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Primary and Metastatic Intracranial Ewing Sarcoma at Diagnosis: Retrospective International Study and Systematic Review

Princess Maxima Center for Pediatric Oncology, 3584 CS Utrecht, The Netherlands
Department of Pediatric Hematology and Oncology, University Children’s Hospital of Essen, Center of Pediatric Oncology, 45122 Essen, Germany
Department of Pediatric Oncology, Academic Medical Center, Emma Children’s Hospital, 1105 AZ Amsterdam, The Netherlands
Children’s Cancer Research Institute, 1090 Vienna, Austria
Vestische Kinder- und Jugendklinik, Witten/Herdecke University, 45711 Datteln, Germany
Department of Pediatric Hematology and Oncology, University Children’s Hospital, 48149 Muenster, Germany
Author to whom correspondence should be addressed.
These authors contributed equally to this work.
Cancers 2020, 12(6), 1675;
Received: 29 May 2020 / Revised: 21 June 2020 / Accepted: 22 June 2020 / Published: 24 June 2020
(This article belongs to the Special Issue Ewing Sarcoma)
Intracranial Ewing sarcoma (EwS) is rare and publications on primary or metastatic intracranial EwS are minimal. The aim of this study was to describe incidence, clinical behavior, treatment, and factors associated with outcome in patients with primary intracranial EwS or patients with a primary extracranial EwS and cerebral metastases at diagnosis. We reviewed all patients with primary or with metastatic intracranial EwS at diagnosis registered in the International Clinical Trial Euro-E.W.I.N.G.99 (EE99). In total, 17 of 1435 patients (1.2%) presented with primary intracranial EwS; 3 of them had metastatic disease. Four patients (0.3%) with primary extracranial EwS presented with intracranial metastatic lesions. The 3-year event-free survival (EFS) was 64% and overall survival (OS) was 70% in patients with a primary intracranial EwS. Local control in patients with primary intracranial EwS consisted of surgery (6%), radiotherapy (RT) (18%), or both modalities (76%). Univariate analysis showed that patients < 15 years of age had significantly better outcome (EFS: 72%; OS: 76%) compared to those aged above 15 years (EFS: 13%; OS: 25%). In conclusion, primary intracranial EwS and extracranial EwS with cerebral metastases at diagnosis is rare, yet survival is comparable with local and metastatic EwS elsewhere in the body. Age and stage of disease are important prognostic factors. Besides chemotherapeutic treatment, local control with surgical resection combined with RT is recommended whenever feasible. View Full-Text
Keywords: Ewing sarcoma; intracranial; metastatic; outcome Ewing sarcoma; intracranial; metastatic; outcome
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Haveman, L.M.; Ranft, A.; van den Berg, H.; Klco-Brosius, S.; Ladenstein, R.; Paulussen, M.; Juergens, H.; Dirksen, U.; Merks, J.H. Primary and Metastatic Intracranial Ewing Sarcoma at Diagnosis: Retrospective International Study and Systematic Review. Cancers 2020, 12, 1675.

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