514P - Role of dose-intense chemotherapy before limb-sparing surgery in Ewing sarcoma

Date 18 December 2016
Event ESMO Asia 2016 Congress
Session Poster lunch
Topics Anti-Cancer Agents & Biologic Therapy
Bone Sarcomas
Surgery and/or Radiotherapy of Cancer
Presenter Anchal Mishra
Citation Annals of Oncology (2016) 27 (suppl_9): ix163-ix168. 10.1093/annonc/mdw597
Authors A.N. Mishra1, Y. Mishra2
  • 1Department Of Orthopaedics & Bone Tumors, Gandhi Medical College, 462001 - Bhopal/IN
  • 2Medical Oncology, Jawaharlal Nehru Cancer Hospital (JNCH), 462022 - Bhopal/IN

Abstract

Background

Ewing’s Sarcoma Family of Tumor (ESFT) constitutes all types of Ewing’s Sarcoma and rare soft tissue tumor called primitive neuroectodermal tumor(PNET). They arise from a primitive cell derived either from an embryologic tissue called the neural crest, or from resident cells in the body called mesenchymal stem cells and >95% cases show t(11;22) translocation with t(21;22) and t(7;22), involving fusion of EWS gene with an ETS family gene. We studied the role of chemotherapy given in dose intense form before taking up the patient for any kind of surgery if needed.

Methods

Irrespective of the size, shape and location of the tumor, we had put our patients on five drugs – vincristine, doxorubicin, cyclophosphamide, ifosfamide and etoposide. Typically, these agents are given as the combination of vincristine, doxorubicin, and cyclophosphamide (or VDC) over 2 days followed by ifosfamide and etoposide (IE) given over 5 days in increased doses and dose free interval is reduced form 3 to 2 weeks.

Results

Every two-week interval compression regimen (dose intesified approach) is superior to the every 3 week regimen in both event-free and overall survival: 76 versus 65 percent event free survival at 4 years (p = 0.029), and 91% versus 85% overall survival at 4 years (p = 0.026). There was also no difference in toxicity between the two regimens and length of theapy reduced significantly.

Conclusions

ESFT is an aggressive cancer with a tendency to recur where it arose (local recurrence) and spread throughout the body (metastasize). In the Indian setting, most of the patients are present very late after the tumor has metastasized to other body parts. A multidisciplinary approach is required for its treatment, involving chemotherapy, radiation therapy, and surgery. For ESFT isolated to one area (localized), chemotherapy is used to shrink the tumor and prevent further spread and then for surgical removal. If surgery is not possible, then radiation therapy is used to kill the localized tumor. The patient then receives further chemotherapy to kill any additional abnormal cells after the tumor is removed. Average survival at five years is 20%.Two-week interval compression regimen (dose intesified approach) is superior to the every 3 week regimen in both event-free and overall survival.

Clinical trial indentification

Trial Protocol Number:- GMC7615

Legal entity responsible for the study

Gandhi Medical College, Bhopal

Funding

Gandhi Mdical College, Bhopal

Disclosure

All authors have declared no conflicts of interest.