Local and systemic control in Ewing’s sarcoma of the femur treated with chemotherapy, and locally by radiotherapy and/or surgery

Abstract

The role of radiotherapy and/or surgery in the local treatment of Ewing's sarcoma has still to be determined. The outcome of Ewing's sarcoma may differ according to its location and a selection bias towards surgery limits the ability to compare methods of local treatment. We have carried out a retrospective review of 91 consecutive patients treated for non-metastatic Ewing's sarcoma of the femur. They received chemotherapy according to four different protocols. The primary lesion was treated by surgery alone (54 patients), surgery and radiotherapy (13) and radiotherapy alone (23). One was treated by chemotherapy alone. At a median follow-up of ten years, 48 patients (53%) remain free from disease, 39 (43%) have relapsed, two (2%) have died from chemotherapeutic toxicity and two (2%) have developed a radio-induced second tumour. The probability of survival without local recurrence was significantly (p = 0.01) higher in patients who were treated by surgery with or without radiotherapy (88%) than for patients who received radiotherapy alone (59%). The five- and ten-year overall survival rates were 64% and 57%, respectively. Patients who were treated by surgery, with or without radiotherapy, had a five- and ten-year overall survival of 64%. Patients who received only radiotherapy had a five- and ten-year survival of 57% and 44%, respectively. Our results indicate that in patients with Ewing's sarcoma of the femur, better local control is achieved by surgical treatment (with or without radiotherapy) compared with the use of radiotherapy alone. Further studies are needed to verify the impact of this strategy on overall survival.

Chemotherapy response is an important predictor of local recurrence in ewing sarcoma

“…11 In this debate, one must remember that the efficacy of local treatment is not uniform for all patients. The goal of the present study was to identify high-risk patients, who are likely to fail surgical treatment.…”

Oncological outcomes of patients with Ewing’s sarcoma

“…[1][2][3] Current management includes a combination of chemotherapy and excision, with or without radiotherapy. 4,5 Ewing's sarcoma is recognised to be a systemic disease, with between 20% and 30% of patients having detectable metastases at presentation. 6 Cure rates are now around 60% to 70% and are related to the presence of metastases at diagnosis, the size of the tumour and the response to chemotherapy.…”

Long-lasting multiagent chemotherapy in adult high-risk Ewing’s sarcoma of bone

“…Most available data, including Cooperative Ewing Sarcoma Study (CESS) 81, 86, and European Intergroup Cooperative Ewing Sarcoma Study (EICESS) 92 trials, on local tumor control in localized Ewing's sarcoma cases suggest superior outcome with local surgical therapy with adequate surgical margins [14][15][16][28][29][30][31] to definitive radiotherapy [16]. Some other studies demonstrated no significant difference in the rates of local recurrence and/or survival between patients who received radiotherapy alone and patients who underwent surgery [32][33][34].…”

“…In previous studies, tumor site (extremity vs. axial) was shown to affect the outcome: patients whose tumors were localized in extremities achieved better results because a high proportion of these patients could be surgically treated either with amputation or with extremity sparing techniques; therefore, adequate surgical margins were possible [14,15,28,31,37]. Naturally, it is difficult to achieve wide resection margins when the axial skeleton is involved, especially with larger lesions.…”