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BMC Cancer
Published in: BMC Cancer 1/2019

Open Access 01-12-2019 | Sarcoma | Research article

Impact of chemotherapy cycles and intervals on outcomes of nonspinal Ewing sarcoma in adults: a real-world experience

Authors: Jianjun Zhang, Yujing Huang, Yuanjue Sun, Aina He, Yan Zhou, Haiyan Hu, Yang Yao, Zan Shen

Published in: BMC Cancer | Issue 1/2019

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Abstract

Background

Adult Ewing sarcoma (ES) is a rare disease, the optimal treatment model is unknown. This study aimed to retrospectively analyze treatment-related prognostic factors of nonspinal ES in Chinese adults.

Methods

Eighty-one patients treated between January 2005 and December 2017 were included in the present study. Thirty-three (40.7%) presented with metastatic disease at diagnosis. Eight patients were submitted to primary surgery followed by chemotherapy, while 73 patients received chemotherapy before and after surgery and/or local radiotherapy. The chemotherapy regimen included 8–17 cycles of vincristine, doxorubicin, and cyclophosphamide (VDC) alternating with ifosfamide and etoposide (IE) every 3 weeks. Clinical outcomes and safety were analyzed.

Results

VDC/IE chemotherapy was well tolerated in adult patients with ES. Multivariate Cox regression analyses revealed that chemotherapy of at least 12 cycles was a favorable independent prognostic factor of event-free survival (hazard ratio, 0.558; 95% confidence interval, 0.323–0.965; P = 0.037) and overall survival (hazard ratio, 0.424; 95% confidence interval, 0.240–0.748; P = 0.003). Similarly, a low frequency of chemotherapy delays was an independent prognostic factor of improved OS (hazard ratio, 0.438; 95% confidence interval, 0.217–0.887; P = 0.022).

Conclusion

Our study suggests that adults with ES should be treated with an aggressive multidisciplinary approach, intensive chemotherapy with adequate cycles and appropriate intervals can be recommended in this group.
Literature
1.
Robinson SI, Ahmed SK, Okuno SH, Arndt CA, Rose PS, Laack NN. Clinical outcomes of adult patients with relapsed Ewing sarcoma: a 30-year single-institution experience. Am J Clin Oncol. 2014;37(6):585–91.CrossRefPubMed
2.
Cotterill SJ, Ahrens S, Paulussen M, Jurgens HF, Voute PA, Gadner H, et al. Prognostic factors in Ewing’s tumor of bone: analysis of 975 patients from the European intergroup cooperative Ewing's sarcoma study group. J Clin Oncol. 2000;18(17):3108–14.CrossRefPubMed
3.
Ganjoo KN, Patel S. The treatment outcome for adult patients with Ewing's sarcoma. Curr Oncol Rep. 2013;15(4):372–7.CrossRefPubMed
4.
Gaspar N, Hawkins DS, Dirksen U, Lewis IJ, Ferrari S, Le Deley MC, et al. Ewing sarcoma: current management and future approaches through collaboration. J Clin Oncol. 2015;33(27):3036–46.CrossRefPubMed
5.
Womer RB, West DC, Krailo MD, Dickman PS, Pawel BR, Grier HE, et al. Randomized controlled trial of interval-compressed chemotherapy for the treatment of localized Ewing sarcoma: a report from the Children's oncology group. J Clin Oncol. 2012;30(33):4148–54.CrossRefPubMedCentralPubMed
6.
Grier HE, Krailo MD, Tarbell NJ, Link MP, Fryer CJ, Pritchard DJ, et al. Addition of ifosfamide and etoposide to standard chemotherapy for Ewing's sarcoma and primitive neuroectodermal tumor of bone. N Engl J Med. 2003;348(8):694–701.CrossRefPubMed
7.
Burgert EO Jr, Nesbit ME, Garnsey LA, Gehan EA, Herrmann J, Vietti TJ, et al. Multimodal therapy for the management of nonpelvic, localized Ewing's sarcoma of bone: intergroup study IESS-II. J Clin Oncol. 1990;8(9):1514–24.CrossRefPubMed
8.
Juergens C, Weston C, Lewis I, Whelan J, Paulussen M, Oberlin O, et al. Safety assessment of intensive induction with vincristine, ifosfamide, doxorubicin, and etoposide (VIDE) in the treatment of Ewing tumors in the EURO-E.W.I.N.G. 99 clinical trial. Pediatr Blood Cancer. 2006;47(1):22–9.CrossRefPubMed
9.
Granowetter L, Womer R, Devidas M, Krailo M, Wang C, Bernstein M, et al. Dose-intensified compared with standard chemotherapy for nonmetastatic Ewing sarcoma family of tumors: a Children's oncology group study. J Clin Oncol. 2009;27(15):2536–41.CrossRefPubMedCentralPubMed
10.
Wagner MJ, Livingston JA, Patel SR, Benjamin RS. Chemotherapy for bone sarcoma in adults. J Oncol Pract. 2016;12(3):208–16.CrossRefPubMed
11.
Bacci G, Ferrari S, Comandone A, Zanone A, Ruggieri P, Longhi A, et al. Neoadjuvant chemotherapy for Ewing's sarcoma of bone in patients older than thirty-nine years. Acta Oncol. 2000;39(1):111–6.CrossRefPubMed
12.
Rodriguez-Galindo C, Liu T, Krasin MJ, Wu J, Billups CA, Daw NC, et al. Analysis of prognostic factors in Ewing sarcoma family of tumors: review of St. Jude Children’s Research Hospital studies. Cancer. 2007;110(2):375–84.CrossRefPubMed
13.
Orr WS, Denbo JW, Billups CA, Wu J, Navid F, Rao BN, et al. Analysis of prognostic factors in extraosseous Ewing sarcoma family of tumors: review of St. Jude Children's Research Hospital experience. Ann Surg Oncol. 2012;19(12):3816–22.CrossRefPubMed
14.
Paulussen M, Ahrens S, Dunst J, Winkelmann W, Exner GU, Kotz R, et al. Localized Ewing tumor of bone: final results of the cooperative Ewing's sarcoma study CESS 86. J Clin Oncol. 2001;19(6):1818–29.CrossRefPubMed
15.
Parkin DM, Stiller CA, Nectoux J. International variations in the incidence of childhood bone tumours. Int J Cancer. 1993;53(3):371–6.CrossRefPubMed
16.
Jawad MU, Cheung MC, Min ES, Schneiderbauer MM, Koniaris LG, Scully SP. Ewing sarcoma demonstrates racial disparities in incidence-related and sex-related differences in outcome: an analysis of 1631 cases from the SEER database, 1973-2005. Cancer. 2009;115(15):3526–36.CrossRefPubMed
17.
Zhang J, Huang Y, Lu J, He A, Zhou Y, Hu H, et al. Impact of first-line treatment on outcomes of Ewing sarcoma of the spine. Am J Cancer Res. 2018;8(7):1262–72.PubMedPubMedCentral
18.
Ladenstein R, Potschger U, Le Deley MC, Whelan J, Paulussen M, Oberlin O, et al. Primary disseminated multifocal Ewing sarcoma: results of the Euro-EWING 99 trial. J Clin Oncol. 2010;28(20):3284–91.CrossRefPubMed
19.
Tao HT, Hu Y, Wang JL, Cheng Y, Zhang X, Wang H, et al. Extraskeletal Ewing sarcomas in late adolescence and adults: a study of 37 patients. Asian Pac J Cancer Prev. 2013;14(5):2967–71.CrossRefPubMed
20.
El Weshi A, Allam A, Ajarim D, Al Dayel F, Pant R, Bazarbashi S, et al. Extraskeletal Ewing’s sarcoma family of tumours in adults: analysis of 57 patients from a single institution. Clin Oncol (R Coll Radiol). 2010;22(5):374–81.CrossRef
21.
Ahmed SK, Robinson SI, Okuno SH, Rose PS, Issa Laack NN. Adult Ewing sarcoma: survival and local control outcomes in 36 patients with metastatic disease. Am J Clin Oncol. 2014;37(5):423–9.CrossRefPubMed
22.
Seker MM, Kos T, Ozdemir N, Seker A, Aksoy S, Uncu D, et al. Treatment and outcomes of Ewing sarcoma in Turkish adults: a single Centre experience. Asian Pac J Cancer Prev. 2014;15(1):327–30.CrossRefPubMed
23.
Gupta AA, Pappo A, Saunders N, Hopyan S, Ferguson P, Wunder J, et al. Clinical outcome of children and adults with localized Ewing sarcoma: impact of chemotherapy dose and timing of local therapy. Cancer. 2010;116(13):3189–94.CrossRefPubMed
24.
Casey DL, Meyers PA, Alektiar KM, Magnan H, Healey JH, Boland PJ, et al. Ewing sarcoma in adults treated with modern radiotherapy techniques. Radiother Oncol. 2014;113(2):248–53.CrossRefPubMed
25.
Lee J, Hoang BH, Ziogas A, Zell JA. Analysis of prognostic factors in Ewing sarcoma using a population-based cancer registry. Cancer. 2010;116(8):1964–73.CrossRefPubMed
26.
Paioli A, Luksch R, Fagioli F, Tamburini A, Cesari M, Palmerini E, et al. Chemotherapy-related toxicity in patients with non-metastatic Ewing sarcoma: influence of sex and age. J Chemother. 2014;26(1):49–56.CrossRefPubMed
27.
Diaz-Beveridge R, Lorente D, Torres B, Canete A, Rodrigo E, Bruixola G, et al. Multimodality treatment of pediatric and adult patients with Ewing sarcoma: a single-institution experience. J Pediatr Hematol Oncol. 2015;37(5):e278–84.CrossRefPubMed
28.
29.
Verrill MW, Judson IR, Harmer CL, Fisher C, Thomas JM, Wiltshaw E. Ewing's sarcoma and primitive neuroectodermal tumor in adults: are they different from Ewing's sarcoma and primitive neuroectodermal tumor in children? J Clin Oncol. 1997;15(7):2611–21.CrossRefPubMed
30.
Fizazi K, Dohollou N, Blay JY, Guerin S, Le Cesne A, Andre F, et al. Ewing's family of tumors in adults: multivariate analysis of survival and long-term results of multimodality therapy in 182 patients. J Clin Oncol. 1998;16(12):3736–43.CrossRefPubMed
31.
Lyman GH. Impact of chemotherapy dose intensity on cancer patient outcomes. J Natl Compr Cancer Netw. 2009;7(1):99–108.CrossRef
32.
Tahover E, Segal A, Isacson R, Rosengarten O, Grenader T, Gips M, et al. Dexrazoxane added to doxorubicin-based adjuvant chemotherapy of breast cancer: a retrospective cohort study with a comparative analysis of toxicity and survival. Anti-Cancer Drugs. 2017;28(7):787–94.CrossRefPubMed
33.
Reichardt P, Tabone MD, Mora J, Morland B, Jones RL. Risk-benefit of dexrazoxane for preventing anthracycline-related cardiotoxicity: re-evaluating the European labeling. Future Oncol. 2018;14(25):2663–76.CrossRefPubMed
34.
Lipshultz SE, Scully RE, Lipsitz SR, Sallan SE, Silverman LB, Miller TL, et al. Assessment of dexrazoxane as a cardioprotectant in doxorubicin-treated children with high-risk acute lymphoblastic leukaemia: long-term follow-up of a prospective, randomised, multicentre trial. Lancet Oncol. 2010;11(10):950–61.CrossRefPubMedCentralPubMed
35.
Chow EJ, Asselin BL, Schwartz CL, Doody DR, Leisenring WM, Aggarwal S, et al. Late mortality after Dexrazoxane treatment: a report from the Children’s oncology group. J Clin Oncol. 2015;33(24):2639–45.CrossRefPubMedCentralPubMed
Metadata
Title
Impact of chemotherapy cycles and intervals on outcomes of nonspinal Ewing sarcoma in adults: a real-world experience
Authors
Jianjun Zhang
Yujing Huang
Yuanjue Sun
Aina He
Yan Zhou
Haiyan Hu
Yang Yao
Zan Shen
Publication date
01-12-2019
Publisher
BioMed Central
Published in
BMC Cancer / Issue 1/2019
Electronic ISSN: 1471-2407
DOI
https://doi.org/10.1186/s12885-019-6407-5

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