8555 Purpose: To evaluate the outcome of patients with Ewing’s sarcoma family of tumors (ESFT) treated with modern radiotherapy techniques using MRI imaging along with optimal chemotherapy. Materials and Methods: The records of all 60 patients with ESFT who received radiation to the primary site at MSKCC between 1990 and 2004 were reviewed. All patients received chemotherapy including vincristine, doxorubicin, cyclophosphamide, ifosfamide and etoposide with or without surgical resection. All patients had MRI and CT scan based treatment planning and 43% received intensity modulated radiation therapy (IMRT). Radiation doses ranged from 30–60 Gy, median 51 Gy. Hyperfractionation was used in 35% of patients. We analyzed outcome and the effect of potential prognostic factors. Follow-up of surviving patients is 6–178 (median 41) months. Results: Median age was 16 (2–40) years with a male:female ratio of 1.1:1. Because of selection bias for radiotherapy, the majority of tumors were in the axial skeleton: spine (18), pelvis (15), extremities (12), chest wall (5), head and neck (5), and other (5) with 78% arising in bone and 22% in soft tissue. Metastases were present at diagnosis in 38% of patients and 52% of primary tumors were ≥ 8 cm. Actuarial 3-year local control was 77%. Time to local failure ranged from 8 to 32 months. The presence of metastases at diagnosis was an adverse prognostic factor for local control, 84% vs. 62% (p=0.04). No other predictive factors for local failure were identified including patient age, tumor size and site, as well as radiation dose, timing, fractionation or whether it was definitive or postoperative. In patients without metastatic disease, 3-year disease-free and overall survival were 70% and 87%, respectively, while in patients with metastases, they were both 21%. Conclusion: In this unfavorable cohort of ESFT patients, radiation therapy was an effective modality for local control, especially for patients without metastases. The presence of metastases at diagnosis is a predictive factor not only for death but also for local failure. Future strategies for metastatic patients may include short course, high dose per fraction regimens. No significant financial relationships to disclose.
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