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Local Control in Pelvic Ewing Sarcoma: Analysis From INT-0091—A Report From the Children's Oncology Group

Torunn I. Yock, Mark Krailo, Christopher J. Fryer, Sarah S. Donaldson, James S. Miser, Zhengjia Chen, Mark Bernstein, Fran Laurie, Mark. C. Gebhardt, Holcombe E. Grier, Nancy J. Tarbell

From the Massachusetts General Hospital; Beth Israel Deaconess Medical Center and Children's Hospital; Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA; Keck School of Medicine, University of Southern California, Los Angeles; Stanford University Medical Center, Stanford; City of Hope National Medical Center, Duarte; COG Statistics and Data Center, Arcadia, CA; British Columbia's Children's Hospital, Vancouver, British Columbia; Hôpital Sainte-Justine, Montréal, Québec City, Canada; and the Quality Assurance Review Center, Providence, RI

Address reprint requests to Torunn I. Yock, MD, MCH, Department of Radiation Oncology, Massachusetts General Hospital, 100 Blossom St, Cox 341, Boston, MA 02114; e-mail: TYOCK{at}PARTNERS.ORG and send a copy to pubs{at}childrensoncologygroup.org

PURPOSE: The impact of the modality used for local control of Ewing sarcoma is uncertain. We investigated the relationship between the type of local control modality, surgery, radiation (RT) or both (S + RT), and subsequent risk for local failure (LF) in patients with nonmetastatic pelvic Ewing sarcoma treated on INT-0091.

PATIENTS AND METHODS: Patients 30 years with Ewing sarcoma, primitive neuroectodermal tumor or primitive sarcoma of bone were randomly assigned to receive chemotherapy with doxorubicin, vincristine, cyclophosphamide, and dactinomycin, (VACA) or with these four drugs alternating with ifosfamide and etoposide (VACA-IE). The local control modality, surgery, RT or both was chosen by the treating physicians. The effect of local control modality was assessed after adjusting for the size of tumor (< 8 cm, 8 cm) and chemotherapy type.

RESULTS: Seventy-five patients with pelvic tumors and a median follow-up of 4.4 years (0.6 to 11.4 years) comprised the study population. Twelve underwent surgery, 44 received RT, and 19 received both. The 5-year event-free survival (EFS) and cumulative incidence of LF was 49% and 21% (16%, LF only; 5%, LF and distant failure). There was no significant difference in EFS or LF by tumor size (< 8 cm, 8 cm), local control (LC) modality, or chemotherapy. However, VACA-IE seems to confer an LC benefit (11% v 30%; P = .06).

CONCLUSION: There was no significant effect of local control modality (surgery, RT or S + RT) selected by the treating physicians on rates of local failure or EFS. However, VACA-IE improves LC (11%) compared with previously published results for pelvic Ewing sarcoma.

Supported by the National Cancer Institute (National Institutes of Health, Bethesda, MD) through its support of Children's Oncology Group (CA 98543), which brought the Pediatric Oncology Group (CA 30969) and the Children's Cancer Group (CA 13539) together to make this trial possible.

Presented in part at the Annual Meeting of the American Society for Therapeutic Radiology and Oncology, Atlanta, GA, October 3-7, 2004.

Authors' disclosures of potential conflicts of interest and author contributions are found at the end of this article.

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