local therapy at 6 to 15weeks versus ≥16weeks had a 5-year OS of 78.7% versus 70.4% and a 10-year OS of 70.3% versus 57.1%, respectively (P<.001). The difference in OS according to time to local therapy was particularly more important in patients receiving radiation therapy alone. Age >21years and treatment by radiation therapy alone were associated with delayed time (>16weeks) to local therapy, whereas private insurance and income >$48,000 were less likely to be associated with delayed local therapy. Delayed time to local therapy ≥16weeks after chemotherapy initiation was independently associated with worse survival in patients with localized Ewing sarcoma.