Publié sur : Publication Powerpoint Delépine - 1995
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Pronostic Value of timing of surgery in localized Ewing's sarcoma of bone
Delépine G, Delépine F, Alkallaf S, Nicole Delepine

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Pronostic value of timing of surgery in localized Ewing's Satcoma og Bone

Introduction

The increasing efficacy of neo-adjuvant chemotherapy in Ewing's sarcoma modifies the prognostic factors.
In a recent monocentric study the classical prognostic value of size and location of the primary disappeared (J. of Chemoerapy,Delepine and Al, vol 9, n°5 352-363 ; 1997).

The role of Local Treatment

Is rarely analysed, because a too small number of comparable patients and type of surgery.

Aim of the study

This study tries to investigate the role of the timing of surgery for disease free survival (DFS).

Material

75 patients (aged from 4 to 40 y., average age 19) with Ewing's sarcoma of bone fulfilled the inclusion criteria.

Inclusion Criteria

Localized tumor at first screening (CT of lungs + bone scan), location of tumor in en bloc resectable bones (limbs, scapula, inominate, rib, maxillar, skull).

Exclusion Criteria

Metastatic patients and vertebral locations were excluded.

Treatments

All patients received a multidrug chemotherapy and were treated by surgery (followed by radiotherapy in case of adult bad responders and/or marginal surgery.

Histologic Response

The histologic response was evaluated according to Picci's criteria (J. Clin. Oncol. ; Picci and Al : 1993 ; 11 1793-69).
The date of local treatment is calculated from biopsy to surgery in weeks.

Results

With a median follow up of 54 months, 41 patients are in first complete remission.

Pronostic value of timing of surgery

Patients operated before the 10th week have a higher chance of first complete remission than patients operated later (65% vs 42%).
The difference is significant (p < 0.03).

Further Analysis

shows that the difference is due to bad responders.
late local control is dismal for bad responders.


Good responders


Bad Responders

Conclusion I

Local treatment must be done early, especially when histologic response is incomplete or uncertain.

Conclusion II

A too long preoperative chemotherapy increases the risk of metastases in bad responders.
These factors must be taken into account when analyzing multicentric protocols.

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