title: Pelvis Ewing sarcoma: Local control and survival in the modern era.
abstract: OBJECTIVE
  Local control for Ewing sarcoma (ES) has improved in modern studies. However, it is unclear if these gains have also been achieved for pelvis tumors. The purpose of this study is to evaluate local control and survival in pelvis ES patients treated in the modern era.
  
  
  METHODS
  All pelvis ES patients diagnosed from 1990 to 2012 and seen at Mayo Clinic were identified. Factors relevant to survival and local control were analyzed.
  
  
  RESULTS
  The cohort consisted of 48 patients. Fifty-two percent had metastatic disease at diagnosis. The 5-year overall survival and event-free survival was 73% and 65%, respectively, for localized disease. The 5-year cumulative incidence of local recurrence was 19%, with a 26% incidence for radiation, 13% for surgery, and 0% for surgery + radiation (P = 0.54). All local failures occurred in-field. Sacral involvement by tumor trended toward a higher incidence of local recurrence (hazard ratio 3.06, P = 0.09). Patients treated with definitive radiation doses ≥5,600 cGy had a lower incidence of local recurrence (17% vs. 28%, P = 0.61).
  
  
  CONCLUSIONS
  Our study demonstrates excellent survival for localized tumors in the modern era. Anatomical localization within the pelvis likely correlates with outcomes. Local control remains problematic, especially for patients treated with definitive radiation. Though statistically not significant, surgery + radiation and definitive radiation dose ≥5,600 cGy were associated with the lowest incidence of local failure, suggesting treatment intensification may improve local control for pelvis ES.
authors.affiliation: Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota.
authors.forename: Safia K
authors.initials: SK
authors.lastname: Ahmed
authors.affiliation: Division of Medical Oncology, Mayo Clinic, Rochester, Minnesota.
authors.forename: Steven I
authors.initials: SI
authors.lastname: Robinson
authors.affiliation: Division of Pediatric Hematology/Oncology, Mayo Clinic, Rochester, Minnesota.
authors.forename: Carola A S
authors.initials: CAS
authors.lastname: Arndt
authors.affiliation: Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota.
authors.forename: Ivy A
authors.initials: IA
authors.lastname: Petersen
authors.affiliation: Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota.
authors.forename: Michael G
authors.initials: MG
authors.lastname: Haddock
authors.affiliation: Division of Pediatric Hematology/Oncology, Mayo Clinic, Rochester, Minnesota.|Division of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota.
authors.forename: Peter S
authors.initials: PS
authors.lastname: Rose
authors.affiliation: Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota.
authors.forename: Nadia N
authors.initials: NN
authors.lastname: Issa Laack
mesh_terms: D000293:Adolescent; D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001859:Bone Neoplasms / Q000401:mortality / Q000473:pathology* / Q000628:therapy*; D002648:Child; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D015994:Incidence; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology; D010388:Pelvis; D011878:Radiotherapy; D012189:Retrospective Studies; D012512:Sarcoma, Ewing / Q000401:mortality / Q000473:pathology* / Q000628:therapy*; D055815:Young Adult
keywords: Ewing sarcoma; local control; pelvis