Identification of Patients With Localized Ewing Sarcoma at Higher Risk for Local Failure: A Report From the Children's Oncology Group

Safia K. Ahmed, R Randall, Steven G. DuBois, William S. Harmsen, Mark Krailo, Karen J. Marcus, Katherine A. Janeway, David S. Geller, Joel I. Sorger, Richard B. Womer, Linda Granowetter, Holcombe E. Grier, Richard G. Gorlick, Nadia N.I. Laack

Research output: Contribution to journalArticle

10 Citations (Scopus)

Abstract

Purpose To identify clinical and treatment variables associated with a higher risk of local failure in Ewing sarcoma patients treated on recent Children's Oncology Group protocols. Methods and Materials Data for 956 patients treated with ifosfamide and etoposide–based chemotherapy on INT-0091, INT-0154, and AEWS0031 were analyzed. Local treatment modalities were defined as surgery, definitive radiation therapy (RT), or surgery plus radiation (S+RT). Five-year cumulative incidence of local failure was determined. Results The local failure rate for the entire cohort was 7.3%, with a 3.9% rate for surgery, 15.3% for RT (P<.01), and 6.6% for S+RT (P=.12). The local failure incidence was 5.4% for extremity tumors, 13.2% for pelvis tumors (P<.01), 5.3% for axial non-spine tumors (P=.90), 9.1% for extraskeletal tumors (P=.08), and 3.6% for spine tumors (P=.49). The incidence of local failure was 14.8% for extremity tumors and 22.4% for pelvis tumors treated with RT, compared with 3.7% for extremity tumors and 3.9% for pelvis tumors treated with surgery (P≤.01). There was no difference in local failure incidence by local treatment modality for axial non-spine, spine, and extraskeletal tumors. The local failure incidence was 11.9% in patients aged ≥18 years versus 6.7% in patients aged <18 years (P=.02). Age ≥18 years (hazard ratio 1.9, P=.04) and treatment with RT (hazard ratio 2.40, P<.01) remained independent prognostic factors for higher local failure incidence on multivariate analysis. Tumor size (</≥ 8 cm) was available in 40% of patients and did not correlate with local failure incidence. Conclusions Local tumor control is excellent and similar between surgery and RT for axial non-spine, spine, and extraskeletal tumors. Age ≥18 years and use of RT, primarily for pelvis and extremity tumors, are associated with the highest risk of local failure. Further efforts should focus on improving outcomes for these patients.

Original languageEnglish (US)
Pages (from-to)1286-1294
Number of pages9
JournalInternational Journal of Radiation Oncology Biology Physics
Volume99
Issue number5
DOIs
StatePublished - Dec 1 2017
Externally publishedYes

Fingerprint

Ewing's Sarcoma
tumors
cancer
radiation therapy
Radiotherapy
Neoplasms
incidence
pelvis
surgery
Pelvis
Incidence
spine
Extremities
Spine
hazards
Ifosfamide
Therapeutics
chemotherapy

ASJC Scopus subject areas

  • Radiation
  • Oncology
  • Radiology Nuclear Medicine and imaging
  • Cancer Research

Cite this

Identification of Patients With Localized Ewing Sarcoma at Higher Risk for Local Failure : A Report From the Children's Oncology Group. / Ahmed, Safia K.; Randall, R; DuBois, Steven G.; Harmsen, William S.; Krailo, Mark; Marcus, Karen J.; Janeway, Katherine A.; Geller, David S.; Sorger, Joel I.; Womer, Richard B.; Granowetter, Linda; Grier, Holcombe E.; Gorlick, Richard G.; Laack, Nadia N.I.

In: International Journal of Radiation Oncology Biology Physics, Vol. 99, No. 5, 01.12.2017, p. 1286-1294.

Research output: Contribution to journalArticle

Ahmed, SK, Randall, R, DuBois, SG, Harmsen, WS, Krailo, M, Marcus, KJ, Janeway, KA, Geller, DS, Sorger, JI, Womer, RB, Granowetter, L, Grier, HE, Gorlick, RG & Laack, NNI 2017, 'Identification of Patients With Localized Ewing Sarcoma at Higher Risk for Local Failure: A Report From the Children's Oncology Group', International Journal of Radiation Oncology Biology Physics, vol. 99, no. 5, pp. 1286-1294. https://doi.org/10.1016/j.ijrobp.2017.08.020
Ahmed, Safia K. ; Randall, R ; DuBois, Steven G. ; Harmsen, William S. ; Krailo, Mark ; Marcus, Karen J. ; Janeway, Katherine A. ; Geller, David S. ; Sorger, Joel I. ; Womer, Richard B. ; Granowetter, Linda ; Grier, Holcombe E. ; Gorlick, Richard G. ; Laack, Nadia N.I. / Identification of Patients With Localized Ewing Sarcoma at Higher Risk for Local Failure : A Report From the Children's Oncology Group. In: International Journal of Radiation Oncology Biology Physics. 2017 ; Vol. 99, No. 5. pp. 1286-1294.
@article{94b11e390ea54f1cb5ee849460846616,
title = "Identification of Patients With Localized Ewing Sarcoma at Higher Risk for Local Failure: A Report From the Children's Oncology Group",
abstract = "Purpose To identify clinical and treatment variables associated with a higher risk of local failure in Ewing sarcoma patients treated on recent Children's Oncology Group protocols. Methods and Materials Data for 956 patients treated with ifosfamide and etoposide–based chemotherapy on INT-0091, INT-0154, and AEWS0031 were analyzed. Local treatment modalities were defined as surgery, definitive radiation therapy (RT), or surgery plus radiation (S+RT). Five-year cumulative incidence of local failure was determined. Results The local failure rate for the entire cohort was 7.3{\%}, with a 3.9{\%} rate for surgery, 15.3{\%} for RT (P<.01), and 6.6{\%} for S+RT (P=.12). The local failure incidence was 5.4{\%} for extremity tumors, 13.2{\%} for pelvis tumors (P<.01), 5.3{\%} for axial non-spine tumors (P=.90), 9.1{\%} for extraskeletal tumors (P=.08), and 3.6{\%} for spine tumors (P=.49). The incidence of local failure was 14.8{\%} for extremity tumors and 22.4{\%} for pelvis tumors treated with RT, compared with 3.7{\%} for extremity tumors and 3.9{\%} for pelvis tumors treated with surgery (P≤.01). There was no difference in local failure incidence by local treatment modality for axial non-spine, spine, and extraskeletal tumors. The local failure incidence was 11.9{\%} in patients aged ≥18 years versus 6.7{\%} in patients aged <18 years (P=.02). Age ≥18 years (hazard ratio 1.9, P=.04) and treatment with RT (hazard ratio 2.40, P<.01) remained independent prognostic factors for higher local failure incidence on multivariate analysis. Tumor size (",
author = "Ahmed, {Safia K.} and R Randall and DuBois, {Steven G.} and Harmsen, {William S.} and Mark Krailo and Marcus, {Karen J.} and Janeway, {Katherine A.} and Geller, {David S.} and Sorger, {Joel I.} and Womer, {Richard B.} and Linda Granowetter and Grier, {Holcombe E.} and Gorlick, {Richard G.} and Laack, {Nadia N.I.}",
year = "2017",
month = "12",
day = "1",
doi = "10.1016/j.ijrobp.2017.08.020",
language = "English (US)",
volume = "99",
pages = "1286--1294",
journal = "International Journal of Radiation Oncology Biology Physics",
issn = "0360-3016",
publisher = "Elsevier Inc.",
number = "5",

}

TY - JOUR

T1 - Identification of Patients With Localized Ewing Sarcoma at Higher Risk for Local Failure

T2 - A Report From the Children's Oncology Group

AU - Ahmed, Safia K.

AU - Randall, R

AU - DuBois, Steven G.

AU - Harmsen, William S.

AU - Krailo, Mark

AU - Marcus, Karen J.

AU - Janeway, Katherine A.

AU - Geller, David S.

AU - Sorger, Joel I.

AU - Womer, Richard B.

AU - Granowetter, Linda

AU - Grier, Holcombe E.

AU - Gorlick, Richard G.

AU - Laack, Nadia N.I.

PY - 2017/12/1

Y1 - 2017/12/1

N2 - Purpose To identify clinical and treatment variables associated with a higher risk of local failure in Ewing sarcoma patients treated on recent Children's Oncology Group protocols. Methods and Materials Data for 956 patients treated with ifosfamide and etoposide–based chemotherapy on INT-0091, INT-0154, and AEWS0031 were analyzed. Local treatment modalities were defined as surgery, definitive radiation therapy (RT), or surgery plus radiation (S+RT). Five-year cumulative incidence of local failure was determined. Results The local failure rate for the entire cohort was 7.3%, with a 3.9% rate for surgery, 15.3% for RT (P<.01), and 6.6% for S+RT (P=.12). The local failure incidence was 5.4% for extremity tumors, 13.2% for pelvis tumors (P<.01), 5.3% for axial non-spine tumors (P=.90), 9.1% for extraskeletal tumors (P=.08), and 3.6% for spine tumors (P=.49). The incidence of local failure was 14.8% for extremity tumors and 22.4% for pelvis tumors treated with RT, compared with 3.7% for extremity tumors and 3.9% for pelvis tumors treated with surgery (P≤.01). There was no difference in local failure incidence by local treatment modality for axial non-spine, spine, and extraskeletal tumors. The local failure incidence was 11.9% in patients aged ≥18 years versus 6.7% in patients aged <18 years (P=.02). Age ≥18 years (hazard ratio 1.9, P=.04) and treatment with RT (hazard ratio 2.40, P<.01) remained independent prognostic factors for higher local failure incidence on multivariate analysis. Tumor size (

AB - Purpose To identify clinical and treatment variables associated with a higher risk of local failure in Ewing sarcoma patients treated on recent Children's Oncology Group protocols. Methods and Materials Data for 956 patients treated with ifosfamide and etoposide–based chemotherapy on INT-0091, INT-0154, and AEWS0031 were analyzed. Local treatment modalities were defined as surgery, definitive radiation therapy (RT), or surgery plus radiation (S+RT). Five-year cumulative incidence of local failure was determined. Results The local failure rate for the entire cohort was 7.3%, with a 3.9% rate for surgery, 15.3% for RT (P<.01), and 6.6% for S+RT (P=.12). The local failure incidence was 5.4% for extremity tumors, 13.2% for pelvis tumors (P<.01), 5.3% for axial non-spine tumors (P=.90), 9.1% for extraskeletal tumors (P=.08), and 3.6% for spine tumors (P=.49). The incidence of local failure was 14.8% for extremity tumors and 22.4% for pelvis tumors treated with RT, compared with 3.7% for extremity tumors and 3.9% for pelvis tumors treated with surgery (P≤.01). There was no difference in local failure incidence by local treatment modality for axial non-spine, spine, and extraskeletal tumors. The local failure incidence was 11.9% in patients aged ≥18 years versus 6.7% in patients aged <18 years (P=.02). Age ≥18 years (hazard ratio 1.9, P=.04) and treatment with RT (hazard ratio 2.40, P<.01) remained independent prognostic factors for higher local failure incidence on multivariate analysis. Tumor size (

UR - http://www.scopus.com/inward/record.url?scp=85030170859&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85030170859&partnerID=8YFLogxK

U2 - 10.1016/j.ijrobp.2017.08.020

DO - 10.1016/j.ijrobp.2017.08.020

M3 - Article

C2 - 28964585

AN - SCOPUS:85030170859

VL - 99

SP - 1286

EP - 1294

JO - International Journal of Radiation Oncology Biology Physics

JF - International Journal of Radiation Oncology Biology Physics

SN - 0360-3016

IS - 5

ER -