Prognostic factors for local and distant control in Ewing sarcoma family of tumors.
BACKGROUND
Advances in the treatment of Ewing sarcoma family of tumors (ESFT) are the result of improvements in systemic and local therapies. The individual contributions of each treatment component cannot be analyzed separately; improvements in local and systemic control can influence each other.


METHODS
We reviewed the records of 220 patients treated on institutional protocols from 1979 to 2004. Factors predictive of local and distant recurrence were analyzed.


RESULTS
The median age at diagnosis was 13.7 years. Ninety-five patients relapsed at a median of 1.6 years. The 5-year overall survival estimate was 63.5% +/- 3.5%. The estimated 5-year cumulative incidence (CI) of local failure was 25.1% +/- 3.0%. Local failure was associated with treatment era (P < 0.001), tumor size (P = 0.037) and type of local control (P = 0.021). Systemic treatment intensification improved local control. The estimated 5-year CI of distant recurrence was 22.5% +/- 2.9%. Patients with localized disease (P < 0.001), smaller tumors (P = 0.018) and those who received surgery +/- radiation for local control (P = 0.023) had lower CI of distant failure.


CONCLUSIONS
Successful treatment of ESFT requires optimal systemic and local therapy. Both treatment modalities are intertwined and the control of both local and distant disease is the result of the combined approach.
Rodríguez-Galindo
C
C
Department of Oncology, St Jude Children's Research Hospital, Memphis, TN 38105, USA. carlos.rodriguez-galindo@stjude.org
Navid
F
F
Liu
T
T
Billups
C A
CA
Rao
B N
BN
Krasin
M J
MJ
D000293:Adolescent; D000328:Adult; D000970:Antineoplastic Agents / Q000627:therapeutic use; D001859:Bone Neoplasms / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery / Q000628:therapy*; D017024:Chemotherapy, Adjuvant; D002648:Child; D002675:Child, Preschool; D019583:Dose Fractionation, Radiation; D005047:Etoposide / Q000008:administration & dosage; D005260:Female; D006801:Humans; D007069:Ifosfamide / Q000008:administration & dosage; D015994:Incidence; D007223:Infant; D008297:Male; D008499:Medical Records; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology / Q000517:prevention & control; D009367:Neoplasm Staging; D011379:Prognosis; D018714:Radiotherapy, Adjuvant; D012189:Retrospective Studies; D012307:Risk Factors; D012512:Sarcoma, Ewing / Q000532:radiotherapy / Q000556:secondary / Q000601:surgery / Q000628:therapy*; D017211:Treatment Failure
D000970:Antineoplastic Agents; D005047:Etoposide; D007069:Ifosfamide