Preoperative Radiotherapy in Patients With Localized Ewing Sarcoma Enrolled on AEWS1031: A Report From the Children's Oncology Group

Daniel J Indelicato¹, Alexandra K Callan², Safia K Ahmed³, Mark Krailo⁴, Natalie DelRocco⁴, Allen B Buxton⁵, Odion T Binitie⁶, Alexander B Christ⁷, Sandy Kessell⁸, Paul J Chuba⁹, Helen R Nadel¹⁰, Bruce R Pawel¹¹, Richard Gorlick¹², Damon R Reed¹³, Steven G DuBois¹⁴, Katherine A Janeway¹⁴, Patrick Leavey¹⁵, Leo Mascarenhas¹⁶, Nadia N Laack¹⁷

Affiliations

¹ Department of Radiation Oncology, University of Florida College of Medicine, Jacksonville, Florida, USA.
² Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
³ Department of Radiation Oncology, Mayo Clinic, Phoenix, Arizona, USA.
⁴ Department of Population and Public Health Science Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California, USA.
⁵ Children's Oncology Group, Monrovia, California, USA.
⁶ Department of Sarcoma, H. Lee Moffitt Cancer Center, Tampa, Florida, USA.
⁷ Department of Orthopedic Surgery, University of California at Los Angeles, San Monica, California, USA.
⁸ Imaging and Radiation Oncology Core, Lincoln, Rhode Island, USA.
⁹ Department of Radiation Oncology, Ascension Webber Cancer Center, Warren, Michigan, USA.
¹⁰ Department of Pediatric Radiology, Stanford University School of Medicine, Stanford, California, USA.
¹¹ Department of Pathology, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, California, USA.
¹² Department of Pediatrics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
¹³ Department of Individualized Cancer Management, H. Lee Moffitt Cancer Center, Tampa, Florida, USA.
¹⁴ Department of Pediatrics, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, Massachusetts, USA.
¹⁵ Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
¹⁶ Division of Pediatric Hematology/Oncology Pediatrics, Cedars-Sinai, Los Angeles, California, USA.
¹⁷ Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota, USA.

PMID: 40415235
PMCID: PMC12187527 (available on 2026-08-01)
DOI: 10.1002/pbc.31820

Multicenter Study

Preoperative Radiotherapy in Patients With Localized Ewing Sarcoma Enrolled on AEWS1031: A Report From the Children's Oncology Group

Daniel J Indelicato et al. Pediatr Blood Cancer. 2025 Aug.

. 2025 Aug;72(8):e31820.

doi: 10.1002/pbc.31820. Epub 2025 May 25.

Authors

Affiliations

¹ Department of Radiation Oncology, University of Florida College of Medicine, Jacksonville, Florida, USA.
² Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
³ Department of Radiation Oncology, Mayo Clinic, Phoenix, Arizona, USA.
⁴ Department of Population and Public Health Science Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California, USA.
⁵ Children's Oncology Group, Monrovia, California, USA.
⁶ Department of Sarcoma, H. Lee Moffitt Cancer Center, Tampa, Florida, USA.
⁷ Department of Orthopedic Surgery, University of California at Los Angeles, San Monica, California, USA.
⁸ Imaging and Radiation Oncology Core, Lincoln, Rhode Island, USA.
⁹ Department of Radiation Oncology, Ascension Webber Cancer Center, Warren, Michigan, USA.
¹⁰ Department of Pediatric Radiology, Stanford University School of Medicine, Stanford, California, USA.
¹¹ Department of Pathology, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, California, USA.
¹² Department of Pediatrics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
¹³ Department of Individualized Cancer Management, H. Lee Moffitt Cancer Center, Tampa, Florida, USA.
¹⁴ Department of Pediatrics, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, Massachusetts, USA.
¹⁵ Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
¹⁶ Division of Pediatric Hematology/Oncology Pediatrics, Cedars-Sinai, Los Angeles, California, USA.
¹⁷ Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota, USA.

PMID: 40415235
PMCID: PMC12187527 (available on 2026-08-01)
DOI: 10.1002/pbc.31820

Abstract

Patients with resectable Ewing sarcoma (ES) in select sites, such as the pelvis or chest wall, have a higher risk of positive microscopic margins following surgery. AEWS1031 was the first North American/Australasia ES cooperative group trial allowing standardized preoperative radiotherapy, intended to minimize the morbidity of combined modality local tumor control as well as improve the likelihood of clear surgical margins. In this study, we found that the use of low-dose preoperative radiation to a smaller target volume resulted in a high rate of R0 resection. The robust pathologic response rate strengthens existing evidence illustrating the radiosensitivity of Ewing sarcoma.

Keywords: Ewing sarcoma; NCTN; cooperative group; preoperative.

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Conflict of interest statement

SGD reports consulting fees from Amgen, Bayer, InhibRx, and Jazz and travel expenses from Loxo, Roche, and Salarius. All remaining authors report no conflicts of interest.

References

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Preoperative Radiotherapy in Patients With Localized Ewing Sarcoma Enrolled on AEWS1031: A Report From the Children's Oncology Group

Affiliations

Preoperative Radiotherapy in Patients With Localized Ewing Sarcoma Enrolled on AEWS1031: A Report From the Children's Oncology Group

Authors

Affiliations

Abstract

Conflict of interest statement

References

Publication types

MeSH terms

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