Publication de Nicole Delepine : Pelvic Ewing's sarcoma, 20 years experience

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Publié sur : Publication Powerpoint Delépine - 2002
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Pelvic Ewing's sarcoma, 20 years experience
Delépine F, Delépine G, Sokolov T, Nicole Delepine

Pelvic Ewing's sarcoma 20 years experience



Introduction



Despite the improved survival of patients with Ewing's sarcoma, pelvic location remains a bad prognostic factor.
This retrospective analysis tries to point out the reasons of such a situation, and to evaluate the impact of modern comprehensive approach on prognosis.

Patients



From 1977/2 to 1998/6, 53 patients have been treated by our group for Ewing's sarcoma of pelvic bones.

Age of patient


32 were males, 21 females aged 6 to 35 years (median 16.3).

Sex of patient


Initial tumoral Volume



Tumoral Volume


At first screening the tumoral volume assessed from CT or NMR averaged : 430 cc médian : 240cc

Initial staging



Metastases


At first screening 15 patients had already metastases. Among them 7 with regional bone metastases on NMR.

Regional metastases


And 38 presented with localised disease.

Chemotherapyh



Treatment included chemotherapy for all patients according to the current protocol at the time of presentation : four drugs (Vincristine,Dactinomycin,Cyclophosphamide,Doxorubicin : V Ad CA, five drugs (VAd CA + ifosfamide) or six drugs association (IVAd CA + Etoposide or Cisplatinium).

Local treatment



-Used radiotherapy alone for 24 patients, surgery alone in 18 and a combination in 11.
-All patients have been followed up every 3 months for 2 years, every 6 months for 2 other years and then yearly.

Iliac Wing Wide resection



Iliac resection


Ewing sarcoma in a girl aged 13 resection with composite acrylic reconstruction.

Sacroiliac Wide resection



Sacroiliac resection


Girl of 11 with sciatic palsy.

Anterior ring Wall resection



Primary metastasic Ewing


Boy of 13 with primary metastatic Ewing of anterior ring.Wide resection after long preoperative chemotherapy.

Ard


Periacetabular Wide Resection



Periacetabular metastase


Periacetabular Ewingwith metastase on L4.Resection of all lesions after bidrug induction therapy.

Results



With a median follow up of ten years, the 5 year actuarial event free survival rate for all patients is 31 % ; 13 % for primary metastatic patients and 37 % for patients seen with localised disease (p<0.001).

% Disease free Survival



Disease free survival


Pronostic factors



In primary localised tumor the major prognostic factors are the adequacy of surgical resection (p<0.01) and the high dose intensity of chemotherapy, particularly during the induction (p<0.05).

Influence of local treatment



Local treatment


Survival after radiotherapy



Local relapse


Patients treated with radiotherapy had a 44% risk of local relapse.
All subsequently died.

Influence of chemotherapy



Chemotherapy


Conclusion



-Primary metastatic patients require new approach
-Early wide resection of the primary and adequate dose intensity of a 6 drugs chemotherapy give best results in pelvic Ewing's despite large tumoral volume or even incomplete response to preoperative chemotherapy.


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