Advertisement

Timing of Local Therapy Affects Survival in Ewing Sarcoma

Published:December 26, 2018DOI:https://doi.org/10.1016/j.ijrobp.2018.12.032

      Purpose

      We aimed to investigate the relationship between survival and time to local therapy after initiation of up-front chemotherapy in the treatment of patients with localized Ewing sarcoma.

      Methods and Materials

      The National Cancer Database was queried for patients with localized Ewing sarcoma treated with primary chemotherapy and subsequent local therapy. Kaplan-Meier survival curves were generated for patients initiating local therapy 6 to 15 weeks and ≥16 weeks after chemotherapy initiation. Multivariable binomial logistic regression was used to identify factors associated with prolonged time to local therapy. A multivariable Cox proportional hazards model was used to identify factors associated with overall survival (OS).

      Results

      The final cohort included 1318 patients. A higher proportion of patients initiating local therapy 6 to 15 weeks after chemotherapy initiation versus ≥16 weeks after chemotherapy initiation were ≤21 years old (79.5% vs 72.0%; P = .004). Age >21 years (P < .001; hazard ratio, 1.65; 95% confidence interval, 1.28-2.12), tumor size >8 cm (P = .016), and time to local therapy ≥16 weeks (P = .005; hazard ratio, 1.41; 95% confidence interval, 1.11-1.80) were associated with reduced OS; after review of margin status, negative margins were associated with improved OS compared with gross disease (P = .029). Patients initiating local therapy at 6 to 15 weeks versus ≥16 weeks had a 5-year OS of 78.7% versus 70.4% and a 10-year OS of 70.3% versus 57.1%, respectively (P < .001). The difference in OS according to time to local therapy was particularly more important in patients receiving radiation therapy alone. Age >21 years and treatment by radiation therapy alone were associated with delayed time (>16 weeks) to local therapy, whereas private insurance and income >$48,000 were less likely to be associated with delayed local therapy.

      Conclusions

      Delayed time to local therapy ≥16 weeks after chemotherapy initiation was independently associated with worse survival in patients with localized Ewing sarcoma.
      To read this article in full you will need to make a payment
      ASTRO Member Login
      ASTRO Members, full access to the journal is a member benefit. Use your society credentials to access all journal content and features.
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Gurney J.G.
        • Severson R.K.
        • Davis S.
        • et al.
        Cancer in children in the United States.
        Cancer. 1995; 75: 2186-2195
        • Hense H.
        • Ahrens S.
        • Paulussen M.
        • et al.
        Descriptive epidemiology of Ewing’s tumor—Analysis of German patients from (EI)CESS 1980-1997.
        Klin Padiatr. 1999; 211: 271-275
        • Paulussen M.
        • Ahrens S.
        • Burdach S.
        • et al.
        Primary metastatic (stage IV) Ewing tumor: Survival analysis of 171 patients from the EICESS studies: European Intergroup Cooperative Ewing Sarcoma Studies.
        Ann Oncol. 1998; 9: 275-281
        • Paulussen M.
        • Ahrens S.
        • Dunst J.
        • et al.
        Localized Ewing tumor of bone: Final results of the cooperative Ewing’s Sarcoma Study CESS 86.
        J Clin Oncol. 2001; 19: 1818-1829
        • Elomaa I.
        • Blomqvist C.P.
        • Saeter G.
        • et al.
        Five-year results in Ewing’s sarcoma: The Scandinavian Sarcoma Group experience with the SSG IX protocol.
        Eur J Cancer. 2000; 36: 875-880
        • Shankar A.G.
        • Ashley S.
        • Craft A.W.
        • et al.
        Outcome after relapse in an unselected cohort of children and adolescents with Ewing sarcoma.
        Med Pediatr Oncol. 2003; 40: 141-147
        • Paulussen M.
        • Ahrens S.
        • Braun-Munzinger G.
        • et al.
        EICESS 92 (European Intergroup Cooperative Ewing’s Sarcoma Study)—Erste Ergebnisse.
        Klin Padiatr. 1999; 211: 276-283
        • Donaldson S.S.
        • Torrey M.
        • Link M.P.
        • et al.
        A multidisciplinary study investigating radiotherapy in Ewing’s sarcoma: End results of POG #8346.
        Int J Radiat Oncol Biol Phys. 1998; 42: 125-135
        • Oberlin O.
        • Deley M.C.
        • Bui B.N.
        • et al.
        Prognostic factors in localized Ewing’s tumours and peripheral neuroectodermal tumours: The third study of the French Society of Paediatric Oncology (EW88 study).
        Br J Cancer. 2001; 85: 1646-1654
        • Jürgens H.
        • Göbel V.
        • Michaelis J.
        • et al.
        The Cooperative Ewing Sarcoma Study CESS 81 of the German Pediatric Oncology Society—Analysis after 4 years.
        Klin Padiatr. 1985; 197: 225-232
        • Dunst J.
        • Schuck A.
        Role of radiotherapy in Ewing tumors.
        Pediatr Blood Cancer. 2004; 42: 465-470
        • Burgers J.M.
        • Oldenburger F.
        • de Kraker J.
        • et al.
        Ewing’s sarcoma of the pelvis: Changes over 25 years in treatment and results.
        Eur J Cancer. 1997; 33: 2360-2367
        • Gupta A.A.
        • Pappo A.
        • Saunders N.
        • et al.
        Clinical outcome of children and adults with localized Ewing sarcoma: Impact of chemotherapy dose and timing of local therapy.
        Cancer. 2010; 116: 3189-3194
        • Lee J.
        • Hoang B.H.
        • Ziogas A.
        • et al.
        Analysis of prognostic factors in Ewing sarcoma using a population-based cancer registry.
        Cancer. 2010; 116: 1964-1973
        • Paulino A.C.
        • Nguyen T.X.
        • Mai W.Y.
        • et al.
        Dose response and local control using radiotherapy in non-metastatic Ewing sarcoma.
        Pediatr Blood Cancer. 2007; 49: 145-148
        • Schuck A.
        • Ahrens S.
        • Paulussen M.
        • 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: 168-177
        • American Cancer Society
        Cancer Facts & Figures 2018.
        American Cancer Society, Atlanta, GA2018: 1-71
      1. Ries L.A.G. Smith M.A. Gurney J.G. Cancer Incidence and Survival Among Children and Adolescents: United States SEER Program 1975-1995. National Cancer Institute, SEER Program. NIH Pub No. 99-4649, Bethesda, MD1999
        • Hardin A.P.
        • Hackell J.M.
        Age limit of pediatrics.
        Pediatrics. 2017; 140: e20172151
        • Lee J.M.
        • Wang X.
        • Ojha R.P.
        • et al.
        The effect of health insurance on childhood cancer survival in the United States.
        Cancer. 2017; 123: 4878-4885
        • Naghavi A.O.
        • Echevarria M.I.
        • Grass D.G.
        • et al.
        Having Medicaid insurance negatively impacts outcomes in patients with head and neck cancer.
        Cancer. 2016; 122: 3529-3537
        • Bradley C.J.
        • Gardiner J.
        • Given C.W.
        • et al.
        Cancer, Medicaid enrollment, and survival disparities.
        Cancer. 2005; 103: 1712-1718
        • Weber D.C.
        • Habrand J.L.
        • Hoppe B.S.
        • et al.
        Proton therapy for pediatric malignancies: Fact, figures and costs. A joint consensus statement from the pediatric subcommittee of PTCOG, PROS and EPTN.
        Radiother Oncol. 2018; 128: 44-55
        • Rombi B.
        • DeLaney T.F.
        • MacDonald S.M.
        • et al.
        Proton radiotherapy for pediatric Ewing’s sarcoma: Initial clinical outcomes.
        Int J Radiat Oncol Biol Phys. 2012; 82: 1142-1148

      Comments

      Commenting Guidelines

      To submit a comment for a journal article, please use the space above and note the following:

      • We will review submitted comments as soon as possible, striving for within two business days.
      • This forum is intended for constructive dialogue. Comments that are commercial or promotional in nature, pertain to specific medical cases, are not relevant to the article for which they have been submitted, or are otherwise inappropriate will not be posted.
      • We require that commenters identify themselves with names and affiliations.
      • Comments must be in compliance with our Terms & Conditions.
      • Comments are not peer-reviewed.