title: Role of radiation in the treatment of non-metastatic osseous Ewing sarcoma.
abstract: BACKGROUND
  Local control, either with surgery, radiation (RT) or both, is essential in the management of localised Ewing sarcoma; however, the relative role of RT remains controversial.
  
  
  METHODS
  Using the Surveillance, Epidemiology, and End Results database, 612 patients treated for non-metastatic skeletal Ewing sarcoma between the years 1988 and 2010 were identified.
  
  
  RESULTS
  Median age and follow-up were 13 years (range: 0-21) and 56 months (range: 0-287), respectively. Five-year overall survival (OS) for the cohort was 74.4 ± 2.0%. Patients received surgery alone (51.3%), RT alone (21.6%) or both (27.1%). Patients with skeletal Ewing sarcoma had improved OS with surgery alone compared with other treatments. However, in subset analyses, RT was not inferior to surgery alone for appendicular (5-year OS: 80.0% vs. 79.3%), non-pelvic (84.3% vs. 79.9%) or localised disease (confined to cortex or periosteum; 79.7% vs. 80.6%). After controlling for stage and site, no increase in mortality was observed with RT versus surgery alone (hazard ratio = 0.77 (95% confidence interval: 0.49-1.19)).
  
  
  CONCLUSIONS
  In regard to survival, RT did not appear to be inferior to surgery alone for most patients, particularly those with disease at favourable sites (localised, appendicular, non-pelvic). In select patients with Ewing sarcoma, RT may be an appropriate strategy for local control that does not necessarily compromise survival outcomes.
authors.affiliation: Department of Radiation Oncology, Vanderbilt University School of Medicine, Nashville, Tennessee, USA.
authors.forename: Matthew S
authors.initials: MS
authors.lastname: Ning
authors.affiliation: Department of Radiation Oncology, Washington University School of Medicine, Saint Louis, Missouri, USA.
authors.forename: Stephanie M
authors.initials: SM
authors.lastname: Perkins
authors.affiliation: Department of Pediatrics, Division of Pediatric Hematology/Oncology, Vanderbilt University School of Medicine, Nashville, Tennessee, USA.
authors.forename: Scott C
authors.initials: SC
authors.lastname: Borinstein
authors.affiliation: Department of Orthopedics, Vanderbilt University School of Medicine, Nashville, Tennessee, USA.
authors.forename: Ginger E
authors.initials: GE
authors.lastname: Holt
authors.affiliation: Department of Radiation Oncology, Vanderbilt University School of Medicine, Nashville, Tennessee, USA.
authors.forename: Mark J
authors.initials: MJ
authors.lastname: Stavas
authors.affiliation: Department of Radiation Oncology, Vanderbilt University School of Medicine, Nashville, Tennessee, USA.
authors.forename: Eric T
authors.initials: ET
authors.lastname: Shinohara
mesh_terms: D000293:Adolescent; D001859:Bone Neoplasms / Q000401:mortality* / Q000532:radiotherapy* / Q000556:secondary; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008137:Longitudinal Studies; D008297:Male; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000517:prevention & control; D015995:Prevalence; D020266:Radiotherapy, Conformal / Q000401:mortality* / Q000706:statistics & numerical data*; D012512:Sarcoma, Ewing / Q000401:mortality* / Q000532:radiotherapy* / Q000556:secondary; D015996:Survival Rate; D013714:Tennessee / Q000453:epidemiology; D016896:Treatment Outcome; D055815:Young Adult
keywords: SEER program; paediatrics; secondary malignancy