Radiotherapy in Ewing's sarcoma and PNET of the chest wall: Results of thetrials CESS 81, CESS 86 and EICESS 92

Purpose: Treatment results and the pattern of relapse were evaluated in the multimodal treatment of Ewing's sarcomas of the chest wall. Methods and Materials: In a retrospective analysis, 114 patients with non-m etastatic Ewing's sarcoma of the chest wall were evaluated. They were treat ed in the CESS 81, CESS 86, or EICESS 92 studies between January 1981 and D ecember 1993. The treatment consisted of polychemotherapy (VACA, VAIA, or E VAIA) and local therapy, either surgery alone (14 patients), radiotherapy a lone (28 patients) or a combination of both (71 patients). The median follo w-up was 46.6 months (range 5-170). A relapse analysis for all patients wit h local or combined relapses was performed. Results: Overall survival was 60% after 5 years, event-free survival was 50 %. Thirty-seven patients had a systemic relapse (32.4%), 11 patients had a local relapse alone (9.6%), and 3 patients had a combined local and systemi c relapse (2.6%). The risk to relapse locally after 5 years was 0% after su rgery alone, 19% after radiation alone, and 19% after postoperative irradia tion. None of the 8 patients with preoperative irradiation have failed loca lly so far. With the introduction of central radiotherapy planning in CESS 86, local control of irradiated patients improved. Ten of 14 patients with local failure could be evaluated in the relapse analysis: 3 patients had an in-field relapse, 4 patients had a marginal relapse, 2 patients had a rela pse outside the radiation fields, and 1 patient failed with pleural dissemi nation. Six treatment deviations were observed. Conclusion: Local control was best after surgery alone in a positively sele cted group of patients. Local control after radiation or combined radiation and surgery was good. With diligent performance of radiotherapy, it will b e possible to further improve the results in the radiotherapy group. (C) 19 98 Elsevier Science Inc.