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@ARTICLE{Kersting:276914,
      author       = {J. Kersting$^*$ and A. Ranft$^*$ and V. Bhadri and B.
                      Brichard and S. Collaud and S. Cyprová and H. Eich and T.
                      Ek and H. Gelderblom and J. Hardes$^*$ and L. Haveman and W.
                      Hartmann and P. Hauser and P. Heesen and H. Jürgens and J.
                      Kanerva and T. Kühne and A. Raciborska and J. Rascon and V.
                      Rechl and A. Streitbürger$^*$ and B. Timmermann$^*$ and Y.
                      Uhlenbruch and U. Dirksen$^*$},
      title        = {{E}ffect of {R}adiotherapy {D}ose on {O}utcome in
                      {N}onmetastatic {E}wing {S}arcoma.},
      journal      = {Advances in radiation oncology},
      volume       = {8},
      number       = {4},
      issn         = {2452-1094},
      address      = {Amsterdam},
      publisher    = {Elsevier},
      reportid     = {DKFZ-2023-01207},
      pages        = {101269},
      year         = {2023},
      abstract     = {Radiation therapy (RT) is an integral part of Ewing sarcoma
                      (EwS) therapy. The Ewing 2008 protocol recommended RT doses
                      ranging from 45 to 54 Gy. However, some patients received
                      other doses of RT. We analyzed the effect of different RT
                      doses on event-free survival (EFS) and overall survival (OS)
                      in patients with EwS.The Ewing 2008 database included 528
                      RT-admitted patients with nonmetastatic EwS. Recommended
                      multimodal therapy consisted of multiagent chemotherapy and
                      local treatment consisting of surgery $(S\&RT$ group) and/or
                      RT (RT group). EFS and OS were analyzed with uni- and
                      multivariable Cox regression models including known
                      prognostic factors such as age, sex, tumor volume, surgical
                      margins, and histologic $response.S\&RT$ was performed in
                      332 patients $(62.9\%),$ and 145 patients $(27.5\%)$
                      received definitive RT. Standard dose ≤ 53 Gy (d1) was
                      admitted in $57.8\%,$ high dose of 54 to 58 Gy (d2) in
                      $35.5\%,$ and very high dose ≥ 59 Gy (d3) in $6.6\%$ of
                      patients. In the RT group, RT dose was d1 in $11.7\%,$ d2 in
                      $44.1\%,$ and d3 in $44.1\%$ of patients. Three-year EFS in
                      the $S\&RT$ group was $76.6\%$ for d1, $73.7\%$ for d2, and
                      $68.2\%$ for d3 (P = .42) and in the RT group $52.9\%,$
                      $62.5\%,$ and $70.3\%$ (P = .63), respectively.
                      Multivariable Cox regression revealed age ≥ 15 years
                      (hazard ratio [HR], 2.68; $95\%$ confidence interval [CI],
                      1.63-4.38) and nonradical margins (HR, 1.76; $95\%$ CI,
                      1.05-2.93) for the $S\&RT$ group (sex, P = .96; histologic
                      response, P = .07; tumor volume, P = .50; dose, P = .10) and
                      large tumor volume (HR, 2.20; $95\%$ CI, 1.21-4.0) for the
                      RT group as independent factors (dose, P = .15; age, P =
                      .08; sex, P = .40).In the combined local therapy modality
                      group, treatment with higher RT dose had an effect on EFS,
                      whereas higher dose of radiation when treated with
                      definitive RT was associated with an increased OS.
                      Indications for selection biases for dosage were found.
                      Upcoming trials will assess the value of different RT doses
                      in a randomized manner to control for potential selection
                      bias.},
      cin          = {ED01},
      ddc          = {610},
      cid          = {I:(DE-He78)ED01-20160331},
      pnm          = {899 - ohne Topic (POF4-899)},
      pid          = {G:(DE-HGF)POF4-899},
      typ          = {PUB:(DE-HGF)16},
      pubmed       = {pmid:37334316},
      pmc          = {pmc:PMC10276219},
      doi          = {10.1016/j.adro.2023.101269},
      url          = {https://inrepo02.dkfz.de/record/276914},
}