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Purpose. Improvements in the systemic management of Ewing's sarcoma of bone over the last 20 years have led to a dramatic improvement in survival. The corollary is that treatment of the primary disease requires re-evaluation, since a significant number of patients still suffer local relapse.Patients. The effect of radiation dose on local control was reviewed in a series of 96 patients treated between 1967 and 1986. Seventy-four had no metastases at presentation (M0), 22 had metastases (M1). The 5-year survival of all patients was 28%, and of M0 patients alone 37%. Although these figures are poor by today's standards, they are consistent with published studies whose patients were enrolled during the same calendar period. Although most deaths occurred by 5 years, survival continued to fall beyond 10 years, which has implications for follow-up in future studies.Results. The local control (LC) rate at 5 years was 56% for all patients and for M0 patients analyzed separately. There was no difference in either LC or survival between the first and second decades of the study. Primary site was a significant determinant of survival and local control, with better outcome for limb tumours compared to pelvic primaries. Chemotherapy also had a major effect on LC. Radiotherapy improved the probability of LC. Omission of radiotherapy, or a dose &lt;40 Gy, was ineffective. In the dose range 40-66 Gy, there was no evidence of a dose-response relationship.

The Impact of Radiotherapy Dose on Local Control of Ewing's Sarcoma of Bone