Ewing's sarcoma: surgical resection as a prognostic factor

Abstract

A retrospective review of 46 cases of Ewing's (43) and extraosseous Ewing's (3) sarcoma was performed to examine for prognostic factors. Follow-up ranged from 27 to 135 months with a mean of 77.6 months, 86% greater than 36 months. Nine (20%) patients presented with distant metastases, 98% received multiagent chemotherapy, and 98% received radiation therapy. Overall actuarial survival and local control at 5 years were .52 ± .08 and .78 ± .07, respectively. The freedom from relapse or treatment related mortality at 5 years was .46 ± .08. In 12 (26%) patients, surgical resection of the involved bone or soft tissue was part of the initial treatment plan. Ninety-two percent (1112) of these patients also received radiation therapy. In addition to surgical resection, tumor size (p = .001 by logrank, p = .02 by Cox). To make the groups more comparable, 8 patients with local failure and 5 patients with non-evaluable primary sites were excluded. After these exclusions, the presence or absence of surgical resection had decreased significance: .92 ± .08 vs. .59 ± .11, respectively; p = .01 by logrank, p = .07 by Cox. Only primary site remained statistically significant: .86 ± .08 for noncentral sites vs. .38 ± .16 for central sites, p < .0002 by logrank, p = .0004 by Cox. Surgical resection when added to local irradiation has prognostic significance in this retrospective review. The reason for this is not clear, but may be related to a decrease in local failure after resection.