Key result
At least 12 chemotherapy cycles linked to ~58% lower mortality risk in nonspinal Ewing sarcoma.
Why the study?
The optimal treatment model for adult nonspinal Ewing sarcoma is unknown, necessitating analysis of treatment-related prognostic factors.
Does intensive chemotherapy with adequate cycles (≥12) and appropriate intervals improve survival in adults with nonspinal Ewing sarcoma?
Cohort (n=81)
No
Does intensive chemotherapy with adequate cycles (≥12) and appropriate intervals improve survival in adults with nonspinal Ewing sarcoma?
Hazard Ratio: 0.424 (95% CI 0.24–0.748)
p-value: p=0.003
In adult patients with nonspinal Ewing sarcoma, receiving at least 12 cycles of chemotherapy and minimizing treatment delays independently improves event-free and overall survival.
May guide ≥12-cycle chemotherapy decisions in adult nonspinal Ewing sarcoma; leaves open randomized confirmation of survival benefit.
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.
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Zhang et al. (2019) conducted a cohort in Nonspinal Ewing sarcoma (n=81). Chemotherapy of at least 12 cycles vs. Chemotherapy of less than 12 cycles was evaluated on Overall survival (HR 0.424, 95% CI 0.240-0.748, p=0.003). In adult patients with nonspinal Ewing sarcoma, receiving at least 12 cycles of chemotherapy was associated with significantly improved overall survival (HR 0.424) compared to fewer cycles.
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