Primary metastatic Ewing's family tumors: results of the Italian Sarcoma Group and Scandinavian Sarcoma Group ISG/SSG IV Study including myeloablative chemotherapy and total-lung irradiation
R Luksch, A Tienghi, K Sundby Hall, F Fagioli, P Picci, E Barbieri, L Gandola, M Eriksson, P Ruggieri, P Daolio, P Lindholm, A Prete, G Bisogno, A Tamburini, G Grignani, M E Abate, M Podda, S Smeland, S Ferrari, R Luksch, A Tienghi, K Sundby Hall, F Fagioli, P Picci, E Barbieri, L Gandola, M Eriksson, P Ruggieri, P Daolio, P Lindholm, A Prete, G Bisogno, A Tamburini, G Grignani, M E Abate, M Podda, S Smeland, S Ferrari
Abstract
Background: The Italian Sarcoma Group and the Scandinavian Sarcoma Group designed a joint study to improve the prognosis for patients with Ewing's family tumors and synchronous metastatic disease limited to the lungs, or the pleura, or a single bone.
Patients and methods: The study was opened in 1999 and closed to the enrollment in 2008. The program consisted of intensive five-drug combination chemotherapy, surgery and/or radiotherapy as local treatment, and consolidation treatment with high-dose busulfan/melphalan plus autologous stem cell rescue and total-lung irradiation.
Results: During the study period, 102 consecutive patients were enrolled. The median follow-up was 62 months (range 24-124). The 5-year event-free survival probability was 0.43 [standard deviation (SD) = 0.05] and the 5-year overall survival probability was 0.52 (SD = 0.052). Unfavorable prognostic factors emerging on multivariate analysis were a poor histological/radiological response at the site of the primary tumor [relative risk (RR) = 3.4], and incomplete radiological remission of lung metastases after primary chemotherapy (RR = 2.6). One toxic death and one secondary leukemia were recorded.
Conclusions: This intensive approach is feasible and long-term survival is achievable in ∼50% of patients. New treatment approaches are warranted for patients responding poorly to primary chemotherapy.
Source: PubMed