Publié sur :
Publication Powerpoint Delépine - 1995
Voir la version PDF de cette publication :
Pronostic Value of timing of surgery in localized Ewing's sarcoma of bone
Delépine G, Delépine F, Alkallaf S, Nicole Delepine
Pronostic value of timing of surgery in localized Ewing's Satcoma og Bone
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).
75 patients (aged from 4 to 40 y., average age 19) with Ewing's sarcoma of bone fulfilled the 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).
Metastatic patients and vertebral locations were excluded.
All patients received a multidrug chemotherapy and were treated by surgery (followed by radiotherapy in case of adult bad responders and/or marginal surgery.
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.
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).
shows that the difference is due to bad responders.
late local control is dismal for bad responders.
Local treatment must be done early, especially when histologic response is incomplete or uncertain.
A too long preoperative chemotherapy increases the risk of metastases in bad responders.
These factors must be taken into account when analyzing multicentric protocols.