title: Treatment of nonmetastatic Ewing's sarcoma family tumors of the spine and sacrum: the experience from a single institution.
abstract: The objective of this study is to determine the best local treatment combined with neoadjuvant chemotherapy for ESFT of the spine and sacrum, for the best local treatment for Ewing sarcoma family tumors (ESFT) according to the primary site is still unclear. Nowadays surgery is used in local treatment of ESFT, but literature is scarce on the best local treatment in sites where surgery is problematic, such as the spine. This study evaluates the outcome and the rate of local recurrence of ESFT in the spine and sacrum when treated with neoadjuvant chemotherapy, and locally by radiotherapy alone or surgery, followed by reduced doses of radiotherapy. Forty-three patients with nonmetastatic ESFT located in the spine and sacrum were treated at our institution between 1983 and 2000 with neoadjuvant chemotherapy, and locally by radiotherapy alone in 26 cases, and surgery followed by radiotherapy at reduced doses in 17. The 5- and 10-year event-free survival (EFS) was 37 and 30%, and the 5- and 10-year overall survival was (OS) 42 and 32%. The prognosis was unrelated to gender and age, tumor volume, chemotherapy protocol, and local treatment. The outcome seemed worse for patients with primary tumors located in the sacrum than for patients with tumors located in the rest of the spine (5-year EFS = 23 vs. 46%). For these patients the results were significantly worse than for those we achieved with neoadjuvant treatment for ESFT located in other sites. However, no differences were observed between patients locally treated with radiotherapy alone and those treated by radiotherapy followed by surgery. We concluded that regardless of the type of local treatment even when associated with neoadjuvant therapy, ESFT in the spine and sacrum has a poor outcome and prognosis is significantly worse than that of primary ESFT in other sites.
authors.affiliation: Sezione di Chemioterapia, Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136, Bologna, Italy. gaetano.bacci@ior.it
authors.forename: Gaetano
authors.initials: G
authors.lastname: Bacci
authors.forename: Stefano
authors.initials: S
authors.lastname: Boriani
authors.forename: Alba
authors.initials: A
authors.lastname: Balladelli
authors.forename: Enza
authors.initials: E
authors.lastname: Barbieri
authors.forename: Alessandra
authors.initials: A
authors.lastname: Longhi
authors.forename: Marco
authors.initials: M
authors.lastname: Alberghini
authors.forename: Katia
authors.initials: K
authors.lastname: Scotlandi
authors.forename: Cristiana
authors.initials: C
authors.lastname: Forni
authors.forename: Paola
authors.initials: P
authors.lastname: Pollastri
authors.forename: Daniel
authors.initials: D
authors.lastname: Vanel
authors.forename: Mario
authors.initials: M
authors.lastname: Mercuri
mesh_terms: D000293:Adolescent; D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D017024:Chemotherapy, Adjuvant; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008297:Male; D009364:Neoplasm Recurrence, Local; D012189:Retrospective Studies; D012447:Sacrum; D012512:Sarcoma, Ewing / Q000188:drug therapy / Q000532:radiotherapy / Q000601:surgery; D013125:Spinal Neoplasms / Q000188:drug therapy / Q000532:radiotherapy / Q000601:surgery; D055815:Young Adult