Pediatr Blood Cancer. 2006 Jan 18; [Epub ahead of print]
An analysis of primary site control and late effects
according to local control modality in non-metastatic Ewing sarcoma.
Paulino AC, Nguyen TX, Mai WY.
Department of Radiology, Division of Radiation Oncology, Baylor College
of Medicine and Methodist Hospital, Houston, Texas.
PURPOSE: To examine prognostic factors for primary site control and
analyze late effects according to local treatment modality in
non-metastatic Ewing sarcoma (ES). MATERIALS AND METHODS: From 1976 to
2001, 76 patients with localized ES and a median age of 14.5 years were
seen and treated at one institution. Tumors were located in the
extremity in 38, pelvis in 13, spine in 11, trunk in 8, and head and
neck in 6. Tumor size was </=8 cm in 44 and >8 cm in 32. Local
therapy included radiotherapy (RT) alone in 40, surgery (S) alone in
27, and surgery followed by postoperative radiotherapy (S + RT) in 9.
Chemotherapy (CT) was delivered to 65 patients (86%). Median follow-up
for surviving patients was 9.7 years. RESULTS: The 5- and 10-year
overall survival rates were 57.5% and 52.1% while the 5- and 10-year
local control rate was 79.2%. The 5- and 10-year local control rates
were 78.2% for RT, 77.6% for surgery, and 88.9% for S + RT (P = 0.68).
Multivariate analysis showed that only the use of CT was found to be a
prognostic factor for local control (P = 0.014). The 5- and 10-year
local control rates were 83.7% for those receiving CT and 51.1% for
those not receiving CT. For patients followed at least 5 years from
diagnosis, late effects were seen in 10 of 19 (52.6%) receiving RT, 2
of 5 (40%) receiving S + RT, and 4 of 16 (25%) receiving surgery alone.
The most common late effects with RT were muscular atrophy, limb length
growth delay, and development of second malignancy. Scoliosis and
decrease range of motion of an extremity were seen regardless of local
treatment modality. Three patients who had surgery alone had an
amputation whereas two who had RT had an amputation secondary to
relapse or development of osteosarcoma. CONCLUSION: In this single
institution study, the use of CT was the only factor found to impact on
local control. Late effects were common regardless of local control
strategy. Pediatric Blood Cancer (c) 2006 Wiley-Liss, Inc.
PMID: 16421909 [PubMed – as supplied by publisher]