Current management of pulmonary relapse in Ewing sarcoma: A report from the Pediatric Surgical Oncology Research Collaborative
Bibliographic record
Abstract
Relapse occurs in 30-40% of patients with localized Ewing sarcoma (EWS). Our objective was to describe the current management and outcomes of patients with initially localized EWS who experience first pulmonary relapse. This multi-center retrospective cohort study included patients ≤22 years old with initially localized EWS treated from 2007 to 2020 at 19 Pediatric Surgical Oncology Research Collaborative institutions, who developed pulmonary relapse. Kaplan-Meier analysis was performed. Thirty-three patients with initially localized EWS developed pulmonary relapse at a median age of 17 (IQR 14;20) years. Eleven (33%) patients also had extra-pulmonary metastases (EPM) at relapse. Among the 22 (67%) patients with pulmonary-only relapse, 10 (45%) had solitary pulmonary nodules. Pulmonary metastasectomy was performed in 8 (80%) patients with solitary pulmonary-only metastases, 5 (42%) patients with multiple pulmonary-only metastases, and 2 (18%) patients who also had EPM. Whole lung irradiation was administered in 7 (70%) with solitary pulmonary-only metastases, 7 (58%) with multiple pulmonary-only metastases, and 2 (18%) with EPM. Rates of further pulmonary relapse/progression were similar between groups (p=0.97). In Kaplan-Meier analysis, 3-year overall survival was 73% with solitary pulmonary-only metastases, 40% with multiple pulmonary-only metastases, and 23% with EPM (p=0.097). While survival for patients with relapsed EWS is poor, the subset of patients with solitary relapse confined to the lung are often good candidates for pulmonary metastasectomy and have a non-statistically significant trend towards improved survival outcomes.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.005 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.001 | 0.003 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.003 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".