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Local Control Modality and Outcome for Ewing Sarcoma of the Femur: A Report From the Children’s Oncology Group

  • Bone and Soft Tissue Sarcomas
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

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.

Methods

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.

Results

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).

Conclusions

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.

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Acknowledgments

This study was supported by National Institute of Health/National Cancer Institute grant 1K23CA154530 and by U10CA180886 (NCTN Operations Center Grant) and U10CA180899 (NCTN Statistics & Data Center Grant), as well as by U10CA98543 (Chair’s Grant) and U10CA98413 (Statistics & Data Center Grant) grants from the National Cancer Institute. Additional support for research was provided by a grant from the WWWW (QuadW) Foundation, Inc. (www.QuadW.org).

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Authors and Affiliations

  1. Division of Pediatrics, UT MD Anderson Cancer Center, Unit 87, 1515 Holcombe Boulevard, Houston, TX, USA

    Najat C. Daw MD & Shailesh M. Advani MD

  2. Department of Radiation Oncology, Mayo Clinic, Rochester, MN, USA

    Nadia N. Laack MD

  3. Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA

    Elizabeth J. McIlvaine PhD & Mark Krailo PhD

  4. Department of Pediatrics, University of Pennsylvania Perelman School of Medicine and Children’s Hospital of Philadelphia, Philadelphia, PA, USA

    Richard B. Womer MD

  5. Department of Pediatrics, New York University (NYU) School of Medicine and NYU Langone Medical Center, New York, NY, USA

    Linda Granowetter MD

  6. Department of Pediatrics, Children’s Hospital Boston/Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA, USA

    Holcombe E. Grier MD

  7. Department of Pediatrics, Stanford University School of Medicine and Lucile Packard Children’s Hospital, Palo Alto, CA, USA

    Neyssa M. Marina MD

  8. Division of Pediatric Hematology/Oncology, IWK Health Center, Halifax, Nova Scotia, Canada

    Mark L. Bernstein MD

  9. Department of Orthopedic Surgery, Children’s Hospital Boston/Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA, USA

    Mark C. Gebhardt MD

  10. Department of Radiation Oncology, Children’s Hospital Boston/Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA, USA

    Karen J. Marcus MD

  11. Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA

    John H. Healey MD

  12. Department of Surgery, All Children’s Hospital, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA

    George D. Letson MD

  13. Section of Pediatric Hematology/Oncology, Montefiore Medical Center–Moses Campus, Bronx, NY, USA

    Richard G. Gorlick MD

  14. Department of Orthopaedics, Huntsman Cancer Institute, University of Utah School of Medicine, Salt Lake City, UT, USA

    R. Lor Randall MD

Authors
  1. Najat C. Daw MD
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  2. Nadia N. Laack MD
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  3. Elizabeth J. McIlvaine PhD
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  4. Mark Krailo PhD
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  5. Richard B. Womer MD
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  6. Linda Granowetter MD
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  7. Holcombe E. Grier MD
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  8. Neyssa M. Marina MD
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  9. Mark L. Bernstein MD
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  10. Mark C. Gebhardt MD
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  11. Karen J. Marcus MD
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  12. Shailesh M. Advani MD
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  13. John H. Healey MD
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  14. George D. Letson MD
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  15. Richard G. Gorlick MD
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  16. R. Lor Randall MD
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Corresponding author

Correspondence to Najat C. Daw MD.

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Daw, N.C., Laack, N.N., McIlvaine, E.J. et al. Local Control Modality and Outcome for Ewing Sarcoma of the Femur: A Report From the Children’s Oncology Group. Ann Surg Oncol 23, 3541–3547 (2016). https://doi.org/10.1245/s10434-016-5269-1

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  • DOI: https://doi.org/10.1245/s10434-016-5269-1

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