title: Ewing's tumors with primary lung metastases: survival analysis of 114 (European Intergroup) Cooperative Ewing's Sarcoma Studies patients.
abstract: OBJECTIVE
  To analyze event-free survival (EFS) and prognostic factors in patients who present with Ewing's tumors (ET) of bone and synchronous pulmonary and/or pleural metastases (ppm).
  
  
  METHODS
  Of 1,270 patients (pts) registered at the continental office of the German/European Intergroup Cooperative Ewing's Sarcoma Studies (CESS81, CESS86, EICESS92), 114 were diagnosed ET with ppm. Patients underwent neoadjuvant therapy and local treatment of the primary tumor. Whole-lung irradiation 15 to 18 Gy was applied to 75 ppm-pts. EFS and 95% confidence intervals (CIs) were estimated according to the Kaplan-Meier method, and prognostic factors were analyzed by log-rank tests and Cox and logistic regression procedures.
  
  
  RESULTS
  On November 1, 1997, at a median time under study of 5.9 years, the 5-year EFS was 0.36 (95% CI, 0.26 to 0.46) and the 10-year EFS was 0.30 (95% CI, 0.19 to 0.41). Thirty-seven of 59 (63%) first relapses involved lung and/or pleura, and the lungs were the only site of relapse in 26 of 59 (44%) ppm-pts. Risk factors identified in univariate and multivariate tests were poor response of the primary tumor toward chemotherapy, metastatic lesions in both lungs, and treatment without additional lung irradiation.
  
  
  CONCLUSIONS
  Chemotherapy response of the primary tumor is a prognostic factor in patients with ET with ppm. Strategies of treatment intensification warrant further evaluation.
authors.affiliation: Department of Pediatric Oncology, University of Münster, Germany. eicess@uni-muenster.de
authors.forename: M
authors.initials: M
authors.lastname: Paulussen
authors.forename: S
authors.initials: S
authors.lastname: Ahrens
authors.forename: A W
authors.initials: AW
authors.lastname: Craft
authors.forename: J
authors.initials: J
authors.lastname: Dunst
authors.forename: B
authors.initials: B
authors.lastname: Fröhlich
authors.forename: S
authors.initials: S
authors.lastname: Jabar
authors.forename: C
authors.initials: C
authors.lastname: Rübe
authors.forename: W
authors.initials: W
authors.lastname: Winkelmann
authors.forename: S
authors.initials: S
authors.lastname: Wissing
authors.forename: A
authors.initials: A
authors.lastname: Zoubek
authors.forename: H
authors.initials: H
authors.lastname: Jürgens
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000401:mortality / Q000556:secondary* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011379:Prognosis; D012044:Regression Analysis; D012512:Sarcoma, Ewing / Q000401:mortality / Q000556:secondary* / Q000628:therapy*; D016019:Survival Analysis; D016896:Treatment Outcome