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Erschienen in: Annals of Surgical Oncology 11/2016

23.05.2016 | Bone and Soft Tissue Sarcomas

Local Control Modality and Outcome for Ewing Sarcoma of the Femur: A Report From the Children’s Oncology Group

verfasst von: Najat C. Daw, MD, Nadia N. Laack, MD, Elizabeth J. McIlvaine, PhD, Mark Krailo, PhD, Richard B. Womer, MD, Linda Granowetter, MD, Holcombe E. Grier, MD, Neyssa M. Marina, MD, Mark L. Bernstein, MD, Mark C. Gebhardt, MD, Karen J. Marcus, MD, Shailesh M. Advani, MD, John H. Healey, MD, George D. Letson, MD, Richard G. Gorlick, MD, R. Lor Randall, MD

Erschienen in: Annals of Surgical Oncology | Ausgabe 11/2016

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Abstract

Background

The choice of a local control (LC) modality for Ewing sarcoma (EWS) of the femur is controversial. This study aimed to determine the effect of LC modality on tumor LC and patient outcomes.

Methods

The study reviewed the treatment and outcomes for 115 patients who had EWS of the femur treated with similar chemotherapy in three cooperative group trials. Patient outcomes were analyzed according to the LC modality using the log-rank test and the cumulative incidence of local or distant failure using competing risks regression.

Results

The median age of the patients was 13 years. The most common tumor location was the proximal femur followed by the mid femur. For 55 patients with available data, the tumor was larger than 8 cm in 29 patients and 8 cm or smaller in 26 patients. For 84 patients (73 %), surgery only was performed, whereas 17 patients (15 %) had surgery plus radiation, and 14 patients (12 %) had radiation only. The 5-year event-free survival (EFS) rate was 65 % (95 % confidence interval [CI], 55–73 %), and the 5-year overall survival (OS) rate was 70 % (95 % CI, 61–78 %). Patient outcomes did not differ significantly according to tumor location within the femur (proximal, mid or distal) or tumor size (<8 vs ≥8 cm). The findings showed no statistically significant differences in EFS, OS, cumulative incidence of local failure, or cumulative incidence of distant failure according to LC modality (surgery, surgery plus radiation, or radiation).

Conclusions

The LC modality did not significantly affect disease outcome for EWS of the femur. Further study of treatment complications and functional outcome may help to define the optimal LC modality.
Literatur
1.
Zurück zum Zitat Grier HE, Krailo MD, Tarbell NJ, et al. Addition of ifosfamide and etoposide to standard chemotherapy for Ewing’s sarcoma and primitive neuroectodermal tumor of bone. N Engl J Med. 2003;348:694–701.CrossRefPubMed Grier HE, Krailo MD, Tarbell NJ, et al. Addition of ifosfamide and etoposide to standard chemotherapy for Ewing’s sarcoma and primitive neuroectodermal tumor of bone. N Engl J Med. 2003;348:694–701.CrossRefPubMed
2.
Zurück zum Zitat Granowetter L, Womer R, Devidas M, et al. Dose-intensified compared with standard chemotherapy for nonmetastatic Ewing sarcoma family of tumors: a Children’s Oncology Group Study. J Clin Oncol. 2009;27:2536–41.CrossRefPubMedPubMedCentral Granowetter L, Womer R, Devidas M, et al. Dose-intensified compared with standard chemotherapy for nonmetastatic Ewing sarcoma family of tumors: a Children’s Oncology Group Study. J Clin Oncol. 2009;27:2536–41.CrossRefPubMedPubMedCentral
3.
Zurück zum Zitat Womer RB, West DC, Krailo MD, et al. Randomized controlled trial of interval-compressed chemotherapy for the treatment of localized Ewing sarcoma: a report from the Children’s Oncology Group. J Clin Oncol. 2012;30:4148–54.CrossRefPubMedPubMedCentral Womer RB, West DC, Krailo MD, et al. Randomized controlled trial of interval-compressed chemotherapy for the treatment of localized Ewing sarcoma: a report from the Children’s Oncology Group. J Clin Oncol. 2012;30:4148–54.CrossRefPubMedPubMedCentral
4.
Zurück zum Zitat DuBois SG, Krailo MD, Gebhardt MC, et al. Comparative evaluation of local control strategies in localized Ewing sarcoma of bone: a report from the Children’s Oncology Group. Cancer. 2015;121:467–75.CrossRefPubMed DuBois SG, Krailo MD, Gebhardt MC, et al. Comparative evaluation of local control strategies in localized Ewing sarcoma of bone: a report from the Children’s Oncology Group. Cancer. 2015;121:467–75.CrossRefPubMed
5.
Zurück zum Zitat Yock TI, Krailo M, Fryer CJ, et al. Local control in pelvic Ewing sarcoma: analysis from INT-0091—a report from the Children’s Oncology Group. J Clin Oncol. 2006;24:3838–43.CrossRefPubMed Yock TI, Krailo M, Fryer CJ, et al. Local control in pelvic Ewing sarcoma: analysis from INT-0091—a report from the Children’s Oncology Group. J Clin Oncol. 2006;24:3838–43.CrossRefPubMed
6.
Zurück zum Zitat Paulussen M, Ahrens S, Dunst J, et al. Localized Ewing tumor of bone: final results of the cooperative Ewing’s Sarcoma Study CESS 86. J Clin Oncol. 2001;19:1818–29.PubMed Paulussen M, Ahrens S, Dunst J, et al. Localized Ewing tumor of bone: final results of the cooperative Ewing’s Sarcoma Study CESS 86. J Clin Oncol. 2001;19:1818–29.PubMed
7.
Zurück zum Zitat Koch JC. The laws of bone architecture. Am J Anat. 1917;21:177–298.CrossRef Koch JC. The laws of bone architecture. Am J Anat. 1917;21:177–298.CrossRef
8.
Zurück zum Zitat Fielding JW, Cochran GV, Zickel RE. Biomechanical characteristics and surgical management of subtrochanteric fractures. Orthop Clin North Am. 1974;5:629–50.PubMed Fielding JW, Cochran GV, Zickel RE. Biomechanical characteristics and surgical management of subtrochanteric fractures. Orthop Clin North Am. 1974;5:629–50.PubMed
9.
Zurück zum Zitat Terek RM, Brien EW, Marcove RC, Meyers PA, Lane JM, Healey JH. Treatment of femoral Ewing’s sarcoma. Cancer. 1996;78:70–8.CrossRefPubMed Terek RM, Brien EW, Marcove RC, Meyers PA, Lane JM, Healey JH. Treatment of femoral Ewing’s sarcoma. Cancer. 1996;78:70–8.CrossRefPubMed
10.
Zurück zum Zitat Bacci G, Ferrari S, Longhi A, et al. Local and systemic control in Ewing’s sarcoma of the femur treated with chemotherapy, and locally by radiotherapy and/or surgery. J Bone Joint Surg Br. 2003;85:107–14.CrossRefPubMed Bacci G, Ferrari S, Longhi A, et al. Local and systemic control in Ewing’s sarcoma of the femur treated with chemotherapy, and locally by radiotherapy and/or surgery. J Bone Joint Surg Br. 2003;85:107–14.CrossRefPubMed
11.
Zurück zum Zitat Ozaki T, Hillmann A, Hoffmann C, et al. Ewing’s sarcoma of the femur: prognosis in 69 patients treated by the CESS group. Acta Orthop Scand. 1997;68:20–4.CrossRefPubMed Ozaki T, Hillmann A, Hoffmann C, et al. Ewing’s sarcoma of the femur: prognosis in 69 patients treated by the CESS group. Acta Orthop Scand. 1997;68:20–4.CrossRefPubMed
12.
Zurück zum Zitat Kaplan EL, Meier P. Nonparametric estimation from incomplete observations. J Am Stat Assoc. 1958;53:457–81.CrossRef Kaplan EL, Meier P. Nonparametric estimation from incomplete observations. J Am Stat Assoc. 1958;53:457–81.CrossRef
13.
Zurück zum Zitat Kalbfleisch JD, Prentice RL (2001) The Statistical Analysis of Failure Time Data. vol 360. John Wiley & Sons, New York Kalbfleisch JD, Prentice RL (2001) The Statistical Analysis of Failure Time Data. vol 360. John Wiley & Sons, New York
14.
Zurück zum Zitat Gray RJ. A class of K-sample tests for comparing the cumulative incidence of a competing risk. Ann Stat. 1988;16:1141–54.CrossRef Gray RJ. A class of K-sample tests for comparing the cumulative incidence of a competing risk. Ann Stat. 1988;16:1141–54.CrossRef
15.
Zurück zum Zitat Fine JP, Gray RJ. A proportional hazards model for the subdistribution of a competing risk. J Am Stat Assoc. 1999;94:496–509.CrossRef Fine JP, Gray RJ. A proportional hazards model for the subdistribution of a competing risk. J Am Stat Assoc. 1999;94:496–509.CrossRef
16.
Zurück zum Zitat Arai Y, Kun LE, Brooks MT, et al. Ewing’s sarcoma: local tumor control and patterns of failure following limited-volume radiation therapy. Int J Radiat Oncol Biol Phys. 1991;21:1501–8.CrossRefPubMed Arai Y, Kun LE, Brooks MT, et al. Ewing’s sarcoma: local tumor control and patterns of failure following limited-volume radiation therapy. Int J Radiat Oncol Biol Phys. 1991;21:1501–8.CrossRefPubMed
17.
Zurück zum Zitat Bacci G, Ferrari S, Bertoni F, et al. Prognostic factors in nonmetastatic Ewing’s sarcoma of bone treated with adjuvant chemotherapy: analysis of 359 patients at the Istituto Ortopedico Rizzoli. J Clin Oncol. 2000;18:4–11.PubMed Bacci G, Ferrari S, Bertoni F, et al. Prognostic factors in nonmetastatic Ewing’s sarcoma of bone treated with adjuvant chemotherapy: analysis of 359 patients at the Istituto Ortopedico Rizzoli. J Clin Oncol. 2000;18:4–11.PubMed
18.
Zurück zum Zitat Cotterill SJ, Ahrens S, Paulussen M, et al. Prognostic factors in Ewing’s tumor of bone: analysis of 975 patients from the European Intergroup Cooperative Ewing’s Sarcoma Study Group. J Clin Oncol. 2000;18:3108–14.PubMed Cotterill SJ, Ahrens S, Paulussen M, et al. Prognostic factors in Ewing’s tumor of bone: analysis of 975 patients from the European Intergroup Cooperative Ewing’s Sarcoma Study Group. J Clin Oncol. 2000;18:3108–14.PubMed
19.
Zurück zum Zitat Rodriguez-Galindo C, Liu T, Krasin MJ, et al. Analysis of prognostic factors in ewing sarcoma family of tumors: review of St. Jude Children’s Research Hospital studies. Cancer. 2007;110:375–84.PubMed Rodriguez-Galindo C, Liu T, Krasin MJ, et al. Analysis of prognostic factors in ewing sarcoma family of tumors: review of St. Jude Children’s Research Hospital studies. Cancer. 2007;110:375–84.PubMed
20.
Zurück zum Zitat Springfield DS, Pagliarulo C. Fractures of long bones previously treated for Ewing’s sarcoma. J Bone Joint Surg Am. 1985;67:477–81.PubMed Springfield DS, Pagliarulo C. Fractures of long bones previously treated for Ewing’s sarcoma. J Bone Joint Surg Am. 1985;67:477–81.PubMed
21.
Zurück zum Zitat Damron TA, Sim FH, O’Connor MI, Pritchard DJ, Smithson WA (1996) Ewing’s sarcoma of the proximal femur. Clin Orthop Relat Res. 322: 232–44.CrossRefPubMed Damron TA, Sim FH, O’Connor MI, Pritchard DJ, Smithson WA (1996) Ewing’s sarcoma of the proximal femur. Clin Orthop Relat Res. 322: 232–44.CrossRefPubMed
22.
Zurück zum Zitat Strong LC, Herson J, Osborne BM, Sutow WW. Risk of radiation-related subsequent malignant tumors in survivors of Ewing’s sarcoma. J Natl Cancer Inst. 1979;62:1401–6.PubMed Strong LC, Herson J, Osborne BM, Sutow WW. Risk of radiation-related subsequent malignant tumors in survivors of Ewing’s sarcoma. J Natl Cancer Inst. 1979;62:1401–6.PubMed
23.
Zurück zum Zitat Kuttesch JF Jr, Wexler LH, Marcus RB, et al. Second malignancies after Ewing’s sarcoma: radiation dose-dependency of secondary sarcomas. J Clin Oncol. 1996;14:2818–25.PubMed Kuttesch JF Jr, Wexler LH, Marcus RB, et al. Second malignancies after Ewing’s sarcoma: radiation dose-dependency of secondary sarcomas. J Clin Oncol. 1996;14:2818–25.PubMed
24.
Zurück zum Zitat Stish BJ, Ahmed SK, Rose PS, Arndt CA, Laack NN. Patient-reported functional and quality-of-life outcomes in a large cohort of long-term survivors of Ewing Sarcoma. Pediatr Blood Cancer. 2015;62:2189–96.CrossRefPubMed Stish BJ, Ahmed SK, Rose PS, Arndt CA, Laack NN. Patient-reported functional and quality-of-life outcomes in a large cohort of long-term survivors of Ewing Sarcoma. Pediatr Blood Cancer. 2015;62:2189–96.CrossRefPubMed
Metadaten
Titel
Local Control Modality and Outcome for Ewing Sarcoma of the Femur: A Report From the Children’s Oncology Group
verfasst von
Najat C. Daw, MD
Nadia N. Laack, MD
Elizabeth J. McIlvaine, PhD
Mark Krailo, PhD
Richard B. Womer, MD
Linda Granowetter, MD
Holcombe E. Grier, MD
Neyssa M. Marina, MD
Mark L. Bernstein, MD
Mark C. Gebhardt, MD
Karen J. Marcus, MD
Shailesh M. Advani, MD
John H. Healey, MD
George D. Letson, MD
Richard G. Gorlick, MD
R. Lor Randall, MD
Publikationsdatum
23.05.2016
Verlag
Springer International Publishing
Erschienen in
Annals of Surgical Oncology / Ausgabe 11/2016
Print ISSN: 1068-9265
Elektronische ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-016-5269-1

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