Abstract
Background
Ewing sarcoma (ES) is the most common chest wall malignancy in adolescents. Current therapy incorporates chemotherapy to treat systemic disease and radiotherapy to assist with local control. We sought to evaluate the timing of surgery and role of adjuvant radiotherapy.
Methods
We reviewed the St. Jude Children’s Research Hospital chest wall ES experience from 1979 to 2009. Patient demographics, tumor characteristics, treatment variables, and outcomes were analyzed with respect to timing of surgery and use of adjuvant radiotherapy.
Results
Our cohort consisted of 36 patients with chest wall ES; median follow-up was 14.2 years, and 15-year estimate of overall survival was 66 %. In patients with localized disease, the timing of surgery (up-front vs. delayed) did not impact margin negativity or the use of adjuvant radiotherapy, but it did decrease the extent of chest wall resection. When considering radiotherapy in patients with localized disease, we found that patients who did not receive radiotherapy had smaller tumor size (median 6 vs. 10 cm) (p = 0.04) and were more likely to have had negative margins (p = 0.01) than patients who received adjuvant radiotherapy. One patient in each group developed a locoregional recurrence. The 15-year estimated of overall survival for patients who received adjuvant radiotherapy was 80 versus 100 % for those who did not.
Conclusions
Delayed surgery decreased the extent of chest wall resection and helped define a patient population with favorable tumor biology. Patients with complete pathologic responses to chemotherapy, and those with tumors <8 cm and negative surgical margins may be spared adjuvant radiotherapy without any decrement in overall survival.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Cotterill SJ, Ahrens S, Paulussen M, Jurgens HF, Voute PA, Gadner H, et al. Prognostic factors in Ewing’s tumor of bone: analysis of 975 patients from the European Intergroup Cooperative Ewing’s Sarcoma Study Group. J Clin Oncol. 2000;18:3108–14.
Rao BN, Hayes FA, Thompson EI, Kumar AP, Fleming ID, Green AA, et al. Chest wall resection for Ewing’s sarcoma of the rib: an unnecessary procedure. Ann Thorac Surg. 1988;46:40–4.
Rao BN, Hayes FA, Thompson EI, Kumar AP, Fleming ID, Green AA, et al. Chest wall resection for Ewing’s sarcoma of the rib: an unnecessary procedure. Ann Thorac Surg. 1995;60:1454–5.
Shamberger RC, LaQuaglia MP, Krailo MD, Miser JS, Pritchard DJ, Gebhardt MC, et al. Ewing sarcoma of the rib: results of an intergroup study with analysis of outcome by timing of resection. J Thorac Cardiovasc Surg. 2000;119:1154–61.
Shamberger RC, LaQuaglia MP, Gebhardt MC, Neff JR, Tarbell NJ, Marcus KC, et al. Ewing sarcoma/primitive neuroectodermal tumor of the chest wall: impact of initial versus delayed resection on tumor margins, survival, and use of radiation therapy. Ann Surg. 2003;238:563–7.
Krasin MJ, Davidoff AM, Rodriguez-Galindo C, Billups CA, Fuller CE, Neel MD, et al. Definitive surgery and multiagent systemic therapy for patients with localized Ewing sarcoma family of tumors: local outcome and prognostic factors. Cancer. 2005;104:367–73.
Corn BW, Trock BJ, Goodman RL. Irradiation-related ischemic heart disease. J Clin Oncol. 1990;8:741–50.
Horning SJ, Adhikari A, Rizk N, Hoppe RT, Olshen RA. Effect of treatment for Hodgkin’s disease on pulmonary function: results of a prospective study. J Clin Oncol. 1994;12:297–305.
Strong LC, Herson J, Osborne BM, Sutow WW. Risk of radiation-related subsequent malignant tumors in survivors of Ewing’s sarcoma. J Natl Cancer Inst. 1979;62:1401–6.
Peto R, Pike MC, Armitage P, Breslow NE, Cox DR, Howard SV, et al. Design and analysis of randomized clinical trials requiring prolonged observation of each patient. II. Analysis and examples. Br J Cancer. 1977;35:1–39.
Kalbfleisch JD, Prentice RL. The statistical analysis of failure time data. New York: Wiley; 1980.
Gray RJ. A class of K-sample tests for comparing the cumulative incidence of a competing risk. Ann Stat. 1988;16:1141–54.
Krasin MJ, Rodriguez-Galindo C, Billups CA, Davidoff AM, Neel MD, Merchant TE, et al. Definitive irradiation in multidisciplinary management of localized Ewing sarcoma family of tumors in pediatric patients: outcome and prognostic factors. Int J Radiat Oncol Biol Phys. 2004;60:830–8.
Schuck A, Ahrens S, Paulussen M, Kuhlen M, Konemann S, Rube, C, et al. Local therapy in localized Ewing tumors: results of 1058 patients treated in the CESS 81 CESS 86, and EICESS 92 trials. Int J Radiat Oncol Biol Phys. 2003;55:168–77.
Schuck A, Ahrens S, Konarzewska A, Paulussen M, Frohlich B, Konemann S, et al. Hemithorax irradiation for Ewing tumors of the chest wall. Int J Radiat Oncol Biol Phys. 2002;54:830–8.
Grier HE, Krailo MD, Tarbell NJ, Link MP, Fryer CJ, Pritchard DJ, et al. Addition of ifosfamide and etoposide to standard chemotherapy for Ewing’s sarcoma and primitive neuroectodermal tumor of bone. N Engl J Med. 2003;348:694–701.
Lin PP, Jaffe N, Herzog CE, Costelloe CM, Deavers MT, Kelly JS, et al. Chemotherapy response is an important predictor of local recurrence in Ewing sarcoma. Cancer. 2007;109:603–11.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Denbo, J.W., Shannon Orr, W., Wu, Y. et al. Timing of Surgery and the Role of Adjuvant Radiotherapy in Ewing Sarcoma of the Chest Wall: A Single-institution Experience. Ann Surg Oncol 19, 3809–3815 (2012). https://doi.org/10.1245/s10434-012-2449-5
Received:
Published:
Issue Date:
DOI: https://doi.org/10.1245/s10434-012-2449-5