Cancer Res Treat.  2015 Oct;47(4):904-912. 10.4143/crt.2014.158.

Role of Radiotherapy in the Multimodal Treatment of Ewing Sarcoma Family Tumors

• Choi Y
• Lim DH
• Lee SH
• Lyu CJ
• Im JH
• Lee YH
• Suh CO

• KMID: 2403411
• DOI: http://doi.org/10.4143/crt.2014.158

Abstract

PURPOSE
The aim of this study was to evaluate the role of radiotherapy (RT) in the management of Ewing sarcoma family tumors (ESFT).
MATERIALS AND METHODS
Retrospective analysiswas performed on 91 patientswith localized ESFT treated from 1988 to 2012. Primary tumor size was > or = 8 cm in 33 patients. Surgery, RT, and combined surgery with RT were applied in 37, 15, and 33 patients, respectively.
RESULTS
Median follow-up was 43.8 months. Forty-three patients (47.3%) showed recurrence or progressive disease. Twelve patients (13.2%) showed local failure after initial treatment. Thirty-nine patients (42.9%) experienced distant metastases. The 5-year overall survival (OS), progression-free survival, and local control (LC) were 60.5%, 58.2%, and 85.1%, respectively. According to treatment, 5-year LCwas 64.8% with RT and 90.2% with combined surgery and RT (p=0.052). Prognostic factors for OS were tumor size (> or = 8 cm, p < 0.001) and surgical resection (p < 0.001). In large tumors (> or = 8 cm), combined surgery and RT produced better LC compared to RT (p=0.033). However, in smaller tumors (< 8 cm), RT without surgery resulted in a similar LC rate as RT with surgery (p=0.374).
CONCLUSION
RT used for patients with unfavorable risk factors resulted in worse outcome than for patientswho received surgery. Smallertumors could be controlled locallywith chemotherapy and RT. For large tumors, combined surgery and RT is needed. Proper selection of local treatment modality, RT, surgery, or both is crucial in the management of ESFT.

Keyword

Ewing sarcoma; Surgery; Radiotherapy; Tumor burden

MeSH Terms

Combined Modality Therapy*
Disease-Free Survival
Drug Therapy
Follow-Up Studies
Humans
Neoplasm Metastasis
Radiotherapy*
Recurrence
Retrospective Studies
Risk Factors
Sarcoma, Ewing*
Tumor Burden

Figure

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  Fig. 1. Patient arrangement according to local treatment methods. ESFT, Ewing sarcoma family tumors; RT, radiotherapy.

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  Fig. 2. Local control and overall survival.

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  Fig. 3. Local control in localized disease; comparison among surgery alone (n=37), combined surgery with radiotherapy (RT; n=33), and RT without surgery (n=15).

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  Fig. 4. . Local control in localized tumors ≥ 8 cm according to treatment methods (A); comparison between combined surgery and radiotherapy (RT) (n=12) and RT without surgery (n=8), and local control in localized tumors < 8 cm according to treatment methods (B); comparison between combined surgery and RT (n=21) and RT without surgery (n=7).

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  Fig. 5. Local control in patients who underwent surgical resection according to implementation of adjuvant radiotherapy (RT) (A); comparison between surgery (n=7) and combined surgery and RT (n=15) in patients with incomplete resection (B); comparison between surgery (n=30) and combined surgery and RT (n=17) with complete resection.

Reference

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