Comparative evaluation of local control strategies in localized Ewing sarcoma of bone: A report from the Children's Oncology Group

Steven G. DuBois, Mark D. Krailo, Mark C. Gebhardt, Sarah S. Donaldson, Karen J. Marcus, John Dormans, Robert C. Shamberger, Scott Sailer, Richard W. Nicholas, John H. Healey, Nancy J. Tarbell, R Randall, Meenakshi Devidas, James S. Meyer, Linda Granowetter, Richard B. Womer, Mark Bernstein, Neyssa Marina, Holcombe E. Grier

Research output: Contribution to journalArticle

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Abstract

BACKGROUND: Patients with Ewing sarcoma require local primary tumor control with surgery, radiation, or both. The optimal choice of local control for overall and local disease control remains unclear. METHODS: Patients with localized Ewing sarcoma of bone who were treated on 3 consecutive protocols with standard-dose, 5-drug chemotherapy every 3 weeks were included (n=465). Propensity scores were used to control for differences between local control groups by constructing multivariate models to assess the impact of local control type on clinical endpoints (event-free survival [EFS], overall survival, local failure, and distant failure) independent of differences in their propensity to receive each local control type. RESULTS: Patients who underwent surgery were younger (P=.02) and had more appendicular tumors (P<.001). Compared with surgery, radiation had higher unadjusted risks of any event (hazard ratio [HR], 1.70; 95% confidence interval [CI], 1.18-2.44), death (HR, 1.84; 95% CI, 1.18-2.85), and local failure (HR, 2.57; 95% CI, 1.37-4.83). On multivariate analysis, compared with surgery, radiation had a higher risk of local failure (HR, 2.41; 95% CI, 1.24-4.68), although there were no significant differences in EFS (HR, 1.42; 95% CI, 0.94-2.14), overall survival (HR, 1.37; 95% CI, 0.83-2.26), or distant failure (HR, 1.13; 95% CI, 0.70-1.84) between local control groups. CONCLUSIONS: In this large group of similarly treated patients, choice of the mode of local control was not related significantly to EFS, overall survival, or distant failure, although the risk of local failure was greater for radiation compared with surgery. These data support surgical resection when appropriate, whereas radiotherapy remains a reasonable alternative in selected patients.

Original languageEnglish (US)
Pages (from-to)467-475
Number of pages9
JournalCancer
Volume121
Issue number3
DOIs
StatePublished - Jan 1 2015
Externally publishedYes

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Ewing's Sarcoma
Confidence Intervals
Bone and Bones
Radiation
Disease-Free Survival
Survival
Propensity Score
Control Groups
Neoplasms
Radiotherapy
Multivariate Analysis
Drug Therapy
Pharmaceutical Preparations

Keywords

  • Ewing sarcoma
  • Local control
  • Propensity score
  • Radiation
  • Surgery

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

Cite this

DuBois, S. G., Krailo, M. D., Gebhardt, M. C., Donaldson, S. S., Marcus, K. J., Dormans, J., ... Grier, H. E. (2015). Comparative evaluation of local control strategies in localized Ewing sarcoma of bone: A report from the Children's Oncology Group. Cancer, 121(3), 467-475. https://doi.org/10.1002/cncr.29065

Comparative evaluation of local control strategies in localized Ewing sarcoma of bone : A report from the Children's Oncology Group. / DuBois, Steven G.; Krailo, Mark D.; Gebhardt, Mark C.; Donaldson, Sarah S.; Marcus, Karen J.; Dormans, John; Shamberger, Robert C.; Sailer, Scott; Nicholas, Richard W.; Healey, John H.; Tarbell, Nancy J.; Randall, R; Devidas, Meenakshi; Meyer, James S.; Granowetter, Linda; Womer, Richard B.; Bernstein, Mark; Marina, Neyssa; Grier, Holcombe E.

In: Cancer, Vol. 121, No. 3, 01.01.2015, p. 467-475.

Research output: Contribution to journalArticle

DuBois, SG, Krailo, MD, Gebhardt, MC, Donaldson, SS, Marcus, KJ, Dormans, J, Shamberger, RC, Sailer, S, Nicholas, RW, Healey, JH, Tarbell, NJ, Randall, R, Devidas, M, Meyer, JS, Granowetter, L, Womer, RB, Bernstein, M, Marina, N & Grier, HE 2015, 'Comparative evaluation of local control strategies in localized Ewing sarcoma of bone: A report from the Children's Oncology Group', Cancer, vol. 121, no. 3, pp. 467-475. https://doi.org/10.1002/cncr.29065
DuBois, Steven G. ; Krailo, Mark D. ; Gebhardt, Mark C. ; Donaldson, Sarah S. ; Marcus, Karen J. ; Dormans, John ; Shamberger, Robert C. ; Sailer, Scott ; Nicholas, Richard W. ; Healey, John H. ; Tarbell, Nancy J. ; Randall, R ; Devidas, Meenakshi ; Meyer, James S. ; Granowetter, Linda ; Womer, Richard B. ; Bernstein, Mark ; Marina, Neyssa ; Grier, Holcombe E. / Comparative evaluation of local control strategies in localized Ewing sarcoma of bone : A report from the Children's Oncology Group. In: Cancer. 2015 ; Vol. 121, No. 3. pp. 467-475.
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abstract = "BACKGROUND: Patients with Ewing sarcoma require local primary tumor control with surgery, radiation, or both. The optimal choice of local control for overall and local disease control remains unclear. METHODS: Patients with localized Ewing sarcoma of bone who were treated on 3 consecutive protocols with standard-dose, 5-drug chemotherapy every 3 weeks were included (n=465). Propensity scores were used to control for differences between local control groups by constructing multivariate models to assess the impact of local control type on clinical endpoints (event-free survival [EFS], overall survival, local failure, and distant failure) independent of differences in their propensity to receive each local control type. RESULTS: Patients who underwent surgery were younger (P=.02) and had more appendicular tumors (P<.001). Compared with surgery, radiation had higher unadjusted risks of any event (hazard ratio [HR], 1.70; 95{\%} confidence interval [CI], 1.18-2.44), death (HR, 1.84; 95{\%} CI, 1.18-2.85), and local failure (HR, 2.57; 95{\%} CI, 1.37-4.83). On multivariate analysis, compared with surgery, radiation had a higher risk of local failure (HR, 2.41; 95{\%} CI, 1.24-4.68), although there were no significant differences in EFS (HR, 1.42; 95{\%} CI, 0.94-2.14), overall survival (HR, 1.37; 95{\%} CI, 0.83-2.26), or distant failure (HR, 1.13; 95{\%} CI, 0.70-1.84) between local control groups. CONCLUSIONS: In this large group of similarly treated patients, choice of the mode of local control was not related significantly to EFS, overall survival, or distant failure, although the risk of local failure was greater for radiation compared with surgery. These data support surgical resection when appropriate, whereas radiotherapy remains a reasonable alternative in selected patients.",
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T2 - A report from the Children's Oncology Group

AU - DuBois, Steven G.

AU - Krailo, Mark D.

AU - Gebhardt, Mark C.

AU - Donaldson, Sarah S.

AU - Marcus, Karen J.

AU - Dormans, John

AU - Shamberger, Robert C.

AU - Sailer, Scott

AU - Nicholas, Richard W.

AU - Healey, John H.

AU - Tarbell, Nancy J.

AU - Randall, R

AU - Devidas, Meenakshi

AU - Meyer, James S.

AU - Granowetter, Linda

AU - Womer, Richard B.

AU - Bernstein, Mark

AU - Marina, Neyssa

AU - Grier, Holcombe E.

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N2 - BACKGROUND: Patients with Ewing sarcoma require local primary tumor control with surgery, radiation, or both. The optimal choice of local control for overall and local disease control remains unclear. METHODS: Patients with localized Ewing sarcoma of bone who were treated on 3 consecutive protocols with standard-dose, 5-drug chemotherapy every 3 weeks were included (n=465). Propensity scores were used to control for differences between local control groups by constructing multivariate models to assess the impact of local control type on clinical endpoints (event-free survival [EFS], overall survival, local failure, and distant failure) independent of differences in their propensity to receive each local control type. RESULTS: Patients who underwent surgery were younger (P=.02) and had more appendicular tumors (P<.001). Compared with surgery, radiation had higher unadjusted risks of any event (hazard ratio [HR], 1.70; 95% confidence interval [CI], 1.18-2.44), death (HR, 1.84; 95% CI, 1.18-2.85), and local failure (HR, 2.57; 95% CI, 1.37-4.83). On multivariate analysis, compared with surgery, radiation had a higher risk of local failure (HR, 2.41; 95% CI, 1.24-4.68), although there were no significant differences in EFS (HR, 1.42; 95% CI, 0.94-2.14), overall survival (HR, 1.37; 95% CI, 0.83-2.26), or distant failure (HR, 1.13; 95% CI, 0.70-1.84) between local control groups. CONCLUSIONS: In this large group of similarly treated patients, choice of the mode of local control was not related significantly to EFS, overall survival, or distant failure, although the risk of local failure was greater for radiation compared with surgery. These data support surgical resection when appropriate, whereas radiotherapy remains a reasonable alternative in selected patients.

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