LONG-TERM FOLLOW-UP AND PROGNOSTIC FACTORS IN EWINGS-SARCOMA - A MULTIVARIATE-ANALYSIS OF 116 PATIENTS FROM A SINGLE INSTITUTION

The records of 116 patients from a single center (1970-1993) with newl y diagnosed Ewing's sarcoma or primitive neuroectodermal tumor were re viewed retrospectively, The aim of this study was to ascertain the imp act of pretreatment variables on disease-free survival. Median age was 14 years(range 1-34). Twenty patients presented with metastatic disea se. Treatment consisted of systemic multiagent chemotherapy plus local irradiation (39%), wide resection (22%): or both (35%). Median potent ial follow-up was 10.7 years (range 2-26), Three patients developed se cond malignancies (1 breast carcinoma, 2 acute myeloid leukemias), Med ian time to relapse was 24 months (range 3-143), The actuarial disease -free survival was 37.4% at 5 years, 33.3% at 10 years and 27.8 at 15 years, Neoadjuvant chemotherapy and a therapy-induced tumor necrosis g reater than or equal to 90% were associated with a better outcome. Pat ients undergoing surgical resection had a superior disease-free surviv al than those treated without surgery (45 vs. 18% at 10 years, p = 0.0 009), Multiple regression analysis showed that raised serum lactate de hydrogenase levels (p < 0.001), hypoalbuminemia (p = 0.001) and distan t metastases at diagnosis (p = 0.03) were independent adverse prognost ic factors. In conclusion, one third of patients with Ewing's sarcoma become long-term survivors with combined modality treatment. Late rela pses and second neoplasms are of concern, Prognostic factors should be considered in the selection of therapy, and the value of serum albumi n warrants confirmatory studies.