Ewing's sarcoma in pediatrics and adults: Outcomes by multimodality approach

Background: To review the clinical characteristics and outcomes of patients with Ewing's sarcoma (EWS) treated at our institute with radiation, chemotherapy, and surgery. Materials and Methods: Patients of EWS treated between January 2009 and December 2014 were retrospectively analyzed. Multimodality treatment with chemotherapy, radiation, and/or surgery has been used. Pattern of failure, locoregional control rates, and disease-free survival (DFS) was estimated using KaplanuMeier method. Univariate and multivariate analysis was done to identify various poor prognostic factors for local control and survival. Results: Eighty-three patients were reviewed. Eleven patients (13.2%) had metastatic disease at presentation, out of which 7 (8.4%) had lung metastasis. The most frequent location was extremities (53%), followed by ribs, clavicle, and scapula (18.1%), axial site (10.8%), pelvis (7.2%), extraosseous site (6%), and skull (4.8%). The median follow-up period was 16 months. Out of 72 patients with localized disease, 37 (44.6%) patients failed the treatment. The most common site of distant failure was lung (18.1%), followed by bone (10.8%) and brain (4.8%). The 1 year, 2 years, and 5 years DFS were 73.8%, 45.7%, and 33.2%, respectively. The 1 year, 2 years, and 5 years local control rates were 73.3%, 65.1%, and 55.8%, respectively. The median time to local failure was 10 months. Age 12 years (P < 0.05) was found to be the only factor associated with poor prognosis for survival by both univariate and multivariate analysis. Axial site (P < 0.03), and chemotherapy regimen with vincristine, adriamycin (doxorubicin), cyclophosphamide only (P < 0.03) were found to be associated with a poor prognosis for local control by univariate analysis. By multivariate analysis, however, none of the factors were found to be a poor prognostic factor for local control. Conclusions: Aggressive combined modality approaches should be considered for all patients with EWS. Survival after progression was dismal.