Impact of local management on long-term outcomes in Ewing tumors of the pelvis and sacral bones: the University of Florida experience.
OBJECTIVE
This retrospective analysis describes our 35-year experience with respect to disease control and functional status.


METHODS
Thirty-five patients with localized Ewing tumors of the pelvis and sacral bones were treated from 1970 to 2005. Twenty-six patients were treated with definitive radiotherapy (RT), and 9 patients were treated with combined local therapy in the form of surgery + RT. The median RT dose was 55.2 Gy. The patients who received RT alone were more likely to be older men with larger tumors exhibiting soft-tissue extension. Patients in the definitive RT group were more likely to receive etoposide and ifosfamide or undergo bone marrow transplant. Median potential follow-up was 19.4 years.


RESULTS
The 15-year actuarial cause-specific survival, freedom from relapse rate, and local control rates were 26% vs. 76% (p = 0.016), 28% vs. 78% (p = 0.015), and 64% vs. 100% (p = 0.087), respectively, for patients treated with definitive RT and combined therapy. Overall, tumors <8 cm had significantly better cause-specific survival, but this was unrelated to local control. The median Toronto Extremity Salvage Score for the definitive RT and combined therapy groups were 99 and 94, respectively (p = 0.19). Seven definitive RT patients (27%) had serious complications.


CONCLUSIONS
Combined modality local therapy should be considered if pelvic Ewing tumors are resectable. However, because of the extent of local disease, most patients have unresectable or partially resectable tumors and therefore require RT in some capacity. For this reason, innovative RT strategies are needed to improve long-term disease outcomes and minimize side effects while maintaining an acceptable functional result.
Indelicato
Daniel J
DJ
Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, FL 32610-0385, USA. dindelic@ufl.edu
Keole
Sameer R
SR
Shahlaee
Amir H
AH
Shi
Wenyin
W
Morris
Christopher G
CG
Gibbs
C Parker
CP
Scarborough
Mark T
MT
Marcus
Robert B
RB
D000293:Adolescent; D000328:Adult; D002648:Child; D003131:Combined Modality Therapy / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010384:Pelvic Bones / Q000601:surgery; D011879:Radiotherapy Dosage; D012189:Retrospective Studies; D012447:Sacrum / Q000601:surgery; D012512:Sarcoma, Ewing / Q000401:mortality / Q000532:radiotherapy* / Q000601:surgery*; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome