Ewing Sarcoma in Nepal Treated With Combined Chemotherapy and Definitive Radiotherapy

Abstract

PURPOSE To our knowledge, we conducted the first prospective oncologic clinical trial in Nepal aimed at providing state-of-the-art chemotherapy to patients with Ewing sarcoma. The efficacy of external-beam radiotherapy (RT) as the sole local treatment modality was explored and deemed justified as a result of the lack of available advanced tumor-orthopedic services in Nepal. PATIENTS AND METHODS Twenty patients, 11 female and 9 male patients between the ages of 6 and 37 years, with newly diagnosed Ewing sarcoma were enrolled. Neoadjuvant combination chemotherapy, comprising well-established drug combinations, was administered in five courses before external-beam RT, during which one course of etoposide and ifosfamide was given. After RT, six additional chemotherapy courses were scheduled. RESULTS RT was tolerated well, providing rapid symptom relief and local tumor control, with no pathologic fractures observed among the 15 patients who received such treatment. Eleven patients completed the entire treatment protocol; seven patients were under continued follow-up, with no evidence of disease in six patients at a median follow-up time of 2.3 years (range, 1.3 to 3.1 years) and one patient alive but with a regional recurrence. Four patients experienced metastatic relapse and died as a result of their disease. Three treatment-related deaths linked to toxicity from chemotherapy occurred. Four of the six patients who refused to complete the treatment protocol and were lost to follow-up experienced progressive disease and were assumed dead. CONCLUSION This study was feasible with RT as the sole local treatment modality in combination with chemotherapy. As a result of the high number of patients lost to follow-up, no firm conclusions can be drawn, but the majority of the patients who completed treatment obtained durable long-term remissions.

Mapping Pediatric Oncology Clinical Trial Collaborative Groups on the Global Stage

“…Koirala Memorial Cancer Hospital in Nepal and Oslo University Hospital in Norway, executed the first prospective cancer clinical trial in Nepal using an adapted treatment regimen for EWS. 126 Although the study had a significant number of patients lost to follow-up, twinning demonstrated that international collaboration could improve patient outcomes. 126…”

“…126 Although the study had a significant number of patients lost to follow-up, twinning demonstrated that international collaboration could improve patient outcomes. 126…”

“…126 Although the study had a significant number of patients lost to follow-up, twinning demonstrated that international collaboration could improve patient outcomes. 126 The Eurasian Alliance in Pediatric Oncology, which was founded in 2018 in collaboration with SJCRH, includes 19 hospitals in Armenia, Azerbaijan, Belarus, Kazakhstan, Kyrgyzstan, Moldova, Mongolia, Russia, Tajikistan, Ukraine, and Uzbekistan. 127 Eurasian Alliance in Pediatric Oncology published a recent study on the integration of palliative care into pediatric oncology and has also developed coursework for the training of pediatric oncology nurses.…”

“…Koirala Memorial Cancer Hospital in Nepal and Oslo University Hospital in Norway, executed the first prospective cancer clinical trial in Nepal using an adapted treatment regimen for EWS. 126 Although the study had a significant number of patients lost to follow-up, twinning demonstrated that international collaboration could improve patient outcomes. 126 The Eurasian Alliance in Pediatric Oncology, which was founded in 2018 in collaboration with SJCRH, includes 19 hospitals in Armenia, Azerbaijan, Belarus, Kazakhstan, Kyrgyzstan, Moldova, Mongolia, Russia, Tajikistan, Ukraine, and Uzbekistan.…”

Proceedings of III South Florida Congress of Development

“…Identificar as formas de produção dos preconceitos, compreender seus efeitos e combater posicionamentos discriminatórios em relação às práticas corporais e aos seus participantes. 6. Interpretar e recriar os valores, os sentidos e os significados atribuídos às diferentes práticas corporais, bem como aos sujeitos que delas participam.…”