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

Indelicato DJ, Callan AK, Ahmed SK, Krailo M, DelRocco N, Buxton AB, Binitie OT, Christ AB, Kessell S, Chuba PJ, Nadel HR, Pawel BR, Gorlick R, Reed DR, DuBois SG, Janeway KA, Leavey P, Mascarenhas L, Laack NN. Preoperative Radiotherapy in Patients With Localized Ewing Sarcoma Enrolled on AEWS1031: A Report From the Children’s Oncology Group. Pediatr Blood Cancer. 2025 Aug;72(8):e31820. doi: 10.1002/pbc.31820. Epub 2025 May 25. PMID: 40415235; PMCID: PMC12187527.

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.