Impact of Abdominopelvic CT on Ewing Sarcoma Management

Dobbs, Matthew D.; Lowas, Stefanie R.; Hernanz-Schulman, Marta; Holt, Ginger E.; Yu, Chang; Kan, J. Herman

doi:10.1016/j.acra.2010.06.010

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Volume 17, Issue 10 , Pages 1288-1291, October 2010

Impact of Abdominopelvic CT on Ewing Sarcoma Management

Matthew D. Dobbs, MD
- Department of Radiology and Radiological Sciences, Vanderbilt University, 1161 21st Avenue South, CCC-1121 Medical Center North, Nashville, TN 37232
- Address correspondence to: M.D.D.
Stefanie R. Lowas, MD
- Department of Pediatric Hematology-Oncology, Vanderbilt University, 1161 21st Avenue South, CCC-1121 Medical Center North, Nashville, TN 37232
Marta Hernanz-Schulman, MD
- Department of Radiology and Radiological Sciences, Vanderbilt University, 1161 21st Avenue South, CCC-1121 Medical Center North, Nashville, TN 37232
Ginger E. Holt, MD
- Department of Orthopedic Oncology, Vanderbilt University, 1161 21st Avenue South, CCC-1121 Medical Center North, Nashville, TN 37232
Chang Yu, PhD
- Department of Biostatistics, Vanderbilt University, 1161 21st Avenue South, CCC-1121 Medical Center North, Nashville, TN 37232
J. Herman Kan, MD
- Department of Radiology and Radiological Sciences, Vanderbilt University, 1161 21st Avenue South, CCC-1121 Medical Center North, Nashville, TN 37232

Received 12 April 2010; accepted 10 June 2010. published online 16 July 2010.

Rationale and Objectives

Abdominopelvic computed tomography (APCT) is often performed in patients with skeletal Ewing sarcoma family of tumors during initial staging and for subsequent clinical indications, such as metastasis surveillance; however, its clinical impact is unknown. The purpose of this study was to evaluate whether these computed tomographic examinations alter oncologic management and therefore patient outcomes.

Materials and Methods

One hundred eight consecutive patients with skeletal Ewing sarcoma family of tumors seen from 1985 to 2008 were retrospectively reviewed to identify imaging workup, pathology, primary site, evidence of metastatic disease, and patient outcomes. Data were analyzed using Wilcoxon's rank sum tests.

Results

Sixty-five of the 108 patients (60%) underwent 342 abdominopelvic computed tomographic examinations during a mean follow-up period of 8.9 years. During this time period, only one of the 65 patients (1.5%) who underwent APCT was discovered to have abdominal metastatic disease. There was no significant difference in the incidence of metastatic disease to the skeleton or chest between the groups without and with APCT (P = .10). There were 26 pelvic and lumbosacral primaries (24%) and 82 limb primaries (76%). Subgroup analysis performed on the 82 patients with limb primaries without (n = 36) and with (n = 46) APCT showed no significant differences in metastatic incidence to the skeleton or chest (P = .14).

Conclusions

This study indicates that APCT, associated with increased radiation exposure and health expenditure, has a limited role in initial staging and follow-up in patients with skeletal Ewing sarcoma, particularly in patients with limb primaries.

Key Words: Ewing sarcoma, musculoskeletal, oncology, radiation, pediatric