Role of Radiotherapy in the Multimodal Treatment of Ewing Sarcoma Family Tumors
2
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
Purpose The aim of this study was to evaluate the role of radiotherapy (RT) in the management ofEwing sarcoma family tumors (ESFT). Materials and MethodsRetrospective analysis was performed on 91 patients with localized ESFT treated from 1988to 2012. Primary tumor size was ! 8 cm in 33 patients. Surgery, RT, and combined surgerywith RT were applied in 37, 15, and 33 patients, respectively. ResultsMedian follow-up was 43.8 months. Forty-three patients (47.3%) showed recurrence orprogressive disease. Twelve patients (13.2%) showed local failure after initial treatment. Thirty-nine patients (42.9%) experienced distant metastases. The 5-year overall survival(OS), progression-free survival, and local control (LC) were 60.5%, 58.2%, and 85.1%,respectively. According to treatment, 5-year LC was 64.8% with RT and 90.2% with combinedsurgery and RT (p=0.052). Prognostic factors for OS were tumor size (! 8 cm, p < 0.001)and surgical resection (p < 0.001). In large tumors (! 8 cm), combined surgery and RTproduced better LC compared to RT (p=0.033). However, in smaller tumors (< 8 cm), RTwithout surgery resulted in a similar LC rate as RT with surgery (p=0.374). ConclusionRT used for patients with unfavorable risk factors resulted in worse outcome than forpatients who received surgery. Smaller tumors could be controlled locally with chemotherapyand RT. For large tumors, combined surgery and RT is needed. Proper selection of localtreatment modality, RT, surgery, or both is crucial in the management of ESFT.
Abstract
Purpose The aim of this study was to evaluate the role of radiotherapy (RT) in the management ofEwing sarcoma family tumors (ESFT). Materials and MethodsRetrospective analysis was performed on 91 patients with localized ESFT treated from 1988to 2012. Primary tumor size was ! 8 cm in 33 patients. Surgery, RT, and combined surgerywith RT were applied in 37, 15, and 33 patients, respectively. ResultsMedian follow-up was 43.8 months. Forty-three patients (47.3%) showed recurrence orprogressive disease. Twelve patients (13.2%) showed local failure after initial treatment. Thirty-nine patients (42.9%) experienced distant metastases. The 5-year overall survival(OS), progression-free survival, and local control (LC) were 60.5%, 58.2%, and 85.1%,respectively. According to treatment, 5-year LC was 64.8% with RT and 90.2% with combinedsurgery and RT (p=0.052). Prognostic factors for OS were tumor size (! 8 cm, p < 0.001)and surgical resection (p < 0.001). In large tumors (! 8 cm), combined surgery and RTproduced better LC compared to RT (p=0.033). However, in smaller tumors (< 8 cm), RTwithout surgery resulted in a similar LC rate as RT with surgery (p=0.374). ConclusionRT used for patients with unfavorable risk factors resulted in worse outcome than forpatients who received surgery. Smaller tumors could be controlled locally with chemotherapyand RT. For large tumors, combined surgery and RT is needed. Proper selection of localtreatment modality, RT, surgery, or both is crucial in the management of ESFT.
참고문헌 (25)
- Maheshwari AV, "Ewing sarcoma family of tumors", J Am Acad Orthop Surg, 18, pp.94~107 (2010)
- Grier HE, "Addition of ifosfamide and etoposide to standard chemotherapy for Ewing's sarcoma and primitive neuroectodermal tumor of bone", N Engl J Med, 348, pp.694~701 (2003)
- Delattre O, "The Ewing family of tumors : a subgroup of smallround-cell tumors defined by specific chimeric transcripts", N Engl J Med, 331, pp.294~299 (1994)
- Miser JS, "Treatment of metastatic Ewing's sarcoma or primitive neuroectodermal tumor of bone : evaluation of combination ifosfamide and etoposide : a Children's Cancer Group and Pediatric Oncology Group study", J Clin Oncol, 22, pp.2873~2876 (2004)
- Sailer SL, "The role of radiation therapy in localized Ewing'sarcoma", Semin Radiat Oncol, 7, pp.225~235 (1997)
- Krasin MJ, "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, 60, pp.830~838 (2004)
- Cotterill SJ, "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, 18, pp.3108~3114 (2000)
- Longhi A, "Late effects of chemotherapy and radiotherapy in osteosarcoma and Ewing sarcoma patients : the Italian Sarcoma Group Experience(1983-2006)", Cancer, 118, pp.5050~5059 (2012)
- Bacci G, "Neoadjuvant chemotherapy for Ewing's sarcoma of bone: no benefit observed after adding ifosfamide and etoposide to vincristine, actinomycin, cyclophosphamide, and doxorubicin in the maintenance phase. Results of two sequential studies", Cancer, 82, pp.1174~1183 (1998)
- Shamberger RC, "Ewing sarcoma", primitive neuroectodermal tumor of the chest wall : impact of initial versus delayed resection on tumor margins, survival, and use of radiation therapy, 2003, pp.238, 563~567
- Lee JA, "Treatment outcome of Korean patients with localized Ewing sarcoma family of tumors : a single institution experience", Jpn J Clin Oncol, 41, pp.776~782 (2011)
- Indelicato DJ, "Definitive radiotherapy for ewing tumors of extremities and pelvis : long-term disease control, limb function, and treatment toxicity", Int J Radiat Oncol Biol Phys, 72, pp.871~877 (2008)
- Donaldson SS, "Ewing sarcoma : radiation dose and target volume", Pediatr Blood Cancer, 42, pp.471~476 (2004)
- La TH, "Radiation therapy for Ewing's sarcoma : results from Memorial Sloan-Kettering in the modern era", Int J Radiat Oncol Biol Phys, 64, pp.544~550 (2006)
- Dunst J, "Role of radiotherapy in Ewing tumors", Pediatr Blood Cancer, 42, pp.465~470 (2004)
- Schuck A, "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, 55, pp.168~177 (2003)
- Dunst J, "Surgery versus radiotherapy in Ewing's sarcoma with good prognosis : analysis of the CESS-86 data", Strahlenther Onkol, 172, pp.244~248 (1996)
- Schuck A, "Radiotherapy in Ewing tumors of the vertebrae : treatment results and local relapse analysis of the CESS 81", 86 and EICESS 92 trials, 2005, pp.63, 1562~1567
- Bacci G, "Treatment of nonmetastatic Ewing's sarcoma family tumors of the spine and sacrum : the experience from a single institution", Eur Spine J, 18, pp.1091~1095 (2009)
- Burgers JM, "Ewing's sarcoma of the pelvis : changes over 25 years in treatment and results", Eur J Cancer, 33, pp.2360~2367 (1997)
- Whaley JT, "Ewing tumors of the head and neck", Am J Clin Oncol, 33, pp.321~326 (2010)
- Picci P, "Prognostic significance of histopathologic response to chemotherapy in nonmetastatic Ewing's sarcoma of the extremities", J Clin Oncol, 11, pp.1763~1769 (1993)
- Burgert EO Jr, "Multimodal therapy for the management of nonpelvic, localized Ewing's sarcoma of bone : intergroup study IESS-II", J Clin Oncol, 8, pp.1514~1524 (1990)
- Burke MJ, "Tandem high-dose chemotherapy with autologous peripheral hematopoietic progenitor cell rescue as consolidation therapy for patients with high-risk Ewing family tumors", Pediatr Blood Cancer, 49, pp.196~198 (2007)
- Dunst J, "Second malignancies after treatment for Ewing's sarcoma : a report of the CESS-studies", Int J Radiat Oncol Biol Phys, 42, pp.379~384 (1998)