title: Local Control Modality and Outcome for Ewing Sarcoma of the Femur: A Report From the Children's Oncology Group.
abstract: The choice of a local control (LC) modality for Ewing sarcoma (EWS) of the femur is controversial. This study aimed to determine the effect of LC modality on tumor LC and patient outcomes.
  
  
  
  The study reviewed the treatment and outcomes for 115 patients who had EWS of the femur treated with similar chemotherapy in three cooperative group trials. Patient outcomes were analyzed according to the LC modality using the log-rank test and the cumulative incidence of local or distant failure using competing risks regression.
  
  
  
  The median age of the patients was 13 years. The most common tumor location was the proximal femur followed by the mid femur. For 55 patients with available data, the tumor was larger than 8 cm in 29 patients and 8 cm or smaller in 26 patients. For 84 patients (73 %), surgery only was performed, whereas 17 patients (15 %) had surgery plus radiation, and 14 patients (12 %) had radiation only. The 5-year event-free survival (EFS) rate was 65 % (95 % confidence interval [CI], 55-73 %), and the 5-year overall survival (OS) rate was 70 % (95 % CI, 61-78 %). Patient outcomes did not differ significantly according to tumor location within the femur (proximal, mid or distal) or tumor size (<8 vs ≥8 cm). The findings showed no statistically significant differences in EFS, OS, cumulative incidence of local failure, or cumulative incidence of distant failure according to LC modality (surgery, surgery plus radiation, or radiation).
  
  
  
  The LC modality did not significantly affect disease outcome for EWS of the femur. Further study of treatment complications and functional outcome may help to define the optimal LC modality.
authors.affiliation: Division of Pediatrics, UT MD Anderson Cancer Center, Unit 87, 1515 Holcombe Boulevard, Houston, TX, USA. ndaw@mdanderson.org.
authors.forename: Najat C
authors.initials: NC
authors.lastname: Daw
authors.affiliation: Department of Radiation Oncology, Mayo Clinic, Rochester, MN, USA.
authors.forename: Nadia N
authors.initials: NN
authors.lastname: Laack
authors.affiliation: Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
authors.forename: Elizabeth J
authors.initials: EJ
authors.lastname: McIlvaine
authors.affiliation: Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
authors.forename: Mark
authors.initials: M
authors.lastname: Krailo
authors.affiliation: Department of Pediatrics, University of Pennsylvania Perelman School of Medicine and Children's Hospital of Philadelphia, Philadelphia, PA, USA.
authors.forename: Richard B
authors.initials: RB
authors.lastname: Womer
authors.affiliation: Department of Pediatrics, New York University (NYU) School of Medicine and NYU Langone Medical Center, New York, NY, USA.
authors.forename: Linda
authors.initials: L
authors.lastname: Granowetter
authors.affiliation: Department of Pediatrics, Children's Hospital Boston/Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA, USA.
authors.forename: Holcombe E
authors.initials: HE
authors.lastname: Grier
authors.affiliation: Department of Pediatrics, Stanford University School of Medicine and Lucile Packard Children's Hospital, Palo Alto, CA, USA.
authors.forename: Neyssa M
authors.initials: NM
authors.lastname: Marina
authors.affiliation: Division of Pediatric Hematology/Oncology, IWK Health Center, Halifax, Nova Scotia, Canada.
authors.forename: Mark L
authors.initials: ML
authors.lastname: Bernstein
authors.affiliation: Department of Orthopedic Surgery, Children's Hospital Boston/Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA, USA.
authors.forename: Mark C
authors.initials: MC
authors.lastname: Gebhardt
authors.affiliation: Department of Radiation Oncology, Children's Hospital Boston/Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA, USA.
authors.forename: Karen J
authors.initials: KJ
authors.lastname: Marcus
authors.affiliation: Division of Pediatrics, UT MD Anderson Cancer Center, Unit 87, 1515 Holcombe Boulevard, Houston, TX, USA.
authors.forename: Shailesh M
authors.initials: SM
authors.lastname: Advani
authors.affiliation: Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA.
authors.forename: John H
authors.initials: JH
authors.lastname: Healey
authors.affiliation: Department of Surgery, All Children's Hospital, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA.
authors.forename: George D
authors.initials: GD
authors.lastname: Letson
authors.affiliation: Section of Pediatric Hematology/Oncology, Montefiore Medical Center-Moses Campus, Bronx, NY, USA.
authors.forename: Richard G
authors.initials: RG
authors.lastname: Gorlick
authors.affiliation: Department of Orthopaedics, Huntsman Cancer Institute, University of Utah School of Medicine, Salt Lake City, UT, USA.
authors.forename: R Lor
authors.initials: RL
authors.lastname: Randall
mesh_terms: D000293:Adolescent; D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001859:Bone Neoplasms / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery*; D017024:Chemotherapy, Adjuvant; D002648:Child; D002675:Child, Preschool; D018450:Disease Progression; D018572:Disease-Free Survival; D005260:Female; D005269:Femur; D006801:Humans; D007223:Infant; D008297:Male; D009362:Neoplasm Metastasis; D018714:Radiotherapy, Adjuvant; D012512:Sarcoma, Ewing / Q000532:radiotherapy* / Q000556:secondary / Q000601:surgery*; D015996:Survival Rate; D047368:Tumor Burden; D055815:Young Adult