6 januari 2023: Bron: Journal of radiation Oncology
In een wel heel summier abstract worden de resultaten gepubliceerd van de effecten van chirurgie plus bestraling in vergelijking met alleen chirurgie bij kinderen / patiënten met het Ewingsarcoom op 5-jaars meting. Uiteindelijk blijkt dat er een groot verschil zat 25 om 6,3 procent tussen wel of geen recidief tussen chirurgie plus radiotherapie en alleen radiotherapie op 5-jaars meting.
Dit staat er in het abstract vertaald in het Nederlands:
Doel van de studie:
Om potentiële klinische prognostische factoren te identificeren die geassocieerd zijn met een hoger risico op lokaal recidief bij patiënten met gelokaliseerd Ewing-sarcoom in het bekken die worden behandeld met radiotherapie - bestraling.
Methoden en materialen:
Gegevens van 101 patiënten die werden behandeld met definitieve radiotherapie - bestraling (RT) of zowel chirurgie als bestraling (S + RT) voor primaire bekkentumoren op INT-0091, INT-0154 en AEWS0031 werden geanalyseerd.
Beeldgegevens van patiënten die geen bestraling ontvingen, waren niet beschikbaar voor centrale beoordeling; daarom werden patiënten met alleen een operatie niet opgenomen.
Cumulatieve incidentiepercentages voor lokaal falen na 5 jaar vanaf het moment van lokale controle werden berekend rekening houdend met concurrerende risico's.
Resultaten:
De meest voorkomende bekkensubsite was heiligbeen (44,6%). Radiotherapie (RT) werd gebruikt bij 68% van de patiënten en chirurgie plus radiotherapie (S + RT) bij 32%.
Het lokale faalpercentage was 25,0% voor radiotherapie (RT) en 6,3% voor chirurgie plus radiotherapie (S + RT) (P = 0,046).
Er was geen statistisch significant verschil in lokale controle door specifieke tumor kenmerken. Tumoren afkomstig uit het ischiopubisch-acetabulumgebied waren geassocieerd met de hoogste incidentie van lokaal falen - recidief, 37,5% (P = 0,02, versus sacrum- en iliacale/biltumoren), met name die behandeld met radiotherapie (RT) (50,0%, P = 0,06).
Een hogere incidentie van lokaal falen - frecidief werd gezien bij elke extra 100 ml tumor bij diagnose van de kanker (p = 0,04).
Multivariabele analyse toonde radiotherapie alleen aan (hazard ratio , 5,1; P = 0,04), tumorsubsite (met name ischiopubische-acetabulumtumoren; HR 4,6; P = 0,02), en toenemend volume per 100 ml (HR, 1,2; P = .01) waren geassocieerd met een hogere incidentie van lokaal recidief.
Conclusies:
Combinatie van chirurgie en radiotherapie wordt in verband gebracht met verbeterde lokale controle bij patiënten met Ewing-sarcoom in het bekken in vergelijking met alleen radiotherapie.
Tumoren waarbij het ischiopubische-acetabulumgebied betrokken is en een toenemend tumorvolume bij diagnose worden in verband gebracht met inferieure lokale controle.
Tumorkenmerken correleerden niet met de keuze van lokale therapiemodaliteit, wat een mogelijkheid suggereert om richtlijnen voor beste lokale therapiepraktijken te ontwikkelen voor toekomstige studies op basis van tumorkenmerken.
Het originele abstract is aan te klikken via de titel van het abstract, maar voor volledig studierapport moet worden betaald:
Purpose
To identify potential clinical prognostic factors associated with a higher risk of local recurrence in patients with localized pelvic Ewing sarcoma treated with radiation therapy.
Methods and Materials
Data for 101 patients treated with definitive radiation therapy (RT) or both surgery and radiation (S + RT) to primary pelvic tumors on INT-0091, INT-0154, and AEWS0031 were analyzed. Imaging data for patients who did not receive radiation were not available for central review; therefore, patients with surgery alone were not included. Cumulative incidence rates for local failure at 5 years from time of local control were calculated accounting for competing risks.
Results
The most common pelvic subsite was sacrum (44.6%). RT was used in 68% of patients and S + RT in 32%. The local failure rate was 25.0% for RT and 6.3% for S + RT (P = .046). There was no statistically significant difference in local control modality by tumor characteristics. Tumors originating in the ischiopubic-acetabulum region were associated with the highest local failure incidence, 37.5% (P = .02, vs sacrum and iliac/buttock tumors), particularly those treated with RT (50.0%, P = .06). A higher incidence of local failure was seen with each additional 100 mL of tumor at diagnosis (P = .04). Multivariable analysis demonstrated RT alone (hazard ratio , 5.1; P = .04), tumor subsite (particularly ischiopubic-acetabulum tumors; HR 4.6; P = .02), and increasing volume per 100 mL (HR, 1.2; P = .01) were associated with a higher incidence of local recurrence.
Conclusions
Combination surgery and RT is associated with improved local control in patients with pelvic Ewing sarcoma compared with definitive RT. Tumors involving the ischiopubic-acetabulum region and increasing tumor volume at diagnosis are associated with inferior local control. Tumor characteristics did not correlate with choice of local therapy modality suggesting an opportunity to develop best local therapy practices guidelines for future studies based on tumor features.
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Article Info
Publication History
Published online: October 24, 2022
Accepted: July 24, 2022
Received: May 18, 2022
Footnotes
Funding was provided by the National Clinical Trials Network Operations Center Grant (U10CA180886), the National Clinical Trials Network Statistics and Data Center Grant (U10CA180899), and by The St. Baldrick's Foundation.
Disclosures: P.S.R. serves on the board of directors of the Sacral Tumor Society. K.J.M. receives royalties as a coauthor in Up-to-Date. R.L.R. receives royalties from Onkos, Zimmer Biomet, and Daichii Sankyo; consulting fees from Onkos, Zimmer Biomet, and Daichii Sankyo; honoraria for presentations from Onkos; and has a leadership role in the Sarcoma Foundation of America and the Musculoskeletal Tumor Society. S.G.D. has received consulting fees from Amgen, Bayer, and Jazz as well as travel expenses from Loxo, Roche, and Salarius. R.G.G. has received consulting fees from Jazz Pharmaceuticals. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
Data Sharing Statement: Research data are stored in an institutional repository and will be shared upon request to the corresponding author.
Acknowledgments—The authors would like to thank the Imaging and Radiation Oncology Core Rhode Island and the Quality Assurance Review Center for their assistance. The authors wish to acknowledge Dr Linda Granowetter for her contributions to this project. She was first author on a publication of the INT0154 study (DOI: 10.1200/JCO.2008.19.1478) and supported analysis on the subset of those patients included in the present manuscript. The authors also wish to thank Feven Abraha in the Department of Quantitative Health Sciences at Mayo Clinic for generating the figures.
Identification
Copyright
© 2022 Elsevier Inc. All rights reserved.
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