Effect of low-dose radiation therapy when combined with surgical resectionfor Ewing sarcoma

Background. As an alternative to high-dose irradiation, limited surgery and low-dose irradiation have been investigated as a means to achieve local co ntrol. We retrospectively examined the clinical characteristics, treatment, and outcome for 25 patients with Ewing sarcoma treated with limited surger y and low-dose irradiation. Procedure. The records of 25 patients (age 4-48 years) were reviewed who were treated between 1979 and 1996 at Memorial Sl oan-Kettering Cancer Center. At the time of diagnosis, 21 of the 25 patient s had prognostically unfavorable tumors including the presence of metastati c disease (n = 12), an axial primary (n = 17), and a tumor measuring greate r than 8 cm (n = 18). The primary tumor was completely resected (wide local excision) in 13 patients, incompletely resected (marginal excision) in 7 p atients, and biopsied only in the remaining 5 patients. The median dose of irradiation to the primary site was 30 Gy. Results. With a median follow-up of 67 months (range 16-189 months) for the surviving patients, 28% failed distantly, and an additional 28% suffered from the progression of previousl y established metastatic disease. No patient failed locally. The median ove rall survival was 43 months. The actuarial overall survival at 5 years was 39% (+/- 11%) for all patients and 60% (+/- 14%) for patients with localize d disease. Conclusions. Limited surgery and postoperative irradiation are o ne strategy that promises to balance the goal of achieving local control wi th the goal of diminishing late effects. Apart from the scenario in which r adiation therapy is absolutely unnecessary, low-dose irradiation may be app ropriate after considering the risk for local recurrence and overall progno sis. (C) 1999 Wiley-Liss, Inc.