Impact of treatment protocol on outcome of localized Ewing’s sarcoma

Abstract

Background: The outcome of localized Ewing′s sarcoma has improved with multi-disciplinary approach. Survivals of Ewing′s sarcoma from the Asian countries differed between centers. ^Methods: We retrospectively analyzed the records of newly diagnosed localized Ewing′s sarcoma patients from 2002 to 2012. The patients were analyzed in three groups; Group 1(2002-2004) who received non-ifosfomide based regimens, Group 2(2005-2008) who received VDC/IE for 12 cycles, and Group 3(2009-2012), who received VDC/IE for 17 cycles. The groups were compared for their baseline characteristics, treatment protocol and outcome. Results: Seventy three patients were included in the study. The median age of presentation was 15 years, with slight male predominance. Axial primary was seen in 62%. The median RFS of the three groups was 26.4, 31.4 and 36.8 months respectively (P = 0.0018). The median OS was 27.9, 35 and 43 months respectively (P = 0.0007). At a median follow-up of 35 months, the 3 year RFS and OS for the three treatment groups were 17%, 31%, 60% and 35%, 45% and 70% respectively. Larger tumor size, axial primary, high LDH were associated with poorer survival. Radiotherapy was associated with inferior local control and survival. Conclusions: We found that the survival of our ESFT patients improved over time with intensified multiagent chemotherapy and with lesser time to local therapy. But the results were still inferior to those reported in literature. We had majority of patients presenting in axial site and radiotherapy as the predominant mode of local control. The outcome may further improve with surgery as local control procedure.

Key words

Localized Ewing′s sarcoma - locoregional therapy - multiagent chemotherapy

Publication History

Article published online:
28 December 2020

• References

• 1 Esiashvili N, Goodman M, Marcus RB Jr. Changes in incidence and survival of Ewing sarcoma patients over the past 3 decades: Surveillance Epidemiology and End Results data. J Pediatr Hematol Oncol 2008;30:425-30.
• 2 Krasin MJ, Davidoff AM, Rodriguez-Galindo C, Billups CA, Fuller CE, Neel MD, et al. Definitive surgery and multiagent systemic therapy for patients with localized Ewing sarcoma family of tumors: Local outcome and prognostic factors. Cancer 2005;104:367-73.
• 3 Rodríguez-Galindo C, Liu T, Krasin MJ, Wu J, Billups CA, Daw NC, et al. Analysis of prognostic factors in Ewing sarcoma family of tumors: Review of St. Jude Children′s Research Hospital studies. Cancer 2007;110:375-84.
• 4 Obata H, Ueda T, Kawai A, Ishii T, Ozaki T, Abe S, et al. Clinical outcome of patients with Ewing sarcoma family of tumors of bone in Japan: The Japanese Musculoskeletal Oncology Group cooperative study. Cancer 2007;109:767-75.
• 5 Ahmed SK, Robinson SI, Okuno SH, Rose PS, Laack NN. Adult Ewing sarcoma: Survival and local control outcomes in 102 patients with localized disease. Sarcoma 2013;2013:681425.
• 6 Grier HE, Krailo MD, Tarbell NJ, Link MP, Fryer CJ, Pritchard DJ, et al. Addition of ifosfamide and etoposide to standard chemotherapy for Ewing′s sarcoma and primitive neuroectodermal tumor of bone. N Engl J Med 2003;348:694-701.
• 7 Schuck A, Ahrens S, Paulussen M, Kuhlen M, Könemann S, Rübe C, et al. Local therapy in localized Ewing tumors: Results of 1058 patients treated in the CESS 81, CESS 86, and EICESS 92 trials. Int J Radiat Oncol Biol Phys 2003;55:168-77.