{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T11:06:51Z","timestamp":1791371211123,"version":"4.3.1"},"reference-count":25,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2024,1,25]],"date-time":"2024-01-25T00:00:00Z","timestamp":1706140800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["acsjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Cancer"],"published-print":{"date-parts":[[2024,5,15]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Local control for patients with Ewing sarcoma (EWS) who present with large tumors are suboptimal when treated with standard radiation therapy (RT) doses of 54\u201355.8\u00a0Gy. The purpose of this study is to determine local control and toxicity of dose\u2010escalated RT for tumors \u22658\u00a0cm (greatest diameter at diagnosis) in pediatric and young adult patients with EWS.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Eligible patients \u226430\u00a0years old with newly diagnosed EWS \u22658\u00a0cm treated with definitive conformal or intensity modulated photon, or proton radiation therapy techniques were included. All patients in the study received dose\u2010escalated RT doses. Outcomes included overall survival (OS), event\u2010free survival (EFS), local failure rates, and toxicity.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Thirty\u2010two patients were included, 20 patients presented with metastatic disease and 12 patients with localized disease. The median RT dose was 64.8\u00a0Gy (range, 59.4\u201369.4\u00a0Gy) with variability of doses to protect normal surrounding tissues. All patients received systemic chemotherapy. The 5\u2010year OS and EFS for the cohort was 64.2% and 42%, respectively. The 5\u2010year cumulative incidence of local failure was 6.6%. There were two combined local and distant failures with no isolated local failures. Twenty\u2010nine patients experienced short term toxicity, 90% of those being radiation dermatitis. Twenty\u2010seven patients experienced long\u2010term toxicity, with only one experiencing grade 4 toxicity, a secondary malignancy after therapy.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>This study demonstrates that definitive RT for pediatric and young adult patients with EWS \u22658\u00a0cm provides high rates of local control, while maintaining a tolerable toxicity profile.<\/jats:p><\/jats:sec>","DOI":"10.1002\/cncr.35196","type":"journal-article","created":{"date-parts":[[2024,1,25]],"date-time":"2024-01-25T13:00:17Z","timestamp":1706187617000},"page":"1836-1843","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":12,"title":["Radiation therapy dose escalation achieves high rates of local control with tolerable toxicity profile in pediatric and young adult patients with Ewing sarcoma"],"prefix":"10.1002","volume":"130","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2519-350X","authenticated-orcid":false,"given":"Marija","family":"Kacar","sequence":"first","affiliation":[{"name":"Department of Oncology St. Jude Children's Research Hospital  Memphis Tennessee USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7792-1252","authenticated-orcid":false,"given":"Margaret B.","family":"Nagel","sequence":"additional","affiliation":[{"name":"Department of Pediatrics UT Southwestern Medical Center Dallas  Dallas Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jia","family":"Liang","sequence":"additional","affiliation":[{"name":"Department of Biostatistics St. Jude Children's Research Hospital  Memphis Tennessee USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yimei","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Biostatistics St. Jude Children's Research Hospital  Memphis Tennessee USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael D.","family":"Neel","sequence":"additional","affiliation":[{"name":"Department of Surgery St. Jude Children's Research Hospital  Memphis Tennessee USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4139-4160","authenticated-orcid":false,"suffix":"Jr.","given":"John T.","family":"Lucas","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology St. Jude Children's Research Hospital  Memphis Tennessee USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2888-443X","authenticated-orcid":false,"given":"M. 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