title: Ewing sarcoma of the hand or foot.
abstract: OBJECTIVE
  Ewing Sarcoma (ES) of the hand or foot is a rare clinical condition. Due to the critical site, it is of major importance to choose an optimal procedure for local control in terms of outcome and function. Local therapeutic options for these patients range from: surgery (OP), surgery followed by radiotherapy (OP & RT), or radiotherapy (RT) alone.
  
  
  METHODS
  Data from 80 patients with ES of the hand or foot were analyzed. All patients received chemotherapy according to the protocols of the Cooperative Ewing Sarcoma Study Group (CESS) from 1991 to 2009 (EICESS-92 and EURO-E.W.I.N.G.99). Local therapy consisted of: OP in 39%, OP & RT in 44%, and RT in 12%. In 5% of the patients no local therapy (noL) was performed. Primary endpoint of our study was the event-free-survival (EFS).
  
  
  RESULTS
  The 3-year overall EFS was 62% (95%CI 0.50-0.72). Patients with localized disease had a significantly better outcome with an EFS of 77% (95%CI 0.63-0.86), compared to patients with primary disseminated disease with an EFS of 30% (95%CI 0.14-0.49; p<0.001). In comparing local treatment modalities, no significant difference was observed. The 3-year EFS for OP was 61% (95% CI 0.40-0.76), for OP & RT 66% (95%CI 0.47-0.79) and for RT only 70% (95%CI 0.32-0.89) (p=0.253). Patients who did not receive local treatment had an unfavourable prognosis (3-year EFS=0.25; 95%CI 0.01-0.67; p=0.024). A multivariate analysis which included local treatment modality and known prognosticators, showed that primary dissemination was the only significant prognostic factor.Ewing sarcoma of the hand or foot is associated with a favourable outcome.
  
  
  CONCLUSIONS
  Our data analysed a limited group of patients and thus did not provide a clear indication for a preferred local treatment modality.
authors.affiliation: Westfalian Wilhelms University Muenster, Muenster, Germany.
authors.forename: D
authors.initials: D
authors.lastname: Froeb
authors.forename: A
authors.initials: A
authors.lastname: Ranft
authors.forename: T
authors.initials: T
authors.lastname: Boelling
authors.forename: M
authors.initials: M
authors.lastname: Paulussen
authors.forename: S
authors.initials: S
authors.lastname: Klco-Brosius
authors.forename: H
authors.initials: H
authors.lastname: Jürgens
authors.forename: U
authors.initials: U
authors.lastname: Dirksen
mesh_terms: D000293:Adolescent; D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001859:Bone Neoplasms / Q000175:diagnosis / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D017024:Chemotherapy, Adjuvant; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy; D060830:Consolidation Chemotherapy; D018572:Disease-Free Survival; D005260:Female; D005528:Foot; D005858:Germany; D019983:Guideline Adherence; D006225:Hand; D006801:Humans; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009367:Neoplasm Staging; D012189:Retrospective Studies; D012512:Sarcoma, Ewing / Q000175:diagnosis / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D055815:Young Adult