SIGNIFICANCE OF SURGICAL MARGIN ON THE PROGNOSIS OF PATIENTS WITH EWINGS-SARCOMA - A REPORT FROM THE COOPERATIVE EWINGS-SARCOMA STUDY

BACKGROUND. There is little information regarding an adequate surgical margin for local control of Ewing's sarcoma. METHODS. Two hundred and forty-four patients (PTS) with Ewing's sarcoma who were registered in the Cooperative Ewing's Sarcoma Studies underwent surgical treatment. Ninety-four PTS underwent definitive surgery (surgery alone), 131 PTS received postoperative irradiation, and 19 PTS received preoperative irradiation. The surgical margins were distributed as follows: radical , 29 PTS; wide, 148 PTS; marginal, 39 PTS; and intralesional, 28 PTS. The impact of the surgical margin on the treatment outcome of PTS was analyzed statistically. RESULTS. The local or combined (local recurren ce and systemic metastasis) relapse rate after surgery with or without irradiation was significantly lower compared with that after definiti ve irradiation (irradiation alone) (7% vs. 31%, P < 0.0001). The local or combined relapse rare after complete resection (radical or wide ma rgin) with or without irradiation was less compared with that after in complete resection (marginal or intralesional margin) with or without irradiation (5% vs. 12% P = 0.0455). The local or combined relapse rat e did not greatly decreased after irradiation after incomplete surgery (from 14% to 12%). In both groups of good (viable tumor cells <10%) a nd poor (viable cells greater than or equal to 10%) histologic respons e, the difference in systemic or combined relapse rate between patient s undergoing complete and incomplete surgery was not significant. The 10-year overall survival of the PTS for each of the margins was distri buted as follows: radical, 58%; wide, 65%; marginal, 61%; and intrales ional, 71% (P = not significant). CONCLUSIONS. Surgery in patients wit h Ewing's sarcoma adds to the safety of local control. Under the curre nt treatment regimen with intensive chemotherapy and irradiation, comp lete resection of the tumor appears capable of decreasing the risk of local recurrence. (C) 1996 American Cancer Society.