Should Aggressive Surgical Local Control Be Attempted in All Patients with Metastatic or Pelvic Ewing's Sarcoma?

Abstract

In previous reports, patients with Ewing's sarcoma received radiation therapy (XRT) for definitive local control because metastatic disease and pelvic location were thought to preclude aggressive local treatment. We sought to determine if single-site metastatic disease should be treated differently from multicentric-metastatic disease. We also wanted to reinvestigate the impact of XRT, pelvic location, and local recurrence on outcomes. Our results demonstrated a significant difference in overall survival (OS) between patients with either localized disease or a single-metastatic site and patients with multicentric-metastatic disease (P = 0.004). Local control was also found to be an independent predictor of outcomes as demonstrated by a significant difference in OS between those with and without local recurrence (P = 0.001). Axial and pelvic location did not predict a decreased OS. Based on these results, we concluded that pelvic location and the diagnosis of metastatic disease at diagnosis should not preclude aggressive local control, except in cases of multicentric-metastatic disease.

The effect of surgery with radiation on pelvic Ewing sarcoma survival

“…Metastatic spread at presentation was the strongest negative predictor, yet almost 40% with lung‐only disease survived compared to 16% with B/BM disease. These rates are comparable to the literature and extremity‐based ES . In this study, approximately 30% of patients with large primary tumors involving more than one area of the pelvis survived.…”

“…Ewing sarcoma (ES) with a primary pelvic site has worse survival than extremity‐based lesions . Larger size, presence of distant disease, older age, and difficulty in achieving adequate surgical margins or radiation doses due to anatomic location are reported as contributing factors to poorer outcomes .…”

“…Ewing sarcoma (ES) with a primary pelvic site has worse survival than extremity‐based lesions . Larger size, presence of distant disease, older age, and difficulty in achieving adequate surgical margins or radiation doses due to anatomic location are reported as contributing factors to poorer outcomes . Ewing sarcoma treated with neoadjuvant chemotherapy and effective local control therapy has improved survival to greater than 50% in patients with localized pelvic disease .…”

Outcomes of Pediatric Patients with metastatic Ewing sarcoma treated with interval compression

“…Although older studies suggest that axial and pelvic locations are associated with inferior outcomes, more recent studies have found that primary tumor site is not a significant prognostic factor, most likely because newer protocols employ surgical local control. 21,22 Likewise, we found that patients treated with surgical resection alone had the best outcomes, whereas those treated with radiotherapy alone had the worst outcomes. However, this may be due to selection bias because patients who were more likely to experience superior responses were also more likely to receive definitive surgery.…”

Validation of recursive partitioning analysis, graded prognostic assessment and basic score for brain metastases as prognostic indices among patients with brain metastases treated with radiotherapy in Indonesia

“…This factor is paramount and affects the overall survival in cancer patients. 19 Furthermore, the number of brain metastatic lesions, which is part of the GPA scoring system, did not confer any prognostic value in cases of multiple or large-size brain metastatic lesions. 20 The median survival in all three-scoring systems tested with our study population showed a longer median survival across all stratification classes compared to their original prognostic studies.…”