Long-lasting multiagent chemotherapy in adult high-risk Ewing’s sarcoma of bone

Abstract

The outcome of Ewing's sarcoma depends on the anatomical site of the tumor. Studies conducted in high-risk patients are limited. We evaluated the outcome of high-risk Ewing's sarcoma patients that received long-term treatment protocol. Twenty-five patients (22 males, 3 females) with poor prognostic features were treated according to long-term Ewing's sarcoma protocol. Central-axis localization, inadequacy or unavailability of surgical resection, older than 15 years of age, are accepted as high-risk factors. The median age of patients was 23 years (range, 18-55). The tumor localization was pelvis (9), femur (1), tibia (1), fibula (1), maxilla (1), clavicle (1), vertebrae (5), metatarse (1), and ribs (5). Neoadjuvant chemotherapy was applied between weeks 0 and 6, local therapy on week 9, and adjuvant maintenance chemotherapy between weeks 11 and 41. All patients received neoadjuvant and adjuvant maintenance chemotherapy. Local therapy consisted of radiotherapy (32%), surgery alone (12%), or surgery and radiotherapy (56%). The median total treatment period was 10 months. The median follow-up was 25 months (range, 7-89). Three-year cumulative OS and DFS rates were 43% (95% CI, 28.5-57.85) and 40% (95% CI 23.63-52.19), respectively. The most common grade III/IV toxicities observed during the treatment protocol were neutropenia (16%) and gastrointestinal toxicities (16%). Our study indicated that long-term multiagent combination chemotherapy may result in better outcome in adult high-risk patients undergoing adequate surgical resection of the tumor and local radiotherapy. Further randomized studies are needed to assess the efficacy of this treatment protocol in patients with adequate surgical margins.

A nomogram for determining the disease-specific survival in Ewing sarcoma: a population study

“…The long-term survival rate of ES for nonmetastatic disease at presentation has improved from 10 to 15% to 60–70% since the early 1990s through the application of multimodality approaches, including surgery, radiotherapy, and neoadjuvant chemotherapy [12, 22, 23]. However, ES exhibits an aggressive behavior that often results in lung metastasis, which is a poor prognostic factor given that only 20% of patients with metastases can survive for a long time [1, 2, 20].…”

A tool for predicting overall survival in patients with Ewing sarcoma: a multicenter retrospective study

“…However, no internationally recognized risk classification scheme for ES patients had been formed. For non-metastatic ES patients, the use of multiple treatment modalities such as surgery, radiotherapy and chemotherapy had increased long-term survival rates from 10%-15% to 60%-70% [ 13 , 14 ]. Temozolomide/irinotecan regimen proved to be the most effective, with 47% of ES patients in remission [ 15 ].…”

“…13 Orthopaedic Medical Center, The Second Hospital of Jilin University, Changchun 130000, China. 14 Neurology department, Xi'an jiaotong university 1st affiliated hospital, Xian 71000, China. 15 Faculty of Medicine, Macau University of Science and Technology, Macau 999078, China.…”

Multidisciplinary therapy including proton beam radiotherapy for a Ewing sarcoma family tumor of maxillary sinus in a 4‐year‐old girl

“…However, complete resection is occasionally unfeasible for ESFT of the head and neck because of possible functional and cosmetic side effects . In fact, various treatments have been performed for the 28 patients with localized ESFT of maxilla previously described (Table ). Of the 13 patients who underwent surgery, 11 also received chemotherapy, 4 also received both chemotherapy and radiotherapy, and 2 received no additional treatment.…”