The Predictive Potential of Molecular Detection in the Nonmetastatic Ewing Family of Tumors

Smadar Avigad*, Ian J. Cohen, Julia Zilberstein, Ella Liberzon, Yacov Goshen, Shifra Ash, Isaac Meller, Yehuda Kollender, Josephine Issakov, Rina Zaizov, Isaac Yaniv

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


BACKGROUND. Tumors in the Ewing family (EFTs) are the second most common bone tumors in children and adolescents. Despite aggressive chemotherapy, one-third of patients with localized tumor still may develop recurrences. This implies that not all tumor cells are eradicated and that the patients may have a level of residual disease, EFTs are characterized by specific chromosomal translocations that result in chimeric transcripts that can be detected with reverse transcriptase-polymerase chain reaction (RT-PCR) analysis. METHODS. The authors report the prognostic potential of the positive chimeric transcript (EWS/FLI1) in bone marrow (BM) and/or peripheral blood (PBL) in 26 patients with EFT during a long follow-up period (median, 61 months). RESULTS. At diagnosis, 43% of patients had positive RT-PCR BM results, with no correlation to tumor progression (P = 0.3). During follow-up, 58% of patients had positive RT-PCR results in their last sample analyzed (BM and/or PBL). A highly significant correlation between the presence of the chimeric transcript and disease progression was detected (P = 0.0028). In a multivariate analysis, the percentage of tumor necrosis (P = 0.007) and RT-PCR results during follow-up (P = 0.02) remained significant prognostic markers. In 10 of 11 patients who developed disease progression, BM and/or PBL samples were positive for the chimeric transcript before evidence of overt clinical recurrence. CONCLUSIONS. Occult tumor cells in BM and/or PBL samples during long follow-up are strong predictors of recurrent disease in patients with nonmetastatic EFTs.

Original languageEnglish
Pages (from-to)1053-1058
Number of pages6
Issue number5
StatePublished - 1 Mar 2004


  • Chimeric transcript
  • Ewing sarcoma
  • Prediction
  • Recurrence


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