Risk analysis factors for local recurrencein Ewing’s sarcoma when should adjuvant radiotherapy be administered?

• Published in: Journal of bone and joint surgery. British volume Vol. 100-B; no. 2; pp. 247 - 255
• Main Authors: Albergo, J I, Gaston C L L, Laitinen, M K, Jeys L M, Tillman, R M, Abudu, A T, Grimer R J
• Format: Journal Article
• Language: English
• Published: London British Editorial Society of Bone & Joint Surgery 01.02.2018
• Subjects: Chemotherapy; Ewings sarcoma; Medical prognosis; Radiation therapy; Tumors
• ISSN: 2049-4394; 2049-4408
• DOI: 10.1302/0301-620X.100B2.BJJ-2017-0222.R1

AimsThe aim of this study was to analyse a group of patients withnon-metastatic Ewing’s sarcoma at presentation and identify prognosticfactors affecting the development of local recurrence, in orderto assess the role of radiotherapy.Patients and MethodsA retrospective review of all patients with a Ewing’s sarcomatreated between 1980 and 2012 was carried out. Only those treatedwith chemotherapy followed by surgery and/or radiotherapy were included.Patients were grouped according to site (central or limb) for furtheranalysis of the prognostic factors.ResultsA total of 388 patients were included in the study. Of these,60 (15%) developed local recurrence at a mean median of 27 months(sd 24, range 7 to 150) and the five-year local recurrence-freesurvival (5yrLRFS) was 83%. For central tumours, the size of thetumour and histological response to chemotherapy were found to besignificant factors for local recurrence. For limb tumours, localrecurrence was affected by intralesional and marginal resections,but not by the histological response to chemotherapy. Radiotherapyin those with a marginal resection reduced the risk of local recurrence(5yrLRFS: 96% versus 81%, p = 0.044).ConclusionLocal recurrence significantly affects the overall survival inpatients with a Ewing’s sarcoma. For those with a tumour in a limb,radiotherapy reduced the risk of local recurrence, especially inthose with a marginal margin of excision, but the effect in centraltumours was less clear. Radiotherapy for those who have had a widemargin of resection does not reduce the risk of local recurrence,regardless of the histological response to chemotherapy.Cite this article: Bone Joint J 2018;100-B:247–55.