Sarcoma and Cutaneous Tumors

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MO_20_2636 - Radiation Treatment for Ewing Sarcoma Family of Tumors in Adult Patients: A Single Institution's Experience over 4 Decades

Monday, October 22
10:45 AM - 12:15 PM
Location: Innovation Hub, Exhibit Hall 3

Radiation Treatment for Ewing Sarcoma Family of Tumors in Adult Patients: A Single Institution’s Experience over 4 Decades
S. Kharod1, C. Jones2, C. G. Morris3, A. Spiguel4, C. P. Gibbs4, and R. A. Zlotecki3; 1Department of Radiation Oncology, University of Florida, Gainesville, FL, 2University of Florida College of Medicine, Gainesville, FL, 3Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, FL, 4Department of Orthopaedics and Rehabilitation, University of Florida College of Medicine, Gainesville, FL

Purpose/Objective(s): To report the clinical characteristics, prognostic factors, and our institution’s treatment outcomes for adult patients with Ewing sarcoma family of tumors treated with definitive radiation therapy.

Materials/Methods: Under institutional review board approval, we reviewed the medical records of adult patients (age ≥ 18 years) diagnosed with non-metastatic Ewing sarcoma and treated with radiation therapy with and without chemotherapy and surgery. Outcomes were stratified by age (age ≥ 30 vs. younger), presence of soft-tissue extension, tumor size (size ≥ 8.5 cm vs. smaller), tumor location, whether or not resection was performed, and treatment era (1970 – 1992 vs 1993 onwards). Toxicities were scored using the RTOG Cooperative Group Common Toxicity Criteria.

Results: Fifty-five patients (34 men; 21 women) treated between 1970 and 2012 were eligible for analysis. The average age at diagnosis was 26.7 years (median, 21 years); 38 patients were under 30 years old, while 17 were 30 or older. Soft-tissue extension was present in 43 patients (78%). The median tumor size was 8.5 cm (range, 2-20 cm). The most common tumor site was the pelvis (40%), followed by the lower extremities (27%), then upper extremities (24%). All patients were treated with radiation therapy; 54 of 55 patients received both radiation therapy and chemotherapy; 12 patients also underwent surgical resection. The median dose of radiation delivered was 55 Gy, with 75% of patients receiving twice-daily treatment. The median follow-up was 3.6 years for all patients and 17.5 years for living patients. The rates of 5-year overall (OS) and cause-specific survival (CSS) for all patients were both 46%. OS and CSS rates were unaffected by age at diagnosis (p=0.97), tumor size (p=0.12), or tumor location (p=0.99). Soft-tissue extension of Ewing sarcoma portended a significantly poorer prognosis for both 5-year OS and CSS: 37% vs. 82% (with and without, respectively; p=0.04). Patients who underwent surgical resection also experienced improved 5-year OS and CSS relative to patients who did not undergo surgery: 77% vs. 37%, respectively (p=0.01). Patients treated in the modern treatment era (1993 onwards) experienced improved 5-year OS compared to those treated earlier: 58% vs. 37% (p=0.0264).

Conclusion: Adult patients diagnosed with Ewing family of tumors experienced similar treatment outcomes regardless of relative age at diagnosis. Soft-tissue extension represents a poor prognostic factor for adult patients. Treatment in the modern era was associated with higher survival. Trimodality therapy consisting of radiation therapy, chemotherapy, and surgery achieved the highest OS and CSS rates; thus, aggressive combined-modality treatment is indicated whenever possible.

Author Disclosure: S. Kharod: None. C. Jones: None. C.G. Morris: None. A. Spiguel: None. R.A. Zlotecki: Stock; ViewRay.

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