Radiotherapy and high-dose chemotherapy in advanced Ewing's tumors

Background: Ewing's tumors are sensitive to radio- and chemotherapy. Patien ts with multifocal disease suffer a poor prognosis. Patients presenting pri mary bone marrow involvement or bone metastases at diagnosis herald a 3-yea r disease-free survival below 15%. The European Intergroup Cooperative Ewin g's Sarcoma Study (EICESS) has established the following indications for hi gh-dose therapy in advanced Ewing's tumors: Patients with primary multifoca l bone disease, patients with early (<2 years after diagnosis) or multifoca l relapse. Patients and Method: As of 1987, 83 patients have been treated in the EICES S group, 39 of them at the transplant center in Dusseldorf, who have been a nalyzed here. All individuals received 4 courses of induction chemotherapy with EVAJA and stem cell collection after course 3 and 4. Consolidation rad iotherapy of the involved bone compartments was administered in a hyperfrac tionated regimen 2 times 1.6 Gy per day, up to 22.4 Gy simultaneously to co urse 5 and 22.4 Gy to course 6 of chemotherapy. The myeloablative chemother apy consisted of melphalan and etoposide (ME) in combination with 12 Gy TBI (Hyper-ME) or Double ME with whole lung irradiation up to 18 Gy (without T BI). Results: The survival probability at 40 months was 31% (44% DOD; 15% DOG). Pelvic infiltration did not reach prognostic relevance in this cohort. Radi otherapy encompassed 75% of the bone marrow at maximum (average 20%). Engra ftment was not affected by radiotherapy. Conclusion: High-dose chemotherapy can improve outcome in poor prognostic a dvanced Ewing's tumors. The disease itself remains the main problem. The ex pected engraftment problems after intensive radiotherapy in large volumes o f bone marrow can be overcome by stem cell reinfusion.