506PD - Ewing Sarcoma family tumors of vertebral column treated with uniform chemotherapy protocols: Experience from a tertiary cancer care center

Date 17 December 2016
Event ESMO Asia 2016 Congress
Session Sarcoma
Topics Anti-Cancer Agents & Biologic Therapy
Bone Sarcomas
Presenter Akash Kumar
Citation Annals of Oncology (2016) 27 (suppl_9): ix163-ix168. 10.1093/annonc/mdw597
Authors A. Kumar1, B. Biswas2, A. Biswas3, S. Bakhshi2
  • 1Medical Oncology, AIIMS, 110029 - New Delhi/IN
  • 2Medical Oncology, All India Institute of Medical Sciences, 110029 - New Delhi/IN
  • 3Radiation Oncology, All India Institute of Medical Sciences, 110029 - New Delhi/IN

Abstract

Background

A Ewing sarcoma family tumor (ESFT) of vertebral column is a rare malignancy. Data on outcome and prognostic factors about this entity is scarce in literature.

Methods

This is single institutional data review of 68 consecutively treated patients of ESFT of vertebral column between June 2003 and November 2015 with uniform chemotherapy protocol. All patients received neoadjuvant chemotherapy, surgery and/or radiotherapy as local treatment followed by adjuvant chemotherapy, except a few who received induction chemotherapy after upfront decompression surgery.

Results

Median age was 16 years (range: 2-53) with male: female ratio 50:18. Sites of disease were cervical spine in 7 (10%), dorsal spine in 14 (21%), lumbar spine in 21 (38%) and sacro-coccigeal in 26 (38%) patients; 29 patients (43%) had baseline metastasis. Median symptom duration was 3.5 months (range: 0.1-24). 48 (70%) patients presented with weakness of limbs. Fourteen (21%) patients received anti-tubercular pharmacotherapy before diagnosis of ESFT. Twenty-six (38%) patients had upfront decompression surgery due to spinal cord compression and 18 patients received adjuvant radiotherapy after induction chemotherapy. Of the remaining 42 patients, 26 were eligible for local therapy: 25 received definitive radiotherapy and one patient underwent surgery with adjuvant radiotherapy. After median follow-up of 29.5 months (range: 3.2-81.1), 5-year event-free-survival (EFS) and overall survival (OS) was 23.2±6.9% and 25.3±8.5%, respectively. Multivariate analysis showed that baseline hemoglobin (≤11 g/dl) and lactate dehydrogenase (≥ 2 x normal) independently predicted inferior outcome for EFS (p 

Conclusions

This is the largest data set of vertebral ESFT from Asia with high rate of metastases at presentation. Majority of patients had delayed presentation and were overtly morbid. One-fifth of patients were mistreated as Koch’s before the actual diagnosis of ESFT. Outcome was dismal with multimodality management with limitation of quality of life data. Serum albumin and hemoglobin emerged as novel prognostic factor affecting outcome.

Clinical trial indentification

Legal entity responsible for the study

Akash Kumar

Funding

All India Institute Of Medical Sciences, New Delhi

Disclosure

All authors have declared no conflicts of interest.