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Role of radiotherapy in Ewing tumors
Author(s) -
Dunst Juergen,
Schuck Andreas
Publication year - 2004
Publication title -
pediatric blood and cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.116
H-Index - 105
eISSN - 1545-5017
pISSN - 1545-5009
DOI - 10.1002/pbc.10446
Subject(s) - medicine , radiation therapy , ewing's sarcoma , radiology , sarcoma , pathology
Background The objective of this review article is to outline the role of radiotherapy in a curative multimodal treatment concept. Procedure We have analyzed the data from major multi‐institutional prospective trials in Ewing tumors for to evaluate the impact of radiotherapy on local control and survival. Results Surgery yields in general better local control and survival figures as compared to radiotherapy. The efficacy of radiotherapy as compared to surgery varies among the studies and seems to be dependent on patient selection and sequencing with chemotherapy. Combined local therapy (surgery plus post‐ or pre‐operative radiotherapy) has yielded excellent local control rates in patients with high‐risk lesions (e.g., pelvic tumors); although not proven by randomized studies, an impact on survival is likely. Indications for post‐operative radiotherapy are unradical or marginal resections and poor histological response. In patients with chest wall primaries, adjuvant hemithorax irradiation has reduced the relapse rate significantly. Pre‐operative irradiation offers theoretical advantages. Bilateral lung irradiation (as consolidation after chemotherapy) seems to improve prognosis in patients with metastases at diagnosis. Conclusions Patients with high‐risk lesions probably benefit from combined local treatment (surgery plus radiotherapy). Improving local control after radiotherapy is a major issue for future studies, and sequencing with chemotherapy seems to be critical factor. The possible curative potential of radiotherapy in metastatic disease requires further investigation. © 2004 Wiley‐Liss, Inc.