Publication de Nicole Delepine : High value of age in localized Ewing Sarcoma.

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Publié sur : Annals of Oncology - volume 11, suppl 4. page 130 n° 595 - 2000
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High value of age in localized Ewing Sarcoma.
F. Delépine, E. Guikov, Nicole Delepine

High value of age in localised Ewing's sarcoma.


Introduction:
In Ewing's sarcoma, the prognostic value of age is debated Most early monocentric studies published disease free survival rate between 10% to 30% for adult patients compared to 20-60% for children. But other multicentric trials (I ESS, CESS or SFOP) did not find such a difference. We imagined that the observed differences could be correlated with the given drug intensities and analysed our data to prove it.

Material:
From 1986/1 to 1999/1, 48 patients with localised Ewing's sarcoma of bone have been treated by our team. They were 29 males and 19 females with a median age of 18 years (5-35) Chemotherapy started with a short bidrug induction (6 weeks of cyclophosphamide - doxorubicin) surgery in all cases (en bloc resection when feasible, curettage for vertebral and sacral locations).
Post-operative chemotherapy used 5 or 6 drugs (vincristine - dactinomycine - ifosfamide - cyclophosphamide - doxorubicin or etoposide - cisplatinium) for
10 months. All patients have been followed up with physical examination, plain
RXrays, bone scan, computed tomographies of the lungs and primary site
every 3 months for 2 years, then every 6 months for 2 years and yearly then
after.

Results:
With a median follow up of 7 years and 6 months, 37 (77%) patients are event free survivors. In this series, the site of the tumor and the tumoral volume had no impact on disease free survival but only age, body surface area and response to preoperative chemotherapy. The life expectancy of patients under 19 years is 96% (24/25) but only 56% (13/23) for patients 19 or older (p< 0.001). The disease free survival of patients with body surface area under 1.4 sqm is 100% compared to 55% for patients with larger surface (p < 0.001).
The univariate analysis shows that received drug intensities of vincristine and dactinomycin are the only independent therapeutic prognostic factors (both correlated with age and body surface area). With the total dose limit of 2 mg for vincnstine and 2 mg for dactinomycin patient with larger surface area (>1.4 sqm) received less drugs by sqm than younger patients. In multivariate analysis, age had no prognostic value, but only the received drug intensities of vincristine and dactinomycin.

Conclusion: In Ewing's sarcoma, age is not an independent prognostic factor but only underlines the importance of given dose intensities of vincnstine and dactinomycin.




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