Publication de Nicole Delepine : Study of age has major pronostic factors in localized Ewing's sarcoma.

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Publié sur : Page 48, CCOS abstracts in Sarcoma. Ed. Taylor et Francis. Volume 5, n°1 - 2001
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Study of age has major pronostic factors in localized Ewing's sarcoma.
F. Delépine, E. Guikov, G. Delépine, Nicole Delepine

Study Of Age As Major Pronostic Factor 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 and 30% for adult patients compared with 20± 60% for children.
But other multicentric trials (IESS, 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 January 1986 to January 1999, 48 patients with localised Ewing's sarcoma of bone have been treated by our team. There were 29 males and 19 females with a median age of 18 years (range, 5± 35 years). Chemotherapy started with a short bi-drug 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 five or sixdrugs (Vincristine± Dactinomycine± Ifosfamide± Cyclophosphamide± Doxorubicin or Etoposide± Cisplatinium) for 10 months.
All patients have been followed-up with physical examination, plain RX-rays, 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 pre-operative chemotherapy.
The life expectancy of patients under 19 years is 96% (24/25), but only 56% (13/23) for patients aged 19 or older (p < 0.001). The disease-free survival of patients with body surface area under 1.3 m2 is 100% compared with 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 vincristine and 2 mg dactinomycin, patients with larger surface area (> 1.3 m2) received less drugs per square meter 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, ageis not an independent prognostic factor, but only underlines the importance of given dose intensities of vincristine and dactinomycin.




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