title: Local control in Ewing sarcoma of the chest wall: results of the EURO-EWING 99 trial.
abstract: BACKGROUND
  Primary Ewing sarcoma (ES) can sometimes present as a chest-wall tumor. Multidisciplinary management, including chemotherapy and local treatment consisting of surgery, radiotherapy (RT), or both, has improved the survival of patients with localized ES; however, the best approach to achieving local control remains controversial.
  
  
  METHODS
  We retrospectively analyzed data from 198 patients with non-metastatic ES of the chest wall, who were registered in the database of the German Society of Pediatric Hematology and Oncology between July 1998 and April 2009. The majority of patients (n = 130) presented with rib tumors; 7 patients received RT only, 85 patients underwent surgery alone, and 106 patients were treated with a combination of surgery and RT.
  
  
  RESULTS
  Overall survival in all patients was 78 and 71 % at 3 and 5 years, respectively. Event-free survival at 5 years (5-year EFS) was 57 % in the RT group, 73 % in the surgery group and 63 % in the surgery + RT group. In patients with complete resections, 5-year EFS did not improve with the addition of RT compared with surgery alone. There was no difference in the 5-year EFS in patients with partial (63 %) or total (64 %) resection of the affected ribs, and median follow-up was 4.71 years (range 0.40-13.48).
  
  
  CONCLUSIONS
  Complete tumor resection is the best way to achieve local control of ES of the chest wall; additional RT is only useful in patients with incomplete resection. The main limitation of this study was its retrospective nature, and the benefit of total resection of the affected ribs could not be proved.
authors.affiliation: Section of Thoracic Surgery and Lung Transplantation, Department of Cardiothoracic Surgery, University Hospital Münster, Münster, Germany.
authors.forename: Benedetta
authors.initials: B
authors.lastname: Bedetti
authors.forename: Karsten
authors.initials: K
authors.lastname: Wiebe
authors.forename: Andreas
authors.initials: A
authors.lastname: Ranft
authors.forename: Hermann
authors.initials: H
authors.lastname: Aebert
authors.forename: Joachim
authors.initials: J
authors.lastname: Schmidt
authors.forename: Heribert
authors.initials: H
authors.lastname: Jürgens
authors.forename: Uta
authors.initials: U
authors.lastname: Dirksen
mesh_terms: D000293:Adolescent; D000328:Adult; D001859:Bone Neoplasms / Q000401:mortality* / Q000473:pathology / Q000628:therapy; D002648:Child; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007390:International Agencies; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D011446:Prospective Studies; D012189:Retrospective Studies; D012272:Ribs / Q000473:pathology*; D012512:Sarcoma, Ewing / Q000401:mortality* / Q000473:pathology / Q000628:therapy; D015996:Survival Rate; D013899:Thoracic Neoplasms / Q000401:mortality* / Q000473:pathology / Q000628:therapy; D035441:Thoracic Wall / Q000473:pathology*