Neoadjuvant chemotherapy for Ewing's sarcoma of bone in patients older than thirty-nine years - Experience of twenty-three cases at the Istituto Ortopedico Rizzoli
G. Bacci et al., Neoadjuvant chemotherapy for Ewing's sarcoma of bone in patients older than thirty-nine years - Experience of twenty-three cases at the Istituto Ortopedico Rizzoli, ACTA ONCOL, 39(1), 2000, pp. 111-116
The aim of this study was to determine whether the behaviour of Ewing's sar
coma of bone in adult patients is the same as that observed in children and
adolescents. We reviewed the clinical features and outcomes of 23 patients
over the age of 39 (17 males, 6 females) who had been treated with neoadju
vant chemotherapy between 1983 and 1995 at our institution. The most common
primary sites of tumor were the extremities (16 cases); tumor volume was m
ore than 100 ml in 17 patients, and elevated serum LDH levels were found in
6 cases. The local treatment was surgery in 8 cases, surgery plus radiothe
rapy in 8, and radiotherapy alone in 7 cases. Chemotherapy comprised a 4-dr
ug regimen in 10 patients, while the other 13 patients received 6 drugs. At
a follow-up of 5.8 years (3.5-15) 13 patients remained continuously free o
f disease and 10 relapsed. The 5-year disease-free survival and overall sur
vival rates were 53% and 59%, respectively. Clinical features, dose intensi
ty, and toxicity of chemotherapy. as well as the outcome of these 23 patien
ts were found to be exactly comparable to the findings observed in 327 pati
ents younger than 40 years treated at our institution in the same period, w
ith the same therapy. We conclude that Ewing's sarcoma of bone in adults is
no different from that occurring in children, and we therefore recommend t
he inclusion of all adult patients in multidisciplinary treatment trials of
this tumor.