title: Role of radiation therapy in the multidisciplinary management of Ewing's Sarcoma of bone in pediatric patients: An effective treatment for local control.
abstract: BACKGROUND
  Radiotherapy (RT) plays an important role in the multidisciplinary management of Ewing's Sarcoma (ES), especially in unresectable cases.
  
  
  OBJECTIVE
  Assessment of efficacy of RT in terms of local control in pediatric patients with primary ES of bone.
  
  
  METHODS
  Thirty-six patients younger than 17 years old with ES treated with combined RT and chemotherapy with (N = 14) or without (N = 22) prior surgery from 1981 to 2008 were retrospectively reviewed. Since 1995, they were all treated according to the Spanish Society of Pediatric Oncology protocol (55.5% cases). Those patients received vincristine, ifosfamide, doxorubicin and etoposide. The TNM classification was as follows: 17 T1, 18 T2 and 1 T3; 36 N0; 29 M0, 5 M1a and 2 M1b. Analysis was stratified by treatment: definitive RT or pre/postoperative RT.
  
  
  RESULTS
  The 36 patients (21 male; 15 female) had a median age of 10 years (range 2-17 years). Median follow-up of living patients was 105 months. The 2-year local control (LC) rate for all patients was 88%. Five-year LC rates for patients treated with definitive and pre/postoperative RT were 91% and 86%, respectively. Two-year overall survival and disease-free survival rates for all patients were 68% and 66%, respectively. Low phosphatase alkaline levels and local and distant recurrences were significantly predictive of worse prognosis (P = 0.021, P = 0.011, P = 0.007, respectively).
  
  
  CONCLUSIONS
  Radiotherapy with and without surgery is a highly effective local treatment option in the multidisciplinary management of ES in pediatric patients.
authors.affiliation: Virgen del Rocío University Hospital, Department of Radiation Oncology, Seville, Spain.
authors.forename: Jose Luis
authors.initials: JL
authors.lastname: Lopez
authors.affiliation: Virgen del Rocío University Hospital, Department of Radiation Oncology, Seville, Spain.
authors.forename: Patricia
authors.initials: P
authors.lastname: Cabrera
authors.affiliation: Virgen del Rocío University Hospital, Department of Radiation Oncology, Seville, Spain.
authors.forename: Rafael
authors.initials: R
authors.lastname: Ordoñez
authors.affiliation: Virgen del Rocío University Hospital, Department of Pediatric Oncology, Seville, Spain.
authors.forename: Catalina
authors.initials: C
authors.lastname: Marquez
authors.affiliation: Virgen del Rocío University Hospital, Department of Pediatric Oncology, Seville, Spain.
authors.forename: Gema Lucia
authors.initials: GL
authors.lastname: Ramirez
authors.affiliation: Methodology Unit, Fundación Pública Andaluza para la Gestión de la Investigación en Salud de Sevilla, Spain.
authors.forename: Juan Manuel
authors.initials: JM
authors.lastname: Praena-Fernandez
authors.affiliation: Virgen del Rocío University Hospital, Department of Radiation Oncology, Seville, Spain.
authors.forename: Maria Jose
authors.initials: MJ
authors.lastname: Ortiz
keywords: Ewing's Sarcoma; Local control; Radiotherapy