Alternative Chemotherapy Schedules in Ewing's Sarcoma: An Indian Perspective

Abstract

AbstractAdvances in the treatment of Ewing's sarcoma family of tumors (ESFTs) are a result of improvements in systemic and local therapies. VACA (vincristine, Adriamycin [doxorubicin], cyclophosphamide, dactinomycin) chemotherapy alone versus VACA + IE (VACA with alternate ifosfamide, etoposide) improve survival, but this regimen cannot be given to all patients due to poor tolerance and 5-day schedule chemotherapy in VACA + IE schedule. We reviewed the records of 50 patients treated as per our institutional protocols from 2007 to 2011. Two schedules of chemotherapy followed were vincristine, Adriamycin, cyclophosphamide (VAC) and VAC with alternate ifosfamide, etoposide (VAC + IE). Factors predictive of local failure and distant recurrence were analyzed. A total of 50 patients were analyzed. The median age at diagnosis was 14 years. Thirty-two patients were male, whereas 18 were female. Approximately, 95% of the patients relapsed after a median time gap of 1.6 years. The median 5-year disease-free survival was 30%. Systemic treatment with VAC or VAC + IE–based chemotherapy had equal local control and distant control rates. Smaller tumors had a better local control and lesser systemic failure than those of larger sizes. Successful treatment of Ewing's sarcoma requires optimal systemic and local therapy. Both the chemotherapy regimens showed equal survival rates. Control of both the local and distant diseases is a result of the combined modality approach. Stage at presentation is the most important factor for prognosis. Complete surgery and local radiotherapy are important predictive factors for local and systemic control.