26 & 27th March 2007, Belfry Hotel, West Midlands

Why have a meeting about local control issues?
Since the results of the European Intergroup Cooperative Ewing's Sarcoma Study (EICESS 92) were released, it became clear that the treatment of Ewing’s Sarcoma was not uniform throughout Europe. Although the tumour was treated with the same chemotherapy regime, the local treatment of the tumour (ie surgery, radiotherapy or a combination of both), was very different between the German/Dutch/Austrian Group and the UK group. The results of the study showed that the overall survival of patients was better in the German group compared to the UK group (5 year survival was 66% vs 54%) and the rate of locally recurrent disease was higher in the UK group. It became clear that the UK group tended to favour either radiotherapy or surgery for the local control of the tumour, whereas the German group more frequently used a combination of surgery and radiotherapy. It was felt that a meeting should be organised to discuss the treatment rationale of Ewing’s and try to come to an International consensus on the best practice treatment of Ewing’s sarcoma.

Where and how was the meeting organised?
The meeting was held at the Belfry Hotel in the West Midlands, due to its transport links and its central location. In total 67 delegates attended from 11 countries throughout Europe and North America. The majority of the cost of the meeting was sponsored by the Bone Cancer Research Trust, together with a smaller contribution from Stanmore Implants Worldwide and Depuy (2 Orthopaedic implant manufacturers). Each country brought a team consisting of at least a surgeon, an oncologist and a radiotherapist, although some teams brought experts in Radiology, Statistics, Pathology and Pharmacology. The United Kingdom and Germany had the largest number of delegates (20 and 9 respectively). The UK group had representatives from the major treating centres including Birmingham, Leeds, Manchester, Newcastle and London.
The meeting was split into 3 sections:-

1. Presentation of national results and local treatment philosophy
2. Case Discussions with opinion capture using electronic voting systems
   • Each team submitted details of cases including radiological investigation (x-rays and MRIs). These cases were used to illustrate different location and types of disease pattern. The audience then voted both individually and in teams, using an electronic voting system, on how they would treat the illustrated case, in a series of hypothetical scenarios.
3. Consensus gathering and future direction.

What were the results of the meeting?
The meeting found that within the UK our treatment rationale has not been uniform throughout the UK and our centres tended towards treating conditions with surgery or radiotherapy. Other countries, notably the Germans, had a very consistent and aggressive approach to the local treatment of Ewing’s sarcoma. They would often favour post operative radiotherapy, even after good surgical margins and a good response to chemotherapy.
A number of controversies still were evident, such as how to define surgical margins and whether the functional loss associated with such aggressive treatment is justified. However, a number of consensus statements were agreed:-

1. Ewing's of the limb should generally be treated by limb salvage surgery +/- radiotherapy
2. Poor surgical margins & poor histological necrosis require post operative radiotherapy
3. Local treatment for Ewing's is site specific
4. Patient with Ewing's and pulmonary metastases should be treated as aggressively as patients with local disease only
5. Results of radiotherapy alone are generally inferior to that of surgery +/-radiotherapy
6. There is a role for centralised treatment planning within the UK

It was agreed that in future we should:-

1. Provide consensus statements of both agreements and disagreements of the meeting in a scientific paper
2. Provide a report of the results to the delegates
3. Agree to merge previously collected data that was presented at the meeting
4. Agree to collect a 20 point data set prospectively, including functional outcomes, internationally to monitor outcomes for Ewing’s, with an international steering committee set up to oversee the process.
5. Within the UK form a national advisory group, possibly with international links about the best way to treat Ewing’s.

How well was the meeting received?
The meeting was universally well appraised and the majority of delegates (87%) would consider changing their practice, as a result of the discussions at the meeting. There has been considerable enthusiasm for a future meeting. The organising committee would like to say a big thank you for the support of the Bone Cancer Research Trust before, during and after the meeting. We hope this meeting will lead to major improvements in the treatment of Ewing’s sarcoma both within the UK and internationally.