Article
A prospective multicentre evaluation of intensive treatment including high dose chemotherapy (HDT) and PSCR for Ewing’s tumours (ET) with extra-pulmonary metastatic disease (EPMD). Results on behalf ofthe Euro-Ewing 99 Study Group
Search Medline for
Authors
Published: | March 20, 2006 |
---|
Outline
Text
Purpose: Development of an effective strategy for patients with EPMD.
Patients and Methods: Of 192 patients (pts) registered, 141pts have completed treatment. Median age is 15.8 years (yrs) ( 0.4-49.29). Primary site was extremity in 57pts and axial/other in 135pts (40.6% in the pelvis). Tumour volume was ≥200ml in 114pts. Metastatic spread was bone marrow (BM) only in 17pts, bone only in 94pts and bone&BM in 79pts. Other metastatic sites involved in addition lung (81pts), liver (7pts), CNS (7pts) and lymph nodes (11pts). Six VIDE induction cycles were completed by 123pts; reasons for <6VIDE were toxicity(7), patient choice(2 ), progression(6). Local treatment (surgery when possible and/or radiotherapy (Rx) as indicated) was documented in 86pts. Recommended HDT was busulphan 600mg/m² and melphalan 140 mg/m² with PSCR. Median follow up is 2 years (range 0.0-4.6).
Results: Partial remission or better was achieved in 45 by cycle 6 (42%). The overall survival at 2 years for all 192 pts is 32.8 (95% CI: 24.3– 41.3). Of 141pts only 84 pts received BuMel-HDT and 10 pts other HDT. BuMel pts achieved an OS of 30% at 2 years. Significantly favourable OS factors at Dx are age < 14 yrs (p=0.0069), BM involvement only (p=0.0057), single bone lesions only (p=0.0043), tumour volume of <200ml (p=0.0004).
Conclusions: Further strategy refinement and validation of HDT appears necessary within investigational, ideally randomised studies.