Comparative evaluation of local control strategies in localized Ewing sarcoma of bone: A report from the Children's Oncology Group

作者：Steven G. DuBois, Mark Krailo, Mark C. Gebhardt, Sarah S. Donaldson, Karen J. Marcus, John P. Dormans, Robert C. Shamberger, Scott L. Sailer, Richard W. Nicholas, John H. Healey, Nancy J. Tarbell, R. Lor Randall, Meenakshi Devidas, James S. Meyer, Linda Granowetter, Richard B. Womer, Mark L. Bernstein, Neyssa Marina, Holcombe E. Grier · 发表于：Cancer · 年份：2014 · DOI：10.1002/cncr.29065 · 被引用次数：190 · 研究领域：Sarcoma Diagnosis and Treatment、Management of metastatic bone disease、Bone Tumor Diagnosis and Treatments

BACKGROUND: Patients with Ewing sarcoma require local primary tumor control with surgery, radiation, or both. The optimal choice of local control for overall and local disease control remains unclear. METHODS: Patients with localized Ewing sarcoma of bone who were treated on 3 consecutive protocols with standard-dose, 5-drug chemotherapy every 3 weeks were included (n=465). Propensity scores were used to control for differences between local control groups by constructing multivariate models to assess the impact of local control type on clinical endpoints (event-free survival [EFS], overall survival, local failure, and distant failure) independent of differences in their propensity to receive each local control type. RESULTS: Patients who underwent surgery were younger (P=.02) and had more appendicular tumors (P<.001). Compared with surgery, radiation had higher unadjusted risks of any event (hazard ratio [HR], 1.70; 95% confidence interval [CI], 1.18-2.44), death (HR, 1.84; 95% CI, 1.18-2.85), and local failure (HR, 2.57; 95% CI, 1.37-4.83). On multivariate analysis, compared with surgery, radiation had a higher risk of local failure (HR, 2.41; 95% CI, 1.24-4.68), although there were no significant differences in EFS (HR, 1.42; 95% CI, 0.94-2.14), overall survival (HR, 1.37; 95% CI, 0.83-2.26), or distant failure (HR, 1.13; 95% CI, 0.70-1.84) between local control groups. CONCLUSIONS: In this large group of similarly treated patients, choice of the mode of local control was ...