Publication de Nicole Delepine : Optimal length of preoperative chemotherapy in Ewing's Sarcoma

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Publié sur : Publication Doc Nicole Delépine - 1998
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Optimal length of preoperative chemotherapy in Ewing's Sarcoma
Gérard Delepine, Nicole Delepine, B. Markowska, S. Alkallaf, J.C. Desbois

Optimal length of preoperative chemotherapy in Ewing's Sarcoma



Purpose



This study investigated the correlation between surgery timing and long term disease free survival (DFS).

Methods



From 01.1977 to 12.1996, 67 patients (45 males, 22 females) (aged from 4 to 35 y, average : 19) with Ewing's sarcoma fulfilled the inclusion criteria : localised tumor at first screening, location of tumor in en bloc resectable bones [maxillar (1), finger (1), rib (5), skull (1), tibia (8), ulna (2), fibula (5), cubitus (1), scapula (3), iliac (13), sup. humerus (5), femur (22)]. The median volume was 215 cm3, mean average 110 (31 < 100). Metastatic patients and vertebral locations were excluded. The patients received a multidrug chemotherapy and were systematically operated. They received radiotherapy in case of bad responders and/or marginal surgery. The histologic response was evaluated according to Picci's criteria. The date of local treatment was calculated from biopsy to surgery in weeks.

Results



With a median follow up of 59 months (12-168), 34 patients were in first complete remission. Patients operated before the 10th week presented a higher chance (DFS 68 %) of first complete remission than patients operated later (DFS 43 %). The difference was significant (p < 0.03). Further analysis showed that the difference is due to bad responders : late local control is dismal for bad responders.

Conclusion



Local treatment must be done early, especially if clinical and radiological response is incomplete or uncertain. A long preoperative chemotherapy (>10 weeks) increases the risk of metastases in bad responders. These factors should be taken into account when analysing multicentric protocols.






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