The outcome of localized Ewing's sarcoma has improved with multi-disciplinary approach. Survivals of Ewing's sarcoma from the Asian countries differed between centers. We aimed to study the impact of treatment protocols used at different periods of time on the outcome of localized Ewing's sarcoma.
We retrospectively analyzed the records of newly diagnosed localized Ewing's sarcoma patients from 2002 to 2012. The patients were analyzed in three groups; Group 1(2002-2004) who received non-ifosfomide based regimens, Group 2(2005-2008) who received VDC/IE for 12 cycles, and Group 3(2009-2012), who received VDC/IE for 17 cycles. The groups were compared for their baseline characteristics, treatment protocol and outcome.Relapse free survival (RFS) and overall survival (OS) rates were estimated by using the Kaplan-Meier method. Log-rank test was used to evaluate prognostic significance of variables.
Seventy three patients were included in the study. The median age of presentation was 15 years and with slight male predominance (M: F = 1.28:1). Axial primary was seen in 62%. The median RFS of the three groups was 26.4, 31.4 and 36.8 months respectively (P = 0.0018). The median OS was 27.9, 35 and 43 months respectively (P = 0.0007). At a median follow-up of 35 months, the 3 year RFS and OS for the three treatment groups were 17%, 31%, 60% and 35%, 45% and 70% respectively. Among the patients with primary in extremity (28), radiotherapy and surgery was given to 17 (60.7%) and 11 (39.3%) patients respectively. Among the patients with axial primary (45), thirty five (77.8%) received radiotherapy, 10 (22.2%) underwent surgery. Three year local recurrence free survival of radiotherapy and surgery groups were 42% and 75% respectively (P = 0.01). Larger tumor size, axial primary, high LDH were associated with poorer survival.
We found that the survival of our ESFT patients improved over time with intensified multiagent chemotherapy. But the results were still inferior to those reported in Euro-American studies. The inferior outcome might be due to axial primary in majority and radiotherapy as the predominant mode of local control. Prospective multicentre trials with uniform protocol are needed to analyze the difference in outcome among ethnic groups.
Clinical trial identification
All authors have declared no conflicts of interest.