Does surgery or radiation provide the best overall survival in Ewing's sarcoma? A review of the National Cancer Data Base

Miller, Benjamin J.; Gao, Yubo; Duchman, Kyle R.

doi:10.1002/jso.24652

Cited by 44 publications

(45 citation statements)

References 34 publications

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“…We used two socioeconomic measures, ZIP code based median household income and percentage of population with a high school degree, to create a composite socioeconomic (SES) summary variable, as has been done in previous reports. 16,17 Our primary outcome of interest was overall survival after treatment for sarcoma, measured at 2-, 5-, and 10-years post treatment. Institutions that participate in the NCDB are required to submit survival data annually, which is reported as all-cause survival.…”

Section: Methodsmentioning

confidence: 99%

Improved survival for extremity soft tissue sarcoma treated in high‐volume facilities

Abarca

Gao

Monga

et al. 2018

Journal of Surgical Oncology

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Section: Methodsmentioning

confidence: 99%

Improved survival for extremity soft tissue sarcoma treated in high‐volume facilities

Abarca

Gao

Monga

et al. 2018

Journal of Surgical Oncology

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“…Patients with these tumors have a 10-year survival rate of 57% and poor prognosis. However, patients < 40 years of age with high grade Ewing’s sarcoma have a good prognosis if the tumor is completely resected surgically [ 8 ]. Unfortunately, complete surgical resection is likely to result in postoperative dysfunction.…”

Section: Discussionmentioning

confidence: 99%

Limb saving surgery for Ewing’s sarcoma of the distal tibia: a case report

et al. 2018

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BackgroundEwing’s sarcoma is a primary malignant tumor of bone occurring mostly in childhood. Few effective reconstruction techniques are available after wide resection of Ewing’s sarcoma at the distal end of the tibia. Reconstruction after wide resection is especially difficult in children, as it is necessary to consider the growth and activity of the lower limbs.Case presentationA 12-year-old Japanese boy had presented with right lower leg pain at age 8 years. Imaging examination showed a bone tumor accompanied by a large extra-skeletal mass in the distal part of his tibia. The tumor was histologically diagnosed as Ewing’s sarcoma. The patient received chemotherapy, followed by wide resection. Reconstruction consisted of a bone transport method involving external fixation of Taylor Spatial Frame. To prevent infection after surgery, the external fixation pin was coated with iodine. One year after surgery, the patient showed poor consolidation of bone, so iliac bone transplantation was performed on the extended bones and docking site of the distal tibia. After 20 months, tibia formation was good. Three years after surgery, there was no evidence of tumor recurrence or metastases; bone fusion was good, and he was able to run.ConclusionsThe bone transport method is an effective surgical method of reconstruction after wide resection of a bone tumor at the distal end of the tibia, if a pin can be inserted into the distal bone fragment. Coating external fixation pins with iodine may prevent postoperative infection.

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“…One of the strongest risk factors is the presence of metastasis at diagnosis and site of metastatic lesions; patients with extrapulmonary metastasis do significantly worse than patients with pulmonary metastasis alone . Other well‐known risk factors are the primary tumor site and tumor volume and/or size . Principles of treatment consist of neoadjuvant chemotherapy followed by local treatment of the primary tumor, either by surgery, radiotherapy, or both, and adjuvant chemotherapy.…”

Section: Introductionmentioning

confidence: 99%

“…The risk of local relapse is significantly lower after wide resection compared with marginal or intralesional resections . How the occurrence of a local recurrence may affect OS is not yet clearly established . If surgery with or without radiotherapy is superior compared with radiotherapy only in order to maximize local control alone is also under debate.…”

Section: Introductionmentioning

confidence: 99%

Individual risk evaluation for local recurrence and distant metastasis in Ewing sarcoma: A multistate model

Bosma

Rueten‐Budde

Lancia

et al. 2019

Pediatric Blood & Cancer

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Background:We investigated the effects of surgical margins, histological response, and radiotherapy on local recurrence (LR), distant metastasis (DM), and survival in Ewing sarcoma. Procedure: Disease evolution was retrospectively studied in 982 patients with Ewing sarcoma undergoing surgery after chemotherapy using a multistate model with initial state surgery, intermediate states LR, pulmonary metastasis (DMpulm), other DM ± LR (DMother), and final state death. Effect of risk factors was estimated using Cox proportional hazard models. Results: The median follow-up was 7.6 years (95% CI, 7.2-8.0). Risk factors for LR are pelvic location, HR 2.04 (1.10-3.80), marginal/intralesional resection, HR 2.28 (1.25-4.16), and radiotherapy, HR 0.52 (0.28-0.95); for DMpulm the risk factors are <90% necrosis, HR 2.13 (1.13-4.00), and previous pulmonary metastasis, HR 4.90 (2.28-8.52); for DMother are 90% to 99% necrosis, HR 1.56 (1.09-2.23), <90% necrosis, HR 2.66 (1.87-3.79), previous bone/other metastasis, HR 3.08 (2.03-4.70); and risk factors for death without LR/DM are pulmonary metastasis, HR 8.08 (4.01-16.29), bone/other metastasis, HR 10.23 (4.90-21.36), and <90% necrosis, HR 6.35 (3.18-12.69). Early LR (0-24 months) negatively influences survival, HR 3.79 (1.34-10.76). Once DMpulm/DMother arise only previous bone/other metastasis remain prognostic for death, HR 1.74 (1.10-2.75). Conclusion: Disease extent and histological response are risk factors for progression to DM or death. Tumor site and surgical margins are risk factors for LR. If disease progression occurs, previous risk factors lose their relevance. In case of isolated LR, time to recurrence is important for decision-making. Radiotherapy seems protective for LR especially in pelvic/axial. Low percentages of LR in extremity tumors and associated toxicity question the need for radiotherapy in extremity Ewing sarcoma. K E Y W O R D S Ewing sarcoma, multistate model, personalized medicine, prediction, survival Abbreviations: 95% CI, 95% confidence interval; DM, distant metastasis; DMother, distant metastasis extrapulmonary with or without pulmonary metastasis; DMpulm, distant metastasis solitary

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Does surgery or radiation provide the best overall survival in Ewing's sarcoma? A review of the National Cancer Data Base

Abstract: Surgery alone resulted in the best overall survival for patients with Ewing's sarcoma of bone. The results of this investigation provide support to the approach of surgical resection with negative margins when possible.

Cited by 44 publications

References 34 publications

Improved survival for extremity soft tissue sarcoma treated in high‐volume facilities

Improved survival for extremity soft tissue sarcoma treated in high‐volume facilities

Limb saving surgery for Ewing’s sarcoma of the distal tibia: a case report

Individual risk evaluation for local recurrence and distant metastasis in Ewing sarcoma: A multistate model

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