Heesen Philip, Ranft Andreas, Bhadri Vivek, Brichard Benedicte, Collaud Stephane, Cyprova Sona, Eich Hans, Ek Torben, Gelderblom Hans, Hardes Jendrik, Haveman Lianne, Jabar Susanne, Hartmann Wolfgang, Andreou Dimosthenis, Hauser Peter, Kersting Josephine, Juergens Heribert, Kanerva Jukka, Kühne Thomas, Raciborska Anna, Rascon Jelena, Streitbürger Arne, Timmermann Beate, Uhlenbruch Yasmin, Dirksen Uta
Pediatrics III, West German Cancer Center, University Hospital Essen, University Duisburg-Essen, Hufelandstrasse 55, 45147 Essen, Germany; University of Zurich, Raemistrasse 71, 8006 Zurich, Switzerland.
Pediatrics III, West German Cancer Center, University Hospital Essen, University Duisburg-Essen, Hufelandstrasse 55, 45147 Essen, Germany; German Cancer Consortium (DKTK), and National Center for Tumor diseases (NCT), Partnersite Essen, Essen, Germany.
Eur J Cancer. 2023 Oct;192:113260. doi: 10.1016/j.ejca.2023.113260. Epub 2023 Jul 27.
Local treatment is a crucial element in the standard of care for Ewing sarcoma (EWS). While systemic treatment is improved in randomised clinical trials, local treatment modalities are discussed controversially. We analysed the association between local therapy and event-free survival (EFS), overall survival (OS), and local recurrence (LR) in prospectively collected data of patients with localised EWS.
We analysed data from the international Ewing 2008 study registered between 2009 and 2019 in 117 centres. After induction chemotherapy, patients received surgery, radiotherapy, or a combination thereof. We performed Cox regression, conducted propensity score-weighted sensitivity analysis, and performed subgroup analyses. Hazard ratios (HRs) and 95% confidence intervals are reported.
We included 863 patients with localised EWS (surgery alone: 331, combination therapy: 358, definitive radiotherapy: 174). In patients treated with combination therapy compared to surgery alone, EFS HR was 0.84 (0.57-1.24; p = 0.38), OS HR was 0.84 (0.57-1.23; p = 0.41), and LR HR was 0.58 (0.26-1.31; p = 0.19). Hazards of any event were increased in patients treated with definitive radiotherapy compared to surgery only, HR 1.53 (1.02-2.31; p = 0.04). Patients with poor responses to chemotherapy benefitted from combination therapy over definitive surgery with an EFS HR 0.49 (0.27-0.89; p = 0.02). Patients with pelvic tumours benefitted from combination therapy over surgery only regarding LR, HR 0.12 (0.02-0.72; p = 0.02).
Patients with poor responses to chemotherapy benefitted from radiotherapy added to surgery. In the whole group, radiotherapy alone as opposed to surgery alone increased the hazards of any event.
局部治疗是尤因肉瘤（EWS）标准治疗的关键要素。虽然随机临床试验中全身治疗有所改善，但局部治疗方式仍存在争议。我们分析了前瞻性收集的局限性EWS患者数据中局部治疗与无事件生存期（EFS）、总生存期（OS）和局部复发（LR）之间的关联。
我们分析了2009年至2019年在117个中心登记的国际尤因2008研究的数据。诱导化疗后，患者接受手术、放疗或两者联合治疗。我们进行了Cox回归分析、倾向评分加权敏感性分析和亚组分析。报告了风险比（HR）和95%置信区间。
我们纳入了863例局限性EWS患者（单纯手术：331例，联合治疗：358例，根治性放疗：174例）。与单纯手术治疗的患者相比，联合治疗患者的EFS HR为0.84（0.57 - 1.24；p = 0.38），OS HR为0.84（0.57 - 1.23；p = 0.41），LR HR为0.58（0.26 - 1.31；p = 0.19）。与仅接受手术治疗的患者相比，接受根治性放疗的患者发生任何事件的风险增加，HR为1.53（1.02 - 2.31；p = 0.04）。化疗反应不佳的患者从联合治疗中获益超过根治性手术，EFS HR为0.49（0.27 - 0.89；p = 0.02）。盆腔肿瘤患者在LR方面从联合治疗中获益超过单纯手术，HR为0.12（0.02 - 0.72；p = 0.02）。
化疗反应不佳的患者从手术联合放疗中获益。在整个组中，与单纯手术相比，单纯放疗增加了发生任何事件的风险。
