Outcomes of Ewing sarcoma in adults over 40 years of age from a low-middle income country.

Goutam Panda,Vanita Noronha,Vijay Patil,Shasanka Das,Smruti Mokal,Sujay Srinivas,Jyoti Bajpai,Arun Chandrasekharan,Prabhat Bhargava,Shripad D Banavali,Bharat Rekhi,Kumar Prabhash,Nehal Khanna,Amit Joshi,Sudeep Gupta,Nandini Menon,Siddhartha Laskar

doi:10.3332/ecancer.2022.1361

Abstract

IntroductionThe data on outcomes and toxicity in adult Ewing sarcoma (ES) patients, particularly those aged ≥40 years, is exceedingly scarce around the world, particularly in low- and middle-income countries (LMICs) and mandates research.MethodsThe study involved histologically ascertained ES patients aged ≥40 years who registered at our institute from 2013 to 2018. Prospectively collected data were analysed for overall survival (OS), event-free survival (EFS) and chemotherapy-related toxicities.ResultsThere were 66 patients, of which 34 were non-metastatic, and 32 were denovo metastatic, recurrent or had doubtful metastasis. At presentation, median age was 46 years, and 42 (63.6%) had extra-skeletal primary and 24 (36.3%) had extremity tumours. Curative treatment was offered to 40 (60.6%) patients. Significant grade 3/4 toxicities in non-metastatic and metastatic cohort, respectively, were febrile neutropenia (61.3%, 37.5%), anaemia (58.1%, 37.5%), thrombocytopenia (45.2%, 25.0%), peripheral neuropathy (25.8%, 12.5%) and dyselectrolytemia (25.8%, 6.25%). Chemotherapy-related toxicity led to death in three patients in the metastatic cohort, versus none in the non-metastatic patients. The 5 year EFS and OS for non-metastatic cohort were 53.8% and 67.8%, while the same for metastatic cohort were 20.7% and 27.5%, respectively. On multivariate analysis, Eastern Cooperative Oncology Group-performance status >2 and metastasis at presentation predicted poorer EFS and OS. Additionally, raised lactate dehydrogenase, larger tumours (>8 cm) and palliative intent treatment predicted worse EFS, while extra-skeletal primary and female gender were indicators of worse OS.ConclusionsOlder adult ES patients benefit from aggressive multimodality treatment even in LMIC infrastructure. However, careful patient selection, close monitoring and pertinent dose modifications is imperative due to higher propensity for potential toxicities.

Highlights

The data on outcomes and toxicity in adult Ewing sarcoma (ES) patients, those aged ≥40 years, is exceedingly scarce around the world, in low- and middle-income countries (LMICs) and mandates research
Publication costs for this article were supported by ecancer (UK Charity number 1176307)
During the 5 years from 2013 to 2018, 1,169 ES patients were registered at our centre

Summary

Introduction

The data on outcomes and toxicity in adult Ewing sarcoma (ES) patients, those aged ≥40 years, is exceedingly scarce around the world, in low- and middle-income countries (LMICs) and mandates research. Adults form a challenging subgroup in view of multiple comorbidities like impaired renal function, hepatic disease, decreased bone marrow reserve, cardiac issues disease and polypharmacy This makes them more susceptible to chemotherapeutic agents’ various toxicities and unlikely to tolerate the dose-dense, standard chemotherapy regimen. Notwithstanding, some authors have reported both groups having comparable results at the cost of increased chemo-related toxicity in older patients [17, 18]. Given this conflicting data, we undertook a study to analyse the survival, toxicity and factors affecting outcomes in the older ES patients over 40 years registered at our centre

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Conclusion