Ewing's sarcoma: only patients with 100% of necrosis after chemotherapy should be classified as having a good response

• Published in: The bone & joint journal Vol. 98-B; no. 8; pp. 1138 - 1144
• Main Authors: Albergo, J I, Gaston, C L, Laitinen, M, Darbyshire, A, Jeys, L M, Sumathi, V, Parry, M, Peake, D, Carter, S R, Tillman, R, Abudu, A T, Grimer, R J
• Format: Journal Article
• Language: English
• Published: England 01.08.2016
• Subjects: Adolescent; Adult; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Bone Neoplasms - drug therapy; Bone Neoplasms - mortality; Bone Neoplasms - surgery; Child; Child, Preschool; Disease-Free Survival; Female; Humans; Infant; Kaplan-Meier Estimate; Male; Middle Aged; Necrosis; Pelvic Neoplasms - drug therapy; Pelvic Neoplasms - mortality; Pelvic Neoplasms - surgery; Prospective Studies; Sarcoma, Ewing - drug therapy; Sarcoma, Ewing - mortality; Sarcoma, Ewing - surgery; Spinal Neoplasms - drug therapy; Spinal Neoplasms - mortality; Spinal Neoplasms - surgery; Thoracic Neoplasms - drug therapy; Thoracic Neoplasms - mortality; Treatment Outcome; Young Adult; Event free survival; Ewing sarcoma; Overall survival; Histological response
• ISSN: 2049-4394; 2049-4408
• DOI: 10.1302/0301-620X.98B8.37346

The purpose of this study was to review a large cohort of patients and further assess the correlation between the histological response to chemotherapy in patients with Ewing's sarcoma with the overall (OS) and event-free survival (EFS). All patients treated for Ewing's sarcoma between 1980 and 2012 were reviewed. Of these, 293 patients without metastases at the time of diagnosis and treated with chemotherapy and surgery were included. Patients were grouped according to the percentage of necrosis after chemotherapy: Group I: 0% to 50%, Group II: 51% to 99% and Group III: 100%. The mean age at diagnosis was 16 years (1 to 62) and the mean follow-up was 9.1 years (six months to 32.6 years). The OS and EFS for the series were 75% and 65% at five years. There were significant differences in survival between the groups of necrosis: 0% to 50% (OS: 49% and EFS: 45% at five years, respectively) compared with 51% to 99% (OS: 72% and EFS: 59% at five years, respectively) and 100% (OS: 94% and EFS: 81% at five years, respectively) (p < 0.001). There were no significant differences in survival between patients treated between 1980 and 1989 compared with those treated between 1990 and 1999, and those treated between 2000 and 2012 (p = 0.55). Only patients with 100% necrosis after chemotherapy should be classified as having a good response to chemotherapy because they have significantly better rates of survival compared with those with any viable tumour in the surgical specimen. Cite this article: Bone Joint J 2016;98-B:1138-44.