Chemotherapy-induced tumor necrosis as a prognostic factor in localized Ewing's sarcoma of the extremities.

Picci, Piero; Böhling, Tom; Bacci, Gaetano; Ferrari, Stefano; Sangiorgi, Luca; Mercuri, Mario; Ruggieri, Pietro; Manfrini, Marco; Ferraro, A.; Casadei, Roberto; Benassi, M. S.; Mancini, Antonia; Rosito, P; Cazzola, Alberto; Barbieri, Enza; Tienghi, A.; Prever, A Brach del; Comandone, Alessandro; Bacchini, Patrizia; Bertoni, Franco

doi:10.1200/jco.1997.15.4.1553

Cited by 232 publications

(182 citation statements)

References 21 publications

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“…Although the histologic response to initial chemotherapy was among the most reliable predictive factors, 16,17,28,31,32 even with the limitation that tumors had to be resected to determine response, we also used simple radiographic evaluations based on changes in extraosseous tumor size. These evaluations also demonstrated sufficient predictive value.…”

Section: Discussionmentioning

confidence: 99%

Clinical outcome of patients with Ewing sarcoma family of tumors of bone in Japan

Obata

Ueda

Kawai

et al. 2007

Cancer

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BACKGROUND.Ewing sarcoma family of tumors (ESFT) of bone is extremely rare in Japan. The objectives of the current study were to assess the clinical outcome and prognostic factors of patients with ESFT of bone in Japan and to compare them between Euro‐American and Japanese populations.METHODS.The authors conducted a retrospective analysis of 243 patients who were treated for ESFT of bone in Japan between 1981 and 2003. Local therapy was surgery in 35% of patients, surgery combined with radiotherapy in 40% of patients, radiotherapy alone in 22% of patients, and no local treatment in 3% of patients. All but 3 patients received various regimens of multidrug chemotherapy.RESULTS.The median patient age was 16 years. The primary disease sites were the trunk in 53% of patients and the extremities in 47% of patients. Forty‐one patients had metastases at presentation. The median follow‐up was 66 months. A univariate survival analysis demonstrated that patients who had metastases at presentation, primary site in the trunk, age ≥16 years, tumor size ≥10 cm, tumor that responded poorly to induction chemotherapy, and local treatment with radiotherapy alone had a significantly worse event‐free survival (EFS). A multivariate analysis further verified that the former 3 factors were significant adverse prognostic factors. Of 201 patients with localized disease, 45 patients who received current chemotherapy regimens that included ifosfamide and etoposide had a significantly better 5‐year EFS rate (67.6%) compared with other patients.CONCLUSIONS.The clinical outcome of patients with localized ESFT of bone in Japan has improved markedly with the use of current chemotherapy regimens that include ifosfamide and etoposide and has become comparable to the outcomes observed in other major series of Euro‐American patients. The prognostic factors are also almost identical. Cancer 2007 © 2007 American Cancer Society.

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Section: Discussionmentioning

confidence: 99%

Clinical outcome of patients with Ewing sarcoma family of tumors of bone in Japan

Obata

Ueda

Kawai

et al. 2007

Cancer

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“…In addition, in patients with localised disease, poor histological response to chemotherapy (Picci et al, 1997;Bacci et al, 2000), tumour volume (Jürgens et al, 1988;Koscielniak et al, 1992;Ahrens et al, 1999), primary tumour site and age less than 15 years at diagnosis have been variably associated with adverse clinical outcome (Cotterill et al, 2000).…”

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confidence: 99%

Prognostic impact of chromosomal aberrations in Ewing tumours

et al. 2002

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Although greater than 50% of Ewing tumours contain non-random cytogenetic aberrations in addition to the pathognomonic 22q12 rearrangements, little is known about their prognostic significance. To address this question, tumour samples from 134 Ewing tumour patients were analysed using a combination of classical cytogenetics, comparative genomic and fluorescence in situ hybridisation. The evaluation of the compiled data revealed that gain of chromosome 8 occurred in 52% of Ewing tumours but was not a predictive factor for outcome. Gain of 1q was associated with adverse overall survival and event-free survival in all patients, irrespective of whether the tumour was localised or disseminated (overall survival: P=0.002 and P=0.029; eventfree survival: P=0.018 and P=0.010). Loss of 16q was a significant predictive factor for adverse overall survival in all patients (P=0.008) and was associated with disseminated disease at diagnosis (P=0.039). Gain of chromosome 12 was associated with adverse event-free survival (P=0.009) in patients with localised disease. These results indicate that in addition to a 22q12 rearrangement confirmation in Ewing tumours it is important to assess the copy number of 1q and 16q to identify patients with a higher probability of adverse outcome.

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“…An EFS of 70% was achieved for patients with localized disease, and OS reached 80%. [4][5][6][7][8][17][18][19][20][21] The outcome of metastatic patients remains dismal, especially for patients with bone and BM involvement. [4][5][6][9][10][11] Rodriguez Galindo et al 23 suggested risk stratification, taking into account simple clinical features, such as age, stage, tumor volume, localization and histological response to chemotherapy, to modulate treatment intensification in different subgroups.…”

Section: Discussionmentioning

confidence: 99%

“…[1][2][3] In the past decade, ESFT outcome was improved largely through a multidisciplinary strategy based on surgery, radiotherapy and intensified chemotherapy regimens, [4][5][6] whereas large studies have identified risk factors associated with the worse prognosis. [4][5][6][7][8] Since the late 1980s, high-dose chemotherapy (HDC), followed by stem-cell rescue, has been proposed to improve the outcome of patients with poor-prognosis ESFT. Although many studies have been published, the role of HDC in ESFT remains unclear.…”

Section: Introductionmentioning

confidence: 99%

Toxicity of high-dose chemotherapy with etoposide, thiotepa and CY in treating poor-prognosis Ewing's sarcoma family tumors: the experience of the Bambino Gesù Children's Hospital

Ilari

Ioris

Milano³

et al. 2010

Bone Marrow Transplant

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We report the toxicity of high-dose chemotherapy (HDC) based on etoposide, thiotepa and CY (ETC) in children with poor-prognosis Ewing's sarcoma family tumors (ESFTs). A total of 26 patients with high-risk ESFT (metastasis or axis localization or tumor volume 4200 ml or necrosis o95%) were reviewed. The conditioning was based on etoposide (600 mg/m 2 ), thiotepa (750 mg/m 2 ) and CY (120 mg/kg) followed by autologous BM or PBSC rescue. The conditioning regimen was well tolerated, without any toxic deaths. The median time from transplant to a neutrophil count of 40.5 Â 10 9 /l was 10 days (range 6-27) and 22.5 days (range 9-114) for a plt count of 450 Â 10 9 /l. Oral mucositis was recorded in 20 patients, grade 1/2 in 19 and grade 3 in the last patient. Diarrhea grade 1/2 was recorded in four patients and grade 1/2 liver toxicity in four patients. Sepsis was documented in four cases and skin toxicity in three. Lung and tubular toxicity, respectively, were reported in one patient each. We conclude that the ETC regimen presented a limited and manageable toxicity. Further studies would confirm the role of ETC in high-risk ESFT.

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Chemotherapy-induced tumor necrosis as a prognostic factor in localized Ewing's sarcoma of the extremities.

Cited by 232 publications

References 21 publications

Clinical outcome of patients with Ewing sarcoma family of tumors of bone in Japan

Clinical outcome of patients with Ewing sarcoma family of tumors of bone in Japan

Prognostic impact of chromosomal aberrations in Ewing tumours

Toxicity of high-dose chemotherapy with etoposide, thiotepa and CY in treating poor-prognosis Ewing's sarcoma family tumors: the experience of the Bambino Gesù Children's Hospital

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