Ewing sarcoma/primitive neuroectodermal tumor of the chest wall: impact of initial versus delayed resection on tumor margins, survival, and use of radiation therapy. Academic Article uri icon

Overview

abstract

  • OBJECTIVE: To establish outcome and optimal timing of local control for patients with nonmetastatic Ewing sarcoma/primitive neuroectodermal tumor (ES/PNET) of the chest wall. METHODS: Patients < or =30 years of age with ES/PNET of the chest wall were entered in 2 consecutive protocols. Therapy included multiagent chemotherapy; local control was achieved by resection, radiotherapy, or both. We compared completeness of resection and disease-free survival in patients undergoing initial surgical resection versus those treated with neoadjuvant chemotherapy followed by resection, radiotherapy, or both. Patients with a positive surgical margin received radiotherapy. RESULTS: Ninety-eight (11.3%) of 869 patients had primary tumors of the chest wall. Median follow-up was 3.47 years and 5-year event-free survival was 56% for the chest wall lesions. Ten of 20 (50%) initial resections resulted in negative margins compared with 41 of 53 (77%) negative margins with delayed resections after chemotherapy (P = 0.043). Event-free survival did not differ by timing of surgery (P = 0.69) or type of local control (P = 0.17). Initial chemotherapy decreased the percentage of patients needing radiation therapy. Seventeen of 24 patients (70.8%) with initial surgery received radiotherapy compared with 34 of 71 patients (47.9%) who started with chemotherapy (P = 0.061). If a delayed operation was performed, excluding those patients who received only radiotherapy for local control, only 25 of 62 patients needed radiotherapy (40.3%; P = 0.016). CONCLUSION: The likelihood of complete tumor resection with a negative microscopic margin and consequent avoidance of external beam radiation and its potential complications is increased with neoadjuvant chemotherapy and delayed resection of chest wall ES/PNET.

authors

  • Brennan, Murray F.
  • Shamberger, Robert C
  • LaQuaglia, Michael Patrick
  • Gebhardt, Mark C
  • Neff, James R
  • Tarbell, Nancy J
  • Marcus, Karen C
  • Sailer, Scott L
  • Womer, Richard B
  • Miser, James S
  • Dickman, Paul S
  • Perlman, Elizabeth J
  • Devidas, Meenakshi
  • Linda, Stephen B
  • Krailo, Mark D
  • Grier, Holcombe E
  • Granowetter, Linda

publication date

  • October 1, 2003

Research

keywords

  • Bone Neoplasms
  • Neuroectodermal Tumors, Primitive
  • Sarcoma, Ewing

Identity

PubMed Central ID

  • PMC1360114

Scopus Document Identifier

  • 10744232124

Digital Object Identifier (DOI)

  • 10.1097/01.sla.0000089857.45191.52

PubMed ID

  • 14530727

Additional Document Info

volume

  • 238

issue

  • 4