title: Comparative evaluation of local control strategies in localized Ewing sarcoma of bone: a report from the Children's Oncology Group.
abstract: BACKGROUND
  Patients with Ewing sarcoma require local primary tumor control with surgery, radiation, or both. The optimal choice of local control for overall and local disease control remains unclear.
  
  
  METHODS
  Patients with localized Ewing sarcoma of bone who were treated on 3 consecutive protocols with standard-dose, 5-drug chemotherapy every 3 weeks were included (n=465). Propensity scores were used to control for differences between local control groups by constructing multivariate models to assess the impact of local control type on clinical endpoints (event-free survival [EFS], overall survival, local failure, and distant failure) independent of differences in their propensity to receive each local control type.
  
  
  RESULTS
  Patients who underwent surgery were younger (P=.02) and had more appendicular tumors (P<.001). Compared with surgery, radiation had higher unadjusted risks of any event (hazard ratio [HR], 1.70; 95% confidence interval [CI], 1.18-2.44), death (HR, 1.84; 95% CI, 1.18-2.85), and local failure (HR, 2.57; 95% CI, 1.37-4.83). On multivariate analysis, compared with surgery, radiation had a higher risk of local failure (HR, 2.41; 95% CI, 1.24-4.68), although there were no significant differences in EFS (HR, 1.42; 95% CI, 0.94-2.14), overall survival (HR, 1.37; 95% CI, 0.83-2.26), or distant failure (HR, 1.13; 95% CI, 0.70-1.84) between local control groups.
  
  
  CONCLUSIONS
  In this large group of similarly treated patients, choice of the mode of local control was not related significantly to EFS, overall survival, or distant failure, although the risk of local failure was greater for radiation compared with surgery. These data support surgical resection when appropriate, whereas radiotherapy remains a reasonable alternative in selected patients.
authors.affiliation: Department of Pediatrics, University of California-San Francisco (UCSF) School of Medicine and UCSF Benioff Children's Hospital, San Francisco, California.
authors.forename: Steven G
authors.initials: SG
authors.lastname: DuBois
authors.forename: Mark D
authors.initials: MD
authors.lastname: Krailo
authors.forename: Mark C
authors.initials: MC
authors.lastname: Gebhardt
authors.forename: Sarah S
authors.initials: SS
authors.lastname: Donaldson
authors.forename: Karen J
authors.initials: KJ
authors.lastname: Marcus
authors.forename: John
authors.initials: J
authors.lastname: Dormans
authors.forename: Robert C
authors.initials: RC
authors.lastname: Shamberger
authors.forename: Scott
authors.initials: S
authors.lastname: Sailer
authors.forename: Richard W
authors.initials: RW
authors.lastname: Nicholas
authors.forename: John H
authors.initials: JH
authors.lastname: Healey
authors.forename: Nancy J
authors.initials: NJ
authors.lastname: Tarbell
authors.forename: R Lor
authors.initials: RL
authors.lastname: Randall
authors.forename: Meenakshi
authors.initials: M
authors.lastname: Devidas
authors.forename: James S
authors.initials: JS
authors.lastname: Meyer
authors.forename: Linda
authors.initials: L
authors.lastname: Granowetter
authors.forename: Richard B
authors.initials: RB
authors.lastname: Womer
authors.forename: Mark
authors.initials: M
authors.lastname: Bernstein
authors.forename: Neyssa
authors.initials: N
authors.lastname: Marina
authors.forename: Holcombe E
authors.initials: HE
authors.lastname: Grier
mesh_terms: D000293:Adolescent; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage; D001859:Bone Neoplasms / Q000188:drug therapy / Q000532:radiotherapy / Q000601:surgery / Q000628:therapy*; D002648:Child; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D015999:Multivariate Analysis; D016032:Randomized Controlled Trials as Topic; D012512:Sarcoma, Ewing / Q000188:drug therapy / Q000532:radiotherapy / Q000601:surgery / Q000628:therapy*
keywords: Ewing sarcoma; local control; propensity score; radiation; surgery