Long-term clinical and functional outcomes after treatment for localized Ewing's tumor of the lower extremity.

Abstract

PURPOSE:

Retrospective review describing the 35-year University of Florida experience with Ewing's tumors of the lower extremity.

PATIENTS AND METHODS:

Fifty-three patients were treated between 1971 and 2006. Thirty patients were treated with radiotherapy (RT) alone and 23 patients were treated with surgery +/- RT. Larger tumors and tumors of the femur were treated more often with definitive RT. Median potential follow-up was 19.2 years. Functional outcome was assessed using the Toronto Extremity Salvage Score (TESS).

RESULTS:

Before 1985, 24% of patients were treated with surgery; since then, the rate has increased to 61%. The 15-year actuarial overall survival (OS), cause-specific survival (CSS), freedom from relapse, and limb preservation rates were 68% vs. 47% (p = 0.21), 73% vs. 47% (p = 0.13), 73% vs. 40% (p = 0.03), and 43% vs. 40% (p = 0.52), respectively, for patients treated with surgery +/- RT vs. RT alone. Excluding 8 patients who underwent amputation or rotationplasty, the 15-year actuarial local control rate was 100% for the surgery +/- RT group and 68% for the definitive RT group (p = 0.03). The ranges of the TESS for surgery +/- RT vs. RT alone were 70-100 (mean, 94) and 97-100 (mean, 99), respectively. Twenty-six percent (6/23) of patients had complications related to surgery requiring amputation or reoperation.

CONCLUSIONS:

Overall survival and CSS were not statistically compromised, but we observed an increased risk of relapse and local failure in patients treated with RT alone, thereby justifying a transition toward primary surgical management in suitable patients. However, despite an adverse risk profile, patients treated with RT alone had similar long-term amputation-free survival and demonstrated comparable functional outcomes. Poor results observed in Ewing's of the femur mandate innovative surgical and RT strategies.

• Authors: Daniel J Indelicato, Sameer R Keole, Amir H Shahlaee, Wenyin Shi, Christopher G Morris, Charles P Gibbs Jr, Mark T Scarborough, Robert B Marcus Jr
• Journal: International journal of radiation oncology, biology, physics (Int J Radiat Oncol Biol Phys) Vol. 70 Issue 2 Pg. 501-9 (Feb 01 2008) ISSN: 0360-3016 [Print] United States
• PMID: 17855013 (Publication Type: Journal Article)

Topics

• Actuarial Analysis
• Adolescent
• Adult
• Amputation, Surgical (adverse effects, statistics & numerical data)
• Bone Neoplasms (mortality, pathology, radiotherapy, surgery)
• Child
• Combined Modality Therapy (methods)
• Female
• Femoral Neoplasms (mortality, pathology, radiotherapy, surgery)
• Follow-Up Studies
• Humans
• Lower Extremity (pathology, surgery)
• Male
• Retrospective Studies
• Sarcoma, Ewing (mortality, pathology, radiotherapy, surgery)
• Tibia (pathology, surgery)
• Treatment Outcome