Survival outcomes in pediatric patients with metastatic Ewing sarcoma who achieve a rapid complete response of pulmonary metastases

Audra J. Reiter, Lynn Huang, Brian T. Craig, Andrew M. Davidoff, Lindsay J. Talbot, Jordan Coggins, Jasmine Smith, Jennifer H. Aldrink, Katherine C. Bergus, Taleen A. MacArthur, Stephanie F. Polites, Chloe Boehmer, Joseph Brungardt, Marcus M. Malek, Hannah N. Rinehardt, Zachary J. Kastenberg, Cameron M. Arkin, Antoine Gourmel, Nelson Piche, Marshall WallaceJiancong Liang, Harold N. Lovvorn, Robin T. Petroze, Gwendolyn Gillies, John P. Marquart, Kerri Becktell, Hau D. Le, Juan Favela, Barrie S. Rich, Richard D. Glick, Natashia M. Seemann, Jacob Davidson, Claire A. Wilson, Jonathan Roach, Erin G. Brown, Kathleen E. Doyle, Brian A. Coakley, Pamela Emengo, Pamela Merola, Christa N. Grant, Anuritha Tirumani, Elisabeth T. Tracy, Mary E. Moya-Mendez, Roshni Dasgupta, Timothy B. Lautz*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


Purpose: Our objectives were to compare overall survival (OS) and pulmonary relapse between patients with metastatic Ewing sarcoma (EWS) at diagnosis who achieve rapid complete response (RCR) and those with residual pulmonary nodules after induction chemotherapy (non-RCR). Patients and methods: This retrospective cohort study included children under 20 years with metastatic EWS treated from 2007 to 2020 at 19 institutions in the Pediatric Surgical Oncology Research Collaborative. Chi-square tests were conducted for differences among groups. Kaplan–Meier curves were generated for OS and pulmonary relapse. Results: Among 148 patients with metastatic EWS at diagnosis, 61 (41.2%) achieved RCR. Five-year OS was 71.2% for patients who achieved RCR, and 50.2% for those without RCR (p =.04), and in multivariable regression among patients with isolated pulmonary metastases, RCR (hazards ratio [HR] 0.42; 95% confidence interval [CI]: 0.17–0.99) and whole lung irradiation (WLI) (HR 0.35; 95% CI: 0.16–0.77) were associated with improved survival. Pulmonary relapse occurred in 57 (37%) patients, including 18 (29%) in the RCR and 36 (41%) in the non-RCR groups (p =.14). Five-year pulmonary relapse rates did not significantly differ based on RCR (33.0%) versus non-RCR (47.0%, p =.13), or WLI (38.8%) versus no WLI (46.0%, p =.32). Discussion: Patients with EWS who had isolated pulmonary metastases at diagnosis had improved OS if they achieved RCR and received WLI, despite having no significant differences in rates of pulmonary relapse.

Original languageEnglish (US)
Article numbere31026
JournalPediatric Blood and Cancer
Issue number7
StatePublished - Jul 2024


  • Ewing sarcoma
  • pediatric surgery
  • pulmonary metastasectomy

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Hematology
  • Oncology

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