Expert Discusses Local Control in Ewing Sarcoma

Dimosthenis Andreou, M.D., discussed the Euro-EWING99 trial with CURE.
Patients with Ewing sarcoma in their pelvic area typically have poorer local control and overall survival (OS), says Dimosthenis Andreou, M.D.

Local recurrence is associated with very poor prognosis in patients with Ewing sarcoma. Thus, researchers in the field are working on identifying potential factors associated with local recurrence in patients undergoing multimodal treatment.

A retrospective analysis evaluated the data from 1,207 patients with previously untreated Ewing sarcoma who were registered in the Euro-EWING99 trial (NCT00020566) between 1998 and 2009. The results of this analysis were presented at the 2016 Annual CTOS Meeting. The primary outcome was local recurrence-free survival, which was defined as the interval between diagnostic biopsy and local recurrence. A secondary outcome was OS.

“We found several things in this meta-analysis that were rather good,” said Andreou. “We confirmed some of the known prognostic factors.”

In an interview with CURE, Andreou, an orthopedic oncologist at the University Hospital Münster, discusses the significant findings of this retrospective analysis and what he hopes people in the field of oncology took away from this year’s CTOS meeting.

What were the key findings from this analysis?

This was a retrospective analysis of the data that was not one of the primary or secondary objectives of the trial. We found several things in this meta-analysis that were rather good. We confirmed some of the known prognostic factors. Patients with pelvic Ewing sarcoma have poorer local control and poorer OS, and the same is the case for patients with primary metastases with large tumors.

Interestingly, what we also saw was not so well known up until now. We saw modifications of treatment; we had a lot of patients who didn’t proceed to finish the protocol as planned, either due to toxicity or because patients were simply fed up with the treatment and did not want to be in the hospital on and off for a year. These patients had a worse local control and worse OS probability, and we also saw some surgical factors that had some influence. For instance, patients presenting with a pathological fracture of the bone had poorer OS, but not the worst local control. That would suggest that the pathological fracture is a marker for an aggressive disease.

Patients with bone Ewing sarcoma usually have a large soft tissue component. And the question is, after neoadjuvant treatment, is the soft tissue component still there? Moreover, the patients who still had soft tissue infiltration of the tumor, after neoadjuvant chemotherapy, had significantly worse prognosis, both in terms of local control and in terms of OS compared with patients who did not have that soft tissue component anymore. 

What are the next steps following these results?

Well, one of the most interesting findings that I haven’t mentioned yet is that in pelvic Ewing sarcomas, in our data at least, in cases where the complete involved bone was resected rather than operated through the involved bone, those patients had significantly better overall and local recurrence-free survival. This is a finding that actually contradicts current practice, as you would typically try to maintain as much of the bone as possible.

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