Role of surgery in local treatment of Ewing's sarcoma of the extremities in patients undergoing adjuvant and neoadjuvant chemotherapy

2004 ◽  
Author(s):  
Gaetano Bacci ◽  
Stefano Ferrari ◽  
Alessandra Longhi ◽  
Davide Donati ◽  
Enza Barbieri ◽  
...  
Keyword(s):  
Neoadjuvant Chemotherapy ◽  
Ewing’S Sarcoma ◽  
Ewing's Sarcoma ◽  
Local Treatment

Neoadjuvant Chemotherapy for Peripheral Malignant Neuroectodermal Tumor of Bone: Recent Experience at the Istituto Rizzoli

2000 ◽  
Vol 18 (4) ◽  
pp. 885-885 ◽  
Author(s):  
Gaetano Bacci ◽  
Stefano Ferrari ◽  
Franco Bertoni ◽  
Davide Donati ◽  
Patrizia Bacchini ◽  
...  
Keyword(s):  
Overall Survival ◽  
Neoadjuvant Chemotherapy ◽  
Neural Differentiation ◽  
Ewing’S Sarcoma ◽  
Ewing's Sarcoma ◽  
Local Treatment ◽  
Neuroectodermal Tumor ◽  
Recent Experience ◽  
Event Free Survival ◽  
Free Survival

PURPOSE: The results achieved in 44 patients with nonmetastatic peripheral neuroectodermal tumor (PNET) of bone treated with neoadjuvant chemotherapy are reported. PATIENTS AND METHODS: A six-drug regimen of chemotherapy (vincristine, doxorubicin, dactinomycin, cyclophosphamide, ifosfamide, and etoposide) was administered to all patients. Local treatment consisted of surgery in 20 patients, surgery followed by radiotherapy in 13, and radiotherapy only in 11. RESULTS: At a mean follow-up of 4.5 years (range, 2 to 7 years), 23 patients (52%) remain event-free, 20 have relapsed (45%), and one has died of chemotherapy-related toxicity. The 5-year event-free survival and overall survival were 54.2% and 62.7%, respectively. To assess the prognostic significance of neural differentiation in the family of Ewing’s sarcoma, these results have been compared with the outcomes of 138 concomitant patients with typical Ewing’s sarcoma (TES) who were treated according to the same protocol. Of these, 103 (75%) remained continuously event-free, 34 (24%) relapsed, and one died of chemotherapy-related toxicity. It follows that PNET patients treated with this chemotherapy regimen have a significantly worse prognosis than typical ES patients (5-year event-free survival, 54.2% v 70.6%, P < .012; 5-year overall survival, 62.7% v 78.3%, P < .002). CONCLUSION: The authors conclude that studies into new adjuvant therapy for Ewing’s sarcoma modulated according to risk of relapse should also consider neural differentiation as a risk factor.

scholarly journals Repeat Local Treatment of Recurrent Colorectal Liver Metastases, the Role of Neoadjuvant Chemotherapy: An Amsterdam Colorectal Liver Met Registry (AmCORE) Based Study

Cancers ◽  
2021 ◽  
Vol 13 (19) ◽  
pp. 4997
Author(s):  
Madelon Dijkstra ◽  
Sanne Nieuwenhuizen ◽  
Robbert S. Puijk ◽  
Florentine E. F. Timmer ◽  
Bart Geboers ◽  
...  
Keyword(s):  
Neoadjuvant Chemotherapy ◽  
Hospital Stay ◽  
Colorectal Liver Metastases ◽  
Local Treatment ◽  
Length Of Hospital Stay ◽  
Progression Free Survival ◽  
Free Survival ◽  
Significant Difference ◽  
Subgroup Analyses

This cohort study aimed to evaluate efficacy, safety, and survival outcomes of neoadjuvant chemotherapy (NAC) followed by repeat local treatment compared to upfront repeat local treatment of recurrent colorectal liver metastases (CRLM). A total of 152 patients with 267 tumors from the prospective Amsterdam Colorectal Liver Met Registry (AmCORE) met the inclusion criteria. Two cohorts of patients with recurrent CRLM were compared: patients who received chemotherapy prior to repeat local treatment (32 patients) versus upfront repeat local treatment (120 patients). Data from May 2002 to December 2020 were collected. Results on the primary endpoint overall survival (OS) and secondary endpoints local tumor progression-free survival (LTPFS) and distant progression-free survival (DPFS) were reviewed using the Kaplan–Meier method. Subsequently, uni- and multivariable Cox proportional hazard regression models, accounting for potential confounders, were estimated. Additionally, subgroup analyses, according to patient, initial and repeat local treatment characteristics, were conducted. Procedure-related complications and length of hospital stay were compared using chi-square test and Fisher’s exact test. The 1-, 3-, and 5-year OS from date of diagnosis of recurrent disease was 98.6%, 72.5%, and 47.7% for both cohorts combined. The crude survival analysis did not reveal a significant difference in OS between the two cohorts (p = 0.834), with 1-, 3-, and 5-year OS of 100.0%, 73.2%, and 57.5% for the NAC group and 98.2%, 72.3%, and 45.3% for the upfront repeat local treatment group, respectively. After adjusting for two confounders, comorbidities (p = 0.010) and primary tumor location (p = 0.023), the corrected HR in multivariable analysis was 0.839 (95% CI, 0.416–1.691; p = 0.624). No differences between the two cohorts were found with regards to LTPFS (HR = 0.662; 95% CI, 0.249–1.756; p = 0.407) and DPFS (HR = 0.798; 95% CI, 0.483–1.318; p = 0.378). No heterogeneous treatment effects were detected in subgroup analyses according to patient, disease, and treatment characteristics. No significant difference was found in periprocedural complications (p = 0.843) and median length of hospital stay (p = 0.600) between the two cohorts. Chemotherapy-related toxicity was reported in 46.7% of patients. Adding NAC prior to repeat local treatment did not improve OS, LTPFS, or DPFS, nor did it affect periprocedural morbidity or length of hospital stay. The results of this comparative assessment do not substantiate the routine use of NAC prior to repeat local treatment of CRLM. Because the exact role of NAC (in different subgroups) remains inconclusive, we are currently designing a phase III randomized controlled trial (RCT), COLLISION RELAPSE trial, directly comparing upfront repeat local treatment (control) to neoadjuvant systemic therapy followed by repeat local treatment (intervention).

Ewing's tumors with primary lung metastases: survival analysis of 114 (European Intergroup) Cooperative Ewing's Sarcoma Studies patients.

1998 ◽  
Vol 16 (9) ◽  
pp. 3044-3052 ◽  
Author(s):  
M Paulussen ◽  
S Ahrens ◽  
A W Craft ◽  
J Dunst ◽  
B Fröhlich ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Primary Tumor ◽  
Ewing’S Sarcoma ◽  
Ewing's Sarcoma ◽  
Lung Metastases ◽  
Local Treatment ◽  
Poor Response ◽  
Chemotherapy Response ◽  
Treatment Intensification ◽  
Lung Irradiation

PURPOSE To analyze event-free survival (EFS) and prognostic factors in patients who present with Ewing's tumors (ET) of bone and synchronous pulmonary and/or pleural metastases (ppm). PATIENTS AND METHODS Of 1,270 patients (pts) registered at the continental office of the German/European Intergroup Cooperative Ewing's Sarcoma Studies (CESS81, CESS86, EICESS92), 114 were diagnosed ET with ppm. Patients underwent neoadjuvant therapy and local treatment of the primary tumor. Whole-lung irradiation 15 to 18 Gy was applied to 75 ppm-pts. EFS and 95% confidence intervals (CIs) were estimated according to the Kaplan-Meier method, and prognostic factors were analyzed by log-rank tests and Cox and logistic regression procedures. RESULTS On November 1, 1997, at a median time under study of 5.9 years, the 5-year EFS was 0.36 (95% CI, 0.26 to 0.46) and the 10-year EFS was 0.30 (95% CI, 0.19 to 0.41). Thirty-seven of 59 (63%) first relapses involved lung and/or pleura, and the lungs were the only site of relapse in 26 of 59 (44%) ppm-pts. Risk factors identified in univariate and multivariate tests were poor response of the primary tumor toward chemotherapy, metastatic lesions in both lungs, and treatment without additional lung irradiation. CONCLUSION Chemotherapy response of the primary tumor is a prognostic factor in patients with ET with ppm. Strategies of treatment intensification warrant further evaluation.

Ewing's sarcoma in childhood — The role of radiotherapy

1997 ◽  
Vol 33 ◽  
pp. S109
Author(s):  
Maria Adelina Costa ◽  
Lurdes Alves ◽  
Isabel Silva ◽  
Ma VirgInia Costa ◽  
Armando Pinto ◽  
...  
Keyword(s):  
Ewing’S Sarcoma ◽  
Ewing's Sarcoma

Abstract 3158: Evidence for a role of EWS in alternative splicing in Ewing's sarcoma

2010 ◽  
Author(s):  
Lucia T. Riedmann ◽  
Maximilian O. Kauer ◽  
Gunhild Jug ◽  
Heinrich Kovar
Keyword(s):  
Alternative Splicing ◽  
Ewing’S Sarcoma ◽  
Ewing's Sarcoma

Role of surgical resection in pelvic Ewing's sarcoma.

1995 ◽  
Vol 13 (9) ◽  
pp. 2336-2341 ◽  
Author(s):  
S P Scully ◽  
H T Temple ◽  
R J O'Keefe ◽  
M T Scarborough ◽  
H J Mankin ◽  
...  
Keyword(s):  
Overall Survival ◽  
Radiation Therapy ◽  
Disease Control ◽  
Surgical Resection ◽  
Ewing’S Sarcoma ◽  
Ewing's Sarcoma ◽  
Disease Free Survival ◽  
Local Disease ◽  
Local Disease Control

PURPOSE The improved survival in patients with Ewing's sarcoma over the past two decades has placed increased importance on achievement of local disease control. Ewing's sarcoma that arises in the pelvis has been recognized to have a worse prognosis than that in the appendicular skeleton, and the role of surgical resection in these cases remains controversial. The current study attempts to identify a benefit to surgical resection in these patients. METHODS We retrospectively examined 39 patients who presented with Ewing's sarcoma in a pelvic location, all of whom were treated systemically with chemotherapy. Twenty patients received radiation only as a means of local control, and 19 underwent resection with or without radiation therapy. The patients were evaluated with end points of disease-free survival and overall survival for a minimum of 24 months and a mean of 58 months. RESULTS There was an even distribution among patients who underwent surgical resection for local control as compared with those who received only radiation therapy with respect to age, site, date of treatment, and stage of disease. Despite uncontrolled biases including tumor size and response to chemotherapy that would be expected to favor patients who undergo resection, surgery in addition to or in substitution for radiation therapy did not result in a statistically significant increase in disease-free survival or overall survival. Local disease control was comparable between those who underwent resection and those who did not: three patients in each group developed a local recurrence. CONCLUSION Currently, morbidity of surgical resection should be weighed against the efficacy and secondary complications of radiation therapy in the decision-making process for local disease control. The issue of whether overall survival and local disease control is improved in patients who undergo surgical resection remains controversial and may require a prospective randomized trial to be answered definitively.

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