PRIMARY METASTATIC (STAGE-IV) EWING TUMOR - SURVIVAL ANALYSIS OF 171 PATIENTS FROM THE EICESS STUDIES

Background. In the multicenter European Intergroup Cooperative Ewing's Sarcoma Studies, localized Ewing tumors of bone were treated by combi nation chemotherapy with surgery and/or radiotherapy. Patients with pr imary metastases (pm-pts) were treated in high risk protocols. Patient s and methods.. One hundred seventy-seven pm-pts were registered from January 1990 to December 1995, 171 were evaluable for survival analyse s. Thirty-six pm-pts received myeloablative megatherapy with stem cell rescue following conventional treatment. Bilateral whole lung irradia tion (WLI) was administered in 57 pm-pts with pulmonary involvement. E vent-free survival (EFS) rates were estimated by Kaplan-Meier analysis . Prognostic factors were identified by log-rank statistics, Cox proce dures and logistic regression. Results. Eighty-nine deaths were record ed by 1 February 1997, EFS four years after diagnosis for all 171 pm-p ts was 0.27. EFS for isolated lung metastases was 0,34, for bone/bone marrow (BM) metastases, 0,28, and for combined lung plus bone/BM metas tases, 0.14 (P < 0.005). WLI improved outcome in case of isolated pulm onary involvement (0.40 vs. 0.19, P < 0,05). In pm-pts with combined p ulmonary/skeletal metastases, intensification by megatherapy and/or WL I improved EFS from 0.00 to 0.27 (P = 0.0001). Conclusions. EFS four y ears after diagnosis in patients with disseminated Ewing tumors is 0,2 7. Whole lung irradiation and megatherapy improve outcome in subgroups of patients with disseminated Ewing disease.