Long-term clinical and functional outcomes after treatment for localized Ewing's tumor of the lower extremity.
OBJECTIVE
Retrospective review describing the 35-year University of Florida experience with Ewing's tumors of the lower extremity.


METHODS
Fifty-three patients were treated between 1971 and 2006. Thirty patients were treated with radiotherapy (RT) alone and 23 patients were treated with surgery +/- RT. Larger tumors and tumors of the femur were treated more often with definitive RT. Median potential follow-up was 19.2 years. Functional outcome was assessed using the Toronto Extremity Salvage Score (TESS).


RESULTS
Before 1985, 24% of patients were treated with surgery; since then, the rate has increased to 61%. The 15-year actuarial overall survival (OS), cause-specific survival (CSS), freedom from relapse, and limb preservation rates were 68% vs. 47% (p = 0.21), 73% vs. 47% (p = 0.13), 73% vs. 40% (p = 0.03), and 43% vs. 40% (p = 0.52), respectively, for patients treated with surgery +/- RT vs. RT alone. Excluding 8 patients who underwent amputation or rotationplasty, the 15-year actuarial local control rate was 100% for the surgery +/- RT group and 68% for the definitive RT group (p = 0.03). The ranges of the TESS for surgery +/- RT vs. RT alone were 70-100 (mean, 94) and 97-100 (mean, 99), respectively. Twenty-six percent (6/23) of patients had complications related to surgery requiring amputation or reoperation.


CONCLUSIONS
Overall survival and CSS were not statistically compromised, but we observed an increased risk of relapse and local failure in patients treated with RT alone, thereby justifying a transition toward primary surgical management in suitable patients. However, despite an adverse risk profile, patients treated with RT alone had similar long-term amputation-free survival and demonstrated comparable functional outcomes. Poor results observed in Ewing's of the femur mandate innovative surgical and RT strategies.
Indelicato
Daniel J
DJ
Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, FL, USA.
Keole
Sameer R
SR
Shahlaee
Amir H
AH
Shi
Wenyin
W
Morris
Christopher G
CG
Gibbs
Charles P
CP
Scarborough
Mark T
MT
Marcus
Robert B
RB
D000206:Actuarial Analysis; D000293:Adolescent; D000328:Adult; D000671:Amputation, Surgical / Q000009:adverse effects / Q000706:statistics & numerical data; D001859:Bone Neoplasms / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery*; D002648:Child; D003131:Combined Modality Therapy / Q000379:methods; D005260:Female; D005266:Femoral Neoplasms / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery; D005500:Follow-Up Studies; D006801:Humans; D035002:Lower Extremity / Q000473:pathology / Q000601:surgery; D008297:Male; D012189:Retrospective Studies; D012512:Sarcoma, Ewing / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery*; D013977:Tibia / Q000473:pathology / Q000601:surgery; D016896:Treatment Outcome