The role of surgical margins in treatment of Ewing's sarcoma family tumors: Experience of a single institution with 512 patients treated with adjuvant and neoadjuvant chemotherapy

Gaetano Bacci, Alessandra Longhi, Antonio Briccoli, Franco Bertoni, Michela Versari, Piero Picci

Research output: Contribution to journalArticle

Abstract

Purpose: To evaluate the importance of surgical margins for local and systemic control of Ewing's sarcoma family tumors (ESFT). Methods and Materials: Between 1979 and 1999, 512 patients with ESFTs entered 4 different adjuvant and neoadjuvant studies performed at a single institution. Of these patients, 335 were treated with surgery alone (196) or surgery followed by radiotherapy at doses of 44.8 Gy (139). We compared their outcome with that of the 177 patients who were locally treated by radiotherapy at 60 Gy. Results: Local control (88.8% vs. 80.2%, p <0.009) and 5-year disease-free survival (63.8% vs. 47.6%, p <0.0007) were significantly better in patients treated with surgery and, among them, in those with adequate surgical margins (96.6% vs. 71,7%, p <0.0008, and 69.6% vs. 46.3%, p <0.0002). Nonetheless, better results were observed only in extremity tumors. Conclusions: Surgery is better than radiotherapy in cases of extremity ESFT with achievable adequate surgical margins, and in cases of inadequate surgical margins, adjuvant reduced-dose radiotherapy is ineffective. Therefore, when inadequate margins are expected, patients are better treated with full-dose radiotherapy from the start.

Original languageEnglish
Pages (from-to)766-772
Number of pages7
JournalInternational Journal of Radiation Oncology Biology Physics
Volume65
Issue number3
DOIs
Publication statusPublished - Jul 1 2006

Keywords

  • Ewing's sarcoma
  • Extremity
  • Neoadjuvant chemotherapy
  • Radiotherapy
  • Surgery

ASJC Scopus subject areas

  • Oncology
  • Radiology Nuclear Medicine and imaging
  • Radiation

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