Survival and Prognostic Factors in Ewing Sarcoma: Evaluating the Role of Radiotherapy in Multimodality Management
Siddhartha Nanda
Department of Radiation Oncology, All India Institute of Medical Sciences, Raipur, CG, India.
Amitima Mehta
Department of Radiation Oncology, All India Institute of Medical Sciences, Raipur, CG, India.
Papuji Meher *
Department of Radiation Oncology, All India Institute of Medical Sciences, Raipur, CG, India.
*Author to whom correspondence should be addressed.
Abstract
Background: Ewing sarcoma is an aggressive small round blue cell malignancy that predominantly affects children and young adults. Radiotherapy plays a central role in local control, particularly in anatomically complex or unresectable disease.
Methods: A retrospective cohort study of 51 patients with histologically confirmed Ewing sarcoma treated between January 2022 and December 2024 at a tertiary care centre was conducted. All patients received multi-agent chemotherapy, and radiotherapy was delivered with curative (adjuvant or definitive) or palliative intent. Advanced conformal techniques, including volumetric modulated arc therapy (VMAT) and three-dimensional conformal radiotherapy (3DCRT), were used according to clinical indication. Overall survival (OS) and disease-free survival (DFS) were estimated using the Kaplan–Meier method. DFS was defined as the time from completion of primary treatment to recurrence or last follow-up. Prognostic factors were explored using univariate Cox proportional hazards regression.
Results: The median age was 21 years (IQR 14.5–28.0), and 43.1% of patients were in the paediatric age group. Metastatic disease at diagnosis was present in 27.5% of patients. Radiotherapy was delivered using conformal techniques in 68.6% of cases, most commonly VMAT. The median radiotherapy dose was 45 Gy. With a median follow-up of 28 months, the median OS and DFS were both 25 months. The 2-year OS rate was 75%. Higher radiotherapy dose and use of advanced conformal techniques were associated with improved survival outcomes in univariate analyses. No grade ≥3 acute toxicities were observed.
Conclusion: Radiotherapy contributes significantly to local control and survival in Ewing sarcoma within a multimodality treatment framework. Metastatic disease at diagnosis remains the dominant adverse prognostic factor. Optimisation of local therapy through appropriate dose and modern conformal techniques may improve outcomes; however, larger prospective studies are required to validate these associations.
Keywords: Sarcoma, ewing, radiotherapy, limb salvage, extracorporeal irradiation