Abstract
Objectives. To assess the clinical features and local control (LC) outcomes in adult patients with localized Ewing Sarcoma (ES). Methods. The records of 102 ES patients with localized disease ≥18 years of age seen from 1977 to 2007 were reviewed. Factors relevant to prognosis, survival, and LC were analyzed. Results. The 5-year overall survival (OS) and event-free survival (EFS) were 60% and 52%, respectively, for the entire cohort. Treatment era (1977–1992 versus 1993–2007) remained an independent prognostic factor for OS on multivariate analysis, with improved outcomes observed in the 1993–2007 era (P = 0.02). The 5-year OS and EFS for the 1993–2007 era were 73% and 60%, respectively. Ifosfamide and etoposide based chemotherapy and surgery were more routinely used in the 1993–2007 era (P < 0.01). The 5-year local failure rate (LFR) was 14%, with a 5-year LFR of 18% for surgery, 33% for radiation, and 0% for combined surgery and radiation in the 1993–2007 era (P = 0.17). Conclusion. Modern survival outcomes for adults with localized ES are similar to multi-institutional results in children. This improvement over time is associated with treatment intensification with chemotherapy and increased use of surgery. Aggressive LC (combined surgery and radiation) may improve outcomes in poor prognosis patients.
Highlights
The combination of chemotherapy and local control (LC) has significantly improved outcomes for Ewing Sarcoma (ES) [1,2,3,4,5]
A few studies have reported on adult ES patients, and most of them had small patient populations and/or included patients
Reports in the literature regarding how adults fare in comparison to children are conflicting, with a few studies concluding that prognosis in adults is inferior compared to children [12, 13] and others stating no difference in outcomes between the populations [11, 14]
Summary
The combination of chemotherapy and local control (LC) has significantly improved outcomes for Ewing Sarcoma (ES) [1,2,3,4,5]. Five-year survival rates up to 78% have been achieved in children with localized disease since the addition of ifosfamide and etoposide (IE) chemotherapy [6]. Historically LC has been problematic, especially in pelvic and axial sites, recent multicenter pediatric trials demonstrate significant improvements in LC with surgery the preferred modality when feasible [6,7,8]. Despite growing literature evaluating the treatment effectiveness in pediatric patients, data assessing outcomes of currently utilized therapy in adults is scarce. This study was designed to evaluate prognostic factors for survival and LC in 102 adult ES patients ≥18 years with localized disease over a 30-year period
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