The INDICATES study

INDIvidualized loCAl Therapy for Ewing Sarcoma (INDICATES):
a new clinical prediction tool

Background

Ewing sarcoma (EwS) is an aggressive form of bone cancer that primarily affects children and adolescents. In addition to chemotherapy, a well-chosen local therapy (LT: surgery, radiotherapy or both) is very important to achieve good survival. Different options have significant implications not only for potentially decades-long survival, but also for quality of life in both the short and very long term. Currently, LT planning is based on the recommendations of a multidisciplinary team (MDT) that takes into account characteristics and preferences of the individual patient. However there is no unified consensus on the course of action to follow.

Aims

This study employs advanced statistical methods to assist the MDT in the decision-making process on INDIvidualized loCAl Therapy for patients with Ewing Sarcoma (INDICATES).

Based on a large multicentre international retrospective database, the project will develop a dynamic model that predicts and updates each patient's survival rate at any time during and after treatment, taking into account individual information recorded during follow-up. Since prediction models usually require detailed data and produce complex results, an ultimate goal is to facilitate the practical use of the developed tool for stakeholders through a user-friendly app interface.

The INDICATES app will be publicly available and thus usable by all patients, hospitals, care providers and hospital centres. Caregivers together with the patient should discuss the results to better weigh which therapy leads to the best survival. In this way, the MDT and patient can then take into account the possible late effects of each therapy, balancing both prognosis and quality of life.

Relevance for cancer research

Given the young age of patients, it is of utmost importance to provide them with personalised care, balancing the different treatment options and the preferences of patient and parents. Since no prediction tools are available for EwS, the INDICATES app will represent a great novelty for the EwS community.

INDICATES will enable practitioners to give more informed advice and, more importantly, patients will soon be able to evaluate with them which therapy is best for them. Using patient and tumour characteristics, the INDICATES app will dynamically predict the impact of different LT strategies on long-term survival, providing more information for patients and MDTs in the shared decision-making process. This will allow continuous monitoring of treatment effectiveness and facilitate communication between patients and physicians. The ultimate goal of INDICATES is to stimulate better treatment, ensuring that patients with EwS receive personalised care, where the risks and benefits of different LT options/combinations and patient preferences are balanced.

Scientific Personnel

Prof.dr. M. Fiocco - Project Leader
Mathematical Institute of Leiden University, Leiden University Medical Center (Biomedical Data Sciences) & Princess Máxima Center for Pediatric Oncology
Prof.dr. M.A.J. van de Sande - Principal Investigator
Leiden University Medical Center (Orthopaedic Surgery) & Princess Máxima Center for Pediatric Oncology
Dr. M. Spreafico - Principal Investigator
Mathematical Institute of Leiden University & Leiden University Medical Center (Biomedical Data Sciences)
Prof.dr. J.H.M. Merks
Princess Máxima Center for Pediatric Oncology & University Medical Center Utrecht
Prof.dr. H. Gelderblom
Leiden University Medical Center (Medical Oncology)
T. Yan
PhD candidate at Mathematical Institute of Leiden University

Participating Centers

The INDICATES study is possible thanks to the collaboration of several international centers. Click here for the list of participating centers.

Are you interested in joining INDICATES?

The primary contact person is dr. Marta Spreafico, Assistant Professor in Medical Statistics at the Mathematical Institute of Leiden University and Researcher at the Leiden Univeristy Medical Center (Biomedical Data Sciences).
E-mail: m.spreafico@math.leidenuniv.nl

Funding

The project "INDICATES - INDIvidualized loCAl Therapy for Ewing Sarcoma: a new clinical prediction tool" is funded by KWF Kankerbestrijding [development research grant 2023-3; consortia project 15461].