Template

Template

LOCAL CONTROL MODALITY AND OUTCOME IN EWING SARCOMA OF THE FEMUR: A REPORT FROM THE CHILDRENS ONCOLOGY GROUP Najat C. Daw, Nadia N. Laack, Elizabeth J. McIlvaine, Mark Krailo, Richard B. Womer, Linda Granowetter, Holcombe E. Grier, Neyssa M. Marina, Mark L. Bernstein, Richard G. Gorlick, R. Lor Randall CTOS 2014, Berlin Germany Background The femur is the most frequently involved bone by Ewing sarcoma and has the greatest structural significance. Reported 5-year overall survival for localized disease 31% - 64%. Survival of patients treated with surgery with or without radiotherapy is better than that of patients treated with radiotherapy alone. Local control modality at this site is controversial . Study Objectives To describe the treatment and outcome of patients with localized Ewing sarcoma of the femur treated on 3 consecutive cooperative group trials To determine the effect of local control modality on tumor local control and patient outcome Patients and Methods Review of patients with localized Ewing sarcoma of femur treated on INT-0091, INT-0154, and AEWS0031. Included only patients who received vincristine, doxorubicin, and cyclophosphamide alternating with ifosfamide and etoposide (VDC/IE) every 3 weeks and local therapy after neoadjuvant chemotherapy. Analysis of disease outcome in relation to local control

modality: surgery, surgery plus radiotherapy (RT), RT. Differences in survival curves were assessed using logrank tests. Cumulative incidence was calculated using the method of Fine. Results 131 patients with localized EWS of femur identified 16 excluded for incomplete data on local control 115 had complete data on local control Characteristic No. of patients Median age in yr (range) 13 (1-33) Gender Male 69 Female 46 Race Caucasian 98 Black 4 Latino/Hispanic 10 Other 1 Missing

2 Location in femur Proximal 49 Mid 26 Distal 19 Unknown 21 Tumor size > 8 cm 29 8 cm 26 Not reported 60 % 60% 40% 85% 4% 9% 1% 2% 43% 23% 17% 18% 25% 23% 52% Treatment Treatment regimen INT-0091 experimental arm INT-0154 standard arm

AEWS0031 standard arm Local control modality Surgery only Surgery + RT RT only Type of surgery/reconstruction (n=101) Amputation Prosthesis/allograft prosthetic composite Allograft Vascularized autograft Rotationplasty Unknown N % 33 50 32 29% 44% 28% 84 17 14 73% 15% 12% 5 35 37 7 2 15

5% 35% 37% 7% 2% 15% Patient Outcome (N=115) Survival From Date of Local Control Estimated Proportion Event-Free, Alive 1.00 0.80 0.60 EFS OS 0.40 5-yr EFS 65%, 95% CI (55%, 73%) 5-yr OS 70%, 95% CI (61%, 78%) 0.20 0.00 0 1 2 3 4

5 6 Years 7 8 9 10 11 Event-Free Survival by Tumor Size EFS by Tumor Size Estimated Proportion Event-Free 1.00 p=0.67 0.80 0.60 Tumor Size <= 8cm > 8cm 0.40 0.20 0.00 0

1 2 3 4 5 6 Years 7 8 9 10 11 EFS by Local Control Modality EFS by Local Control Modality Estimated Proportion Event-Free 1.00 p=0.32 0.80 Local Control 0.60 Surgery Only

RT Only Surgery + RT 0.40 0.20 0.00 0 1 2 3 4 5 6 Years 7 8 9 10 11 Overall Survival by Local Control Modality OS by Local Control Modality Estimated Proportion Event-Free

1.00 p=0.43 0.80 Local Control 0.60 Surgery Only RT Only Surgery + RT 0.40 0.20 0.00 0 1 2 3 4 5 6 Years 7 8 9

10 11 Cumulative Incidence of Local Failure not Associated with Type of Local Control .15 Cumulative Incidence p=0.57 .1 Local Control Surgery Only RT Only Surgery + RT .05 0 0 50 Months 100 150 Conclusions Ewing sarcoma of the femur arises most commonly in the proximal aspect of the bone. Most common local treatment was surgery alone. Patients treated with VDC/IE every 3 weeks appear to have an EFS comparable to that of patients with Ewing sarcoma in general. The local control modality did not significantly

affect disease outcome. Further study of treatment complications and functional outcome of the limb is needed to determine the optimal local control modality. Acknowledgements COG Bone Sarcoma Committee members Treating physicians/investigators and CRAs at participating sites Participating patients and their families Outcome by Surgery vs Any RT EFS by Local Control Modality EFS OS by Local Control Modality Overall Survival 1.00 p=0.13 0.80 p=0.20 Estimated Proportion Event-Free Estimated Proportion Event-Free 1.00 0.60 0.40 0.20

0.00 0.80 0.60 Local Control Local Control Surgery Only Any RT Surgery Only Any RT 0.40 0.20 0.00 0 1 2 3 4 5 6 Years 7

8 9 10 11 0 1 2 3 4 5 6 Years 7 8 9 10 11 Age 13(1, 33) Life Status at Last Contact Alive

80 Dead 35 Event Type None 74 Relapse 34 SMN 2 Death 5 Gender Male 69 Female 46 Type of Local Control Surgery Only 84 RT Only 14 Surgery + RT 17 Margins of Excision Radical 17 Wide 71 Marginal 4 Intralesional 1 Missing 22 Race White Black

Hispanic Other Missing Reconstruction Amputation METL PRO, ALLO PRO, Composite ALLO REP, Allograft, Intercalary Rotationplasty, TURNABT Vascularized Fibula, Autograft, EXP BONE, OTHER NOT APP Missing Tumor Size <= 8cm > 8cm Study and Treatment CCG7881 Experimental P9354 Regimen A (low dose) AEWS0031 Standard 98 4 10 1 2 5 35 37 2 7 2 27 26 29 33 50 32 Site on Femur Distal

Mid Proximal Unknown Missing Relapse Stage None Local Systemic Systemic + Local Death Missing 19 26 49 3 18 20 2 17 4 2 70

Recently Viewed Presentations

  • Public Forums - Connecticut

    Public Forums - Connecticut

    WHAT IS LONG TERM CARE? * WHAT IS A FUNCTIONAL IMPAIRMENT WHAT IS A COGNITIVE IMPAIRMENT WHERE IS LONG TERM CARE PROVIDED? HOME AND COMMUNITY- BASED SERVICES HOME AND COMMUNITY- BASED SERVICES (cont'd) Charge Per Visit Charge Per Hour Skilled...
  • System Information update procedure

    System Information update procedure

    Since RL-SIG is included in 11bd PPDU, the auto-detection method which isadopted in 11ax can be used for distinction of 11bd. Sept 2019. Dongguk Lim, LG Electronics. Slide . Repetition check. MRC & Contents check. 11p. Received PPDU. N. N....
  • Adjunctive hyperbaric oxygen therapy for the treatment of

    Adjunctive hyperbaric oxygen therapy for the treatment of

    Synergistic α (Phospholipase C) and θ (Perfringolysin O) toxins. ... There are 4 main lethal enterotoxins produced by the bacteria w/ the alpha toxin, known to cause gas gangrene, and more relevantly for this case, intravascular hemolysis. This toxin is...
  • Somerset LPC Be prepared to Survive & Thrive

    Somerset LPC Be prepared to Survive & Thrive

    Somerset LPC. Be prepared to Survive & Thrive In The New Pharmacy Contract! Main topics in presentation are back to basics: Nomination of patients. EPS and the NHSBSA…. Schedule of payments and impact of incorrect claiming. Prescription tracker. eRD. 24/01/2017...
  • It&#x27;s 11th grade Now What? - Uplift Education

    It's 11th grade Now What? - Uplift Education

    Ice Breaker. Take a moment to talk to the person next to you about the following prompt: ... One change I have noticed in my 11th grade scholar is….. Agenda. 11th grade checklist. How do I help my 11th grade...
  • Personal Property Tax Abatements - Indiana

    Personal Property Tax Abatements - Indiana

    Real vs. Personal Property. The determination of whether an asset is to be assessed as real or personal property, or as an intangible asset or is subject to excise tax is an important aspect of verifying the correctness of a...
  • Blood Product Administration - Naval Hospital Bremerton

    Blood Product Administration - Naval Hospital Bremerton

    MEDEVAC vehicles and aircraft are specifically configured for casualty care and designated with a Red Cross. These assets generally minimally armed. ... be given with Hextend or through an IV line with Hextend in it. Inject 1 gram of TXA...
  • Incentive Auction Broadcaster Reimbursement (Form 399)

    Incentive Auction Broadcaster Reimbursement (Form 399)

    User will see an entry for each licensed broadcast site. To add additional sites, such as for unlicensed auxiliary transmitters, select "Add Another __" Select "Edit" to describe existing equipment. Select "Type of Change" to describe reimbureable costs and select...