Laughlin Brady S, Bogan Aaron, Allen-Rhoades Wendy A, Rose Peter S, Polites Stephanie F, Ashman Jonathan B, Petersen Ivy, Haddock Michael G, Mahajan Anita, Laack Nadia N, Ahmed Safia K
Department of Radiation Oncology, Mayo Clinic, Phoenix, Arizona.
Department of Quantitative Health Sciences, Mayo Clinic, Scottsdale, Arizona.
Adv Radiat Oncol. 2025 Feb 28;10(4):101729. doi: 10.1016/j.adro.2025.101729. eCollection 2025 Apr.
Local treatment with surgery (S) and radiation therapy (RT) for chest wall Ewing sarcoma (cwES) is often challenging given the extent of the tumor and the aggressiveness of local treatments needed for cure. We report tumor and treatment characteristics, oncologic outcomes, and toxicities of patients with cwES at 2 centers of a single institution.
Consecutive patients with cwES treated from 1997 to 2022 were retrospectively reviewed. All patients were treated with standard 5-drug chemotherapy (vincristine, doxorubicin, cyclophosphamide, alternating with ifosfamide and etoposide) before initiation of local therapy. Local treatment was S, RT, or both. The decision on modality and timing was determined by a multidisciplinary sarcoma group or by consensus between sarcoma experts regarding patient preferences.
The cohort consisted of 39 patients. The median age at diagnosis was 19.2 years (range, 3.5-53.6 years). Median tumor volume (TV) was 235.5 mL (range, 5.3-6761.9 mL). The local control (LC) modality was S in 18 patients (46%), RT in 4 (10%), and S + RT in 17 (44%). Four (10%) patients treated with S + RT had R1 margins. The median follow-up was 3.2 years (range, 0.1-21.6 years). Grade 3 radiation-associated toxicity relative to the RT modality was 16.7% and 7.1% for photons (n = 6) and protons (n = 14), respectively. The 2-year LC by modality was 100% for RT (95% CI, 100%-100%), 88.2% (95% CI, 74.2%-100%) for S, and 73.3% (95% CI, 54.0%-99.5%) for S + RT. The 5-year LC, failure-free survival, and overall survival for all patients were 79.7% (95% CI, 67.3%-94.4%), 52.3% (95% CI, 38.1%-71.9%), and 64.2% (95% CI, 49.6%-83.1%), respectively. In univariate and multivariate analysis, TV ≥ 130 mL was associated with a significantly worse 5-year failure-free survival (31.8% TV ≥ 130 mL vs 80.8% TV < 130 mL; hazard ratio, 4.94, = .013 and adjusted hazard ratio, 5.43; 95% CI, 1.28-22.98; = .022). The multivariate model was adjusted for age, metastatic disease at diagnosis, and S.
Outcomes for cwES tumors are highly dependent on tumor size, even with the use of combined modality local therapy. With early follow-up, smaller tumors may be well controlled with either S or RT.
鉴于胸壁尤文肉瘤（cwES）的肿瘤范围以及治愈所需局部治疗的侵袭性，采用手术（S）和放射治疗（RT）进行局部治疗往往具有挑战性。我们报告了单一机构2个中心cwES患者的肿瘤和治疗特征、肿瘤学结局及毒性反应。
对1997年至2022年期间连续治疗的cwES患者进行回顾性分析。所有患者在开始局部治疗前均接受标准的五药联合化疗（长春新碱、阿霉素、环磷酰胺，与异环磷酰胺和依托泊苷交替使用）。局部治疗方式为手术、放疗或两者联合。治疗方式和时机的决定由多学科肉瘤小组或肉瘤专家根据患者偏好达成共识后做出。
该队列包括39例患者。诊断时的中位年龄为19.2岁（范围3.5 - 53.6岁）。中位肿瘤体积（TV）为235.5 mL（范围5.3 - 6761.9 mL）。局部控制（LC）方式为手术的有18例患者（46%），放疗的有4例（10%），手术 + 放疗的有17例（44%）。接受手术 + 放疗的4例（10%）患者切缘为R1。中位随访时间为3.2年（范围0.1 - 21.6年）。相对于放疗方式，光子放疗和质子放疗3级放疗相关毒性反应分别为16.7%和7.1%（光子放疗n = 6，质子放疗n = 14）。按治疗方式计算的2年局部控制率，放疗为100%（95% CI，100% - 100%），手术为88.2%（95% CI，74.2% - 100%），手术 + 放疗为73.3%（95% CI，54.0% - 99.5%）。所有患者的5年局部控制率、无失败生存率和总生存率分别为79.7%（95% CI，67.3% - 94.4%）、52.3%（95% CI，38.1% - 71.9%）和64.2%（95% CI，49.6% - 83.1%）。在单因素和多因素分析中，肿瘤体积≥130 mL与5年无失败生存率显著降低相关（肿瘤体积≥130 mL组为31.8%，肿瘤体积<130 mL组为80.8%；风险比，4.94，P = .013，调整后风险比，5.43；95% CI，1.28 - 22.98；P = .022）。多因素模型对年龄、诊断时的转移性疾病和手术进行了校正。
cwES肿瘤的结局高度依赖于肿瘤大小，即使采用联合局部治疗也是如此。早期随访显示，较小的肿瘤采用手术或放疗均可得到良好控制。
