Risk adapted chemotherapy for localised Ewing鈥檚 sarcoma of bone: The French EW93 study

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• 作者：Nathalie Gaspar^a ; ^s ; ^{Nathalie.GASPAR@igr.fr} ; Annie Rey^b ; ^s ; Perrine Marec Bé ; rard^c ; ^s ; Jean Michon^d ; ^s ; Jean Claude Gentet^e ; ^s ; Marie Dominique Tabone^f ; ^s ; Henri Roché ; ^g ; ^s ; Anne Sophie Defachelles^h ; ^s ; Odile Lejarsⁱ ; ^s ; Emmanuel Plouvier^j ; ^s ; Claudine Schmitt^k ; ^s ; Binh Bui^l ; ^s ; Patrick Boutard^m ; ^s ; Sophie Taqueⁿ ; ^s ; Martine Munzer^o ; ^s ; Jean-Pierre Vannier^p ; ^s ; Dominique Plantaz^q ; ^s ; Natacha Enz-Werlé ; ^r ; ^s ; Odile Oberlin^a ; ^s
• 关键词：Ewing&rsquo ; s sarcoma ; Peripheral neuroectodermal tumours (PNET) ; High dose chemotherapy ; Stem cell transplant ; Prognostic factors ; Histological response
• 刊名：European Journal of Cancer
• 出版年：2012
• 期刊代码：88_09598049
• 类别：med
• 出版时间：June, 2012
• 卷：48
• 期：9
• 页码：1376-1385
• 文件大小：981 K

摘要

Aim of the study

To determine whether a risk factor adapted chemotherapy would improve the outcome of non-metastatic bone Ewing鈥檚 sarcoma.

Methods

Standard risk tumours (SR, good histological response to chemotherapy or small unresected tumours) received the previous EW88 chemotherapy. Ifosfamide/etoposide (IE) were introduced after 3 courses of cyclophosphamide/doxorubicine when tumour regression was <50%or during consolidation therapy for the intermediate risk tumours (IR, intermediate histological response 5-30%residual cells or large unresected tumours >100 ml). High risk tumours (HR, histological poor response >30%residual cells or clinical poor response <50%for unresectable tumours), received IE prior high dose busulfan/melphalan with stem cell rescue.

Results

From 1993 to 1999, 214 patients were enrolled. 5y-EFS and OS were 60%(95%confidence interval (CI), 53-66) and 69%(95%CI, 63-75), respectively. 116 (54%), 46 (21%), 48 (22%) patients were considered as SR, IR and HR of relapse, respectively. No advantage to IE was observed in the IR group. As compared to previous study, tumour with poor histological response to induction chemotherapy seemed to benefit from the consolidation strategy including busulfan/melphalan: EFS were 45%(95%CI, 30-60) and 20%(95%CI, 7-43) for EW93 and EW88, respectively. Despite a risk-adapted strategy, histological response to chemotherapy remains the main prognostic factor in resected tumours, while initial tumour volume is the main prognostic factor for unresected tumours.

Conclusion

These results showing a potential benefit of a consolidation strategy including busulfan/melphalan as compared to conventional chemotherapy needed confirmation by a randomised trial and were one of the bases of the ongoing EuroEwing99.