The Journal of Bone and Joint Surgery 80:1020-33 (1998)
© 1998 The Journal of Bone and Joint Surgery, Inc.
The Histological Response to Chemotherapy as a Predictor of the Oncological Outcome of Operative Treatment of Ewing Sarcoma*
JAY S. WUNDER, M.D. ,
GABE PAULIAN, B.SC. ,
ANDREW G. HUVOS, M.D.,
GLENN HELLER, PH.D.,
PAUL A. MEYERS, M.D. and
JOHN H. HEALEY, M.D., NEW YORK, N.Y.
Investigation performed at the Departments of Surgery, Pathology, Pediatrics, and Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, Affiliated with Cornell University Medical College, New York City
Seventy-four patients who had a Ewing sarcoma of bone were managed with preoperative and postoperative chemotherapy and operative resection, with or without postoperative irradiation. The primary objectives of the study were to determine the histological response to preoperative chemotherapy in terms of the percentage of tumor necrosis and to assess the relationship between the histological response and the oncological outcome.
The minimum duration of follow-up of the surviving patients who were continuously free of disease was five years. Sections of each operative specimen were examined, and the histological response to chemotherapy was graded semiquantitatively. Grade I indicated necrosis of 50 per cent of the tumor or less; grade II, necrosis of more than 50 per cent but less than 90 per cent; grade III, necrosis of 90 to 99 per cent; and grade IV, necrosis of 100 per cent of the tumor. Of the seventy-four tumors, forty-four (59 per cent) were exquisitely sensitive to chemotherapy and had complete (grade-IV) or nearly complete (grade-III) necrosis. In contrast, fourteen tumors (19 per cent) had little or no response to chemotherapy (grade I) and sixteen (22 per cent) had a moderate degree of necrosis (grade II).
The histological response to preoperative chemotherapy (p = 0.0001), followed by the size of the tumor (p = 0.001), were the most important predictors of event-free survival. At five years, the rate of event-free survival was zero of fourteen patients who had had a grade-I response, six of sixteen who had had a grade-II response, and thirty-seven (84 per cent) of forty-four who had had a grade-III or IV response. The risk of local recurrence was most strongly associated with the operative margins; there were only four local recurrences (6 per cent) after sixty-seven resections with negative margins. Local recurrence may also have been influenced by the histological response and the use of local radiation. There were no local recurrences after operative treatment of six tumors that had been associated with pathological fracture.
The histological response to preoperative chemotherapy and the size of the primary tumor are the most important clinical predictors of the outcome of operative treatment of non-metastatic Ewing sarcoma. These indicators should be used to identify patients who are at high risk for metastasis as such patients may be candidates for more intensive or novel therapies.
 CiteULike  Connotea  Del.icio.us  Technorati What's this?
This article has been cited by other articles:
|
|
|
|
 
T A LESLIE, J E KENNEDY, R O ILLING, G R TER HAAR, F WU, R R PHILLIPS, P J FRIEND, I S D ROBERTS, D W CRANSTON, and M R MIDDLETON
High-intensity focused ultrasound ablation of liver tumours: can radiological assessment predict the histological response?
Br. J. Radiol.,
July 1, 2008;
81(967):
564 - 571.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. Burke, J. R. Anderson, S. C. Kao, D. Rodeberg, S. J. Qualman, S. L. Wolden, W. H. Meyer, and P. P. Breitfeld
Assessment of Response to Induction Therapy and Its Influence on 5-Year Failure-Free Survival in Group III Rhabdomyosarcoma: The Intergroup Rhabdomyosarcoma Study-IV Experience A Report From the Soft Tissue Sarcoma Committee of the Children's Oncology Group
J. Clin. Oncol.,
November 1, 2007;
25(31):
4909 - 4913.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
R. K. Heck Jr., T. D. Peabody, and M. A. Simon
Staging of Primary Malignancies of Bone
CA Cancer J Clin,
November 1, 2006;
56(6):
366 - 375.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
A. Srivastava, B. Fuchs, K. Zhang, M. Ruan, C. Halder, E. Mahlum, K. Weber, M. E. Bolander, and G. Sarkar
High WT1 Expression Is Associated with Very Poor Survival of Patients with Osteogenic Sarcoma Metastasis.
Clin. Cancer Res.,
July 15, 2006;
12(14):
4237 - 4243.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
D. S. Hawkins, S. M. Schuetze, J. E. Butrynski, J. G. Rajendran, C. B. Vernon, E. U. Conrad III, and J. F. Eary
[18F]Fluorodeoxyglucose Positron Emission Tomography Predicts Outcome for Ewing Sarcoma Family of Tumors
J. Clin. Oncol.,
December 1, 2005;
23(34):
8828 - 8834.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
H.-Y. Huang, P. B. Illei, Z. Zhao, M. Mazumdar, A. G. Huvos, J. H. Healey, L. H. Wexler, R. Gorlick, P. Meyers, and M. Ladanyi
Ewing Sarcomas With p53 Mutation or p16/p14ARF Homozygous Deletion: A Highly Lethal Subset Associated With Poor Chemoresponse
J. Clin. Oncol.,
January 20, 2005;
23(3):
548 - 558.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
K. L. Zakian, A. Shukla-Dave, P. Meyers, R. Gorlick, J. Healey, H. T. Thaler, A. G. Huvos, D. M. Panicek, and J. A. Koutcher
Identification of Prognostic Markers in Bone Sarcomas Using Proton-Decoupled Phosphorus Magnetic Resonance Spectroscopy
Cancer Res.,
December 15, 2003;
63(24):
9042 - 9047.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. P. Dyke, D. M. Panicek, J. H. Healey, P. A. Meyers, A. G. Huvos, L. H. Schwartz, H. T. Thaler, P. S. Tofts, R. Gorlick, J. A. Koutcher, et al.
Osteogenic and Ewing Sarcomas: Estimation of Necrotic Fraction during Induction Chemotherapy with Dynamic Contrast-enhanced MR Imaging
Radiology,
July 1, 2003;
228(1):
271 - 278.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
C. M. L. da Costa, A. Lopes, and B. de Camargo
A simple cost-effective lactate dehydrogenase level measurement can stratify patients with Ewing's tumor into low and high risk
Ann. Onc.,
April 1, 2003;
14(4):
656 - 656.
[Full Text]
[PDF]
|
|
|
|
|
|
|
K. Kimura, S. Tatezaki, T. Ishii, T. Yonemoto, T. Shigehara, and T. Takenouchi
Hemiarthroplasty of the Elbow with a Vascularized Fibular Graft after Excision of Ewing's Sarcoma of the Proximal Ulna: a Case Report
Jpn. J. Clin. Oncol.,
October 1, 2002;
32(10):
430 - 434.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
C. P. Gibbs Jr., K. Weber, and M. T. Scarborough
Malignant Bone Tumors
J. Bone Joint Surg. Am.,
November 1, 2001;
83(11):
1728 - 1745.
[Full Text]
[PDF]
|
|
|
|
|
|
|
F. C. Eilber, G. Rosen, J. Eckardt, C. Forscher, S. D. Nelson, M. Selch, F. Dorey, and F. R. Eilber
Treatment-Induced Pathologic Necrosis: A Predictor of Local Recurrence and Survival in Patients Receiving Neoadjuvant Therapy for High-Grade Extremity Soft Tissue Sarcomas
J. Clin. Oncol.,
July 1, 2001;
19(13):
3203 - 3209.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
E. de Alava and J. Pardo
Ewing Tumor: Tumor Biology and Clinical Applications
International Journal of Surgical Pathology,
January 1, 2001;
9(1):
7 - 17.
[Abstract]
[PDF]
|
|
|
|
