LONG-TERM FOLLOW-UP FOR PATIENTS WITH EWINGS-SARCOMA OF BONE TREATED WITH ADJUVANT AND NEOADJUVANT CHEMOTHERAPY - UPDATED RESULTS OF 3 SEQUENTIAL STUDIES

The long-term results obtained in 252 patients with non-metastatic Ewi ng's sarcoma of bone treated between March 1972 and June 1988 accordin g to three sequential protocols of treatment were evaluated. Primary t umor was treated with radiotherapy in 125 cases, with surgery in 52 an d with surgical resection followed by radiotherapy in 75. In the first protocol (REA 1; 1972-78) chemotherapy was performed with a 3-drug re gimen (VCR, CPM, ADM), whereas in the REA 2 protocol (1979-82) and in the REN 1 protocol (1983-88) a 4-drug regimen was used (VCR, CPM, ADM, ACTD). Chemotherapy was delivered as adjuvant treatment in REA 1 and 2, and as neoadjuvant in the last study. At a mean follow-up of 14.8 y ears, with the 95% of patients with a minimum FU of 10 years, 101 pts (40%) remained continuously free of disease, 144 patients relapsed, tw o patients died of adriamycin cardiotoxicity and 5 patients developed a second neoplasm. 6% of the patients relapsed 5 or more years after t he diagnosis with the latest recurrence registered at the tenth year. Type of local treatment, LDH serum level, chemotherapy protocol and se x were predictive factors of DFS after a multivariate analysis. The po ssibility of late relapse in Ewing's sarcoma has been confirmed by our retrospective study and for patients with Ewing's sarcoma, a 10-year follow up should be recommended.