Ahmed Safia K, Randall R Lor, DuBois Steven G, Harmsen William S, Krailo Mark, Marcus Karen J, Janeway Katherine A, Geller David S, Sorger Joel I, Womer Richard B, Granowetter Linda, Grier Holcombe E, Gorlick Richard G, Laack Nadia N I
Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota.
Department of Orthopedics, Huntsman Cancer Institute, University of Utah School of Medicine, Salt Lake City, Utah.
Int J Radiat Oncol Biol Phys. 2017 Dec 1;99(5):1286-1294. doi: 10.1016/j.ijrobp.2017.08.020. Epub 2017 Aug 24.
To identify clinical and treatment variables associated with a higher risk of local failure in Ewing sarcoma patients treated on recent Children's Oncology Group protocols.
Data for 956 patients treated with ifosfamide and etoposide-based chemotherapy on INT-0091, INT-0154, and AEWS0031 were analyzed. Local treatment modalities were defined as surgery, definitive radiation therapy (RT), or surgery plus radiation (S+RT). Five-year cumulative incidence of local failure was determined.
The local failure rate for the entire cohort was 7.3%, with a 3.9% rate for surgery, 15.3% for RT (P<.01), and 6.6% for S+RT (P=.12). The local failure incidence was 5.4% for extremity tumors, 13.2% for pelvis tumors (P<.01), 5.3% for axial non-spine tumors (P=.90), 9.1% for extraskeletal tumors (P=.08), and 3.6% for spine tumors (P=.49). The incidence of local failure was 14.8% for extremity tumors and 22.4% for pelvis tumors treated with RT, compared with 3.7% for extremity tumors and 3.9% for pelvis tumors treated with surgery (P≤.01). There was no difference in local failure incidence by local treatment modality for axial non-spine, spine, and extraskeletal tumors. The local failure incidence was 11.9% in patients aged ≥18 years versus 6.7% in patients aged <18 years (P=.02). Age ≥18 years (hazard ratio 1.9, P=.04) and treatment with RT (hazard ratio 2.40, P<.01) remained independent prognostic factors for higher local failure incidence on multivariate analysis. Tumor size (</≥ 8 cm) was available in 40% of patients and did not correlate with local failure incidence.
Local tumor control is excellent and similar between surgery and RT for axial non-spine, spine, and extraskeletal tumors. Age ≥18 years and use of RT, primarily for pelvis and extremity tumors, are associated with the highest risk of local failure. Further efforts should focus on improving outcomes for these patients.
确定在儿童肿瘤学组近期方案治疗的尤因肉瘤患者中，与局部复发高风险相关的临床和治疗变量。
分析了956例接受基于异环磷酰胺和依托泊苷化疗的INT-0091、INT-0154和AEWS0031方案治疗患者的数据。局部治疗方式定义为手术、根治性放疗（RT）或手术加放疗（S+RT）。确定了局部复发的5年累积发生率。
整个队列的局部复发率为7.3%，手术组为3.9%，放疗组为15.3%（P<0.01），手术加放疗组为6.6%（P=0.12）。肢体肿瘤的局部复发发生率为5.4%，骨盆肿瘤为13.2%（P<0.01），轴位非脊柱肿瘤为5.3%（P=0.90），骨外肿瘤为9.1%（P=0.08），脊柱肿瘤为3.6%（P=0.49）。接受放疗的肢体肿瘤和骨盆肿瘤的局部复发发生率分别为14.8%和22.4%，而接受手术治疗的肢体肿瘤和骨盆肿瘤分别为3.7%和3.9%（P≤0.01）。轴位非脊柱、脊柱和骨外肿瘤的局部治疗方式在局部复发发生率上无差异。≥18岁患者的局部复发发生率为11.9%，<18岁患者为6.7%（P=0.02）。多因素分析显示，≥18岁（风险比1.9，P=0.04）和放疗（风险比2.40，P<0.01）仍然是局部复发发生率较高的独立预后因素。40%的患者有肿瘤大小（</≥8 cm）数据，其与局部复发发生率无关。
对于轴位非脊柱、脊柱和骨外肿瘤，手术和放疗的局部肿瘤控制效果良好且相似。≥18岁以及主要针对骨盆和肢体肿瘤使用放疗与局部复发的最高风险相关。应进一步努力改善这些患者的治疗结果。
