Outpatient chemotherapy for non-metastatic Ewing's sarcoma (ES): Pilot experience. Sarcoma Group, King Faisal Specialist Hospital, Saudi Arabia

Abstract

9057 Background: Non-metastatic ES is considered curable with combined modality therapy involving surgery (S), chemotherapy (C) ± radiation therapy (RT). C involves prolonged treatment with multiple cycles, thus adding to in-patient cost. We report our experience with combined modality therapy in ES in ambulatory care setting. Methods: Patients (age = 14) with newly diagnosed non-metastatic ES diagnosed between May 1999 –December 2001 included. All had confirmed histology, staging, C, and surgery/RT whenever feasible/indicated. C: vincristine 1.5 mg/m2 on day 1, adriamycin 20 mg/m2 alternating with actinomycin D 0.5 mg/m2 daily days 1–3, all intravenous, and ifosfamide 2000 mg/m2 intravenous infusion days 1–3 with equivalent mesna in 3 divided doses, one pre and 2 post ifosfamide. Dose intensities of all drugs identical to previously used in-patient regime. Standard anti emetics, 1 litre of hydration given daily. Total 14 cycles q 21 days, response evaluation after 4, 8, 12 cycles and end of therapy. S after 4 cycles if feasible, RT if unresectable or margins positive. Results: Total 19 patients, M:F 14:5, median age 18 (14–42). Primary site chest wall 4, ilium, femur, tibia, fibula 2 each, extraskeletal 3, other bones 4. Primary S in 2 extraskeletal cases, S after initial C in 12 (4 had > 90% necrosis), 2 unresectable, 3 refused S. Median C cycles 11. RT in 12 patients (refused S 4, unresectable 2, others margin status positive or unknown). Overall response - complete 16, partial 1, progression 2. Toxicities: febrile neutropenia 2, non neutropenic grade 3 infections 2, grade 3 mucositis 1. No hemorrhagic cystitis, no grade 3/4 hematologic or renal toxicity, no toxic deaths. Of 16 with complete response, 6 relapsed, 1 with partial response progressed. With median follow up 22 months (8–50), 10/19 (53%) alive with no evidence of disease, 6 alive with disease, 3 died of disease. Conclusion: Outpatient chemotherapy for ES is feasible, well tolerated with manageable toxicities, outcome is comparable to in-patient management. More patients being recruited and longer follow-up required. No significant financial relationships to disclose.