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Zandaki D, Ismael T, Halalsheh H, Ibrahimi AKH, Sarhan N, Ghandour K, Shehadeh A, Sultan I. Outcomes of Pediatric Patients With Metastatic Ewing Sarcoma Treated With Interval Compression. J Pediatr Hematol Oncol 2023; 45:111-115. [PMID: 35537074 DOI: 10.1097/mph.0000000000002478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 03/31/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Interval compression (IC), a regimen of alternating vincristine/doxorubicin/cyclophosphamide and ifosfamide/etoposide every 2 weeks, improves survival for localized Ewing sarcoma (ES), with uncertain effect on metastatic disease. MATERIALS AND METHODS We reviewed the charts of pediatric patients with metastatic ES treated with IC at our center between January 2013 and March 2020. We calculated event-free survival and overall survival (OS) and used log-rank tests for univariate comparisons. RESULTS We identified 34 patients 2.7 to 17.1 years of age (median: 11.6 y). Twenty-six patients (76%) had pulmonary metastases, and 14 (41%) had extrapulmonary metastases. All patients received local control therapy: surgery only (n=7, 21%), radiotherapy only (n=18, 53%), or both (n=9, 26%). The estimated 3-year OS and event-free survival were 62%±9% and 39%±9%, respectively. Patients with pulmonary-only and extrapulmonary metastasis had a 3-year OS of 88%±8% and 27%±13%, respectively ( P =0.0074). Age group (above vs. below 12 y), or primary tumor site did not affect survival, but local control therapy did (surgery only, 83%±15%; combined surgery and radiation, 30%±18%; radiation only, 15%±10%; P =0.048). CONCLUSION IC yielded similar outcomes for patients with metastatic ES to other reported regimens. We suggest including this approach to other blocks of therapy.
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Affiliation(s)
- Dua'a Zandaki
- Department of Pediatrics, King Hussein Cancer Center
| | - Taleb Ismael
- Department of Pediatrics, King Hussein Cancer Center
- Department of Pediatrics, the University of Jordan, Amman, Jordan
| | - Hadeel Halalsheh
- Department of Pediatrics, King Hussein Cancer Center
- Department of Pediatrics, the University of Jordan, Amman, Jordan
| | | | - Nasim Sarhan
- Department of Pediatrics, King Hussein Cancer Center
| | | | | | - Iyad Sultan
- Department of Pediatrics, King Hussein Cancer Center
- Department of Pediatrics, the University of Jordan, Amman, Jordan
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Huang C, Yu QP, Ding Z, Zhou Z, Shi X. The clinical characteristics, novel predictive tool, and risk classification system for primary Ewing sarcoma patients that underwent chemotherapy: A large population-based retrospective cohort study. Cancer Med 2023; 12:6244-6259. [PMID: 36271609 PMCID: PMC10028057 DOI: 10.1002/cam4.5379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Revised: 09/07/2022] [Accepted: 10/09/2022] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND This study aims to determine the independent prognostic predictors of cancer-specific survival (CSS) in patients with primary Ewing sarcoma (ES) that underwent chemotherapy and create a novel prognostic nomogram and risk stratification system. METHODS Demographic and clinicopathologic characteristics related to patients with primary ES that underwent chemotherapy between 2000 and 2018 were extracted from the Surveillance, Epidemiology, and End Results (SEER) database. CSS was the primary endpoint of this study. First, independent prognostic predictors of CSS identified from univariate and multivariate Cox regression analyses were used to construct a prognostic nomogram for predicting 1-, 3-, and 5-year CSS of patients with primary ES that underwent chemotherapy. Then, calibration curves and receiver operating characteristic (ROC) curves were used to evaluate the nomogram's prediction accuracy, while decision curve analysis (DCA) was used to evaluate the nomogram's clinical utility. Finally, a mortality risk stratification system was constructed for this subpopulation. RESULTS A total of 393 patients were included in this study. Age, tumor size, bone metastasis, and surgery were independent prognostic predictors of CSS. The calibration curves, ROC, and DCA showed that the nomogram had excellent discrimination and clinical value, with the 1-, 3-, and 5-year AUCs higher than 0.700. Moreover, the mortality risk stratification system could effectively divide all patients into three risk subgroups and achieve targeted patient management. CONCLUSIONS Based on the SEER database, a novel prognostic nomogram for predicting 1-, 3-, and 5- year CSS in patients with primary ES that underwent chemotherapy has been constructed and validated. The nomogram showed relatively good performance, which could be used in clinical practice to assist clinicians in individualized treatment strategies.
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Affiliation(s)
- Chao Huang
- Department of Orthopedics, West China Hospital of Sichuan University, Chengdu, China
| | - Qiu-Ping Yu
- Health Management Center, West China Hospital of Sichuan University, Chengdu, China
| | - Zichuan Ding
- Department of Orthopedics, West China Hospital of Sichuan University, Chengdu, China
| | - Zongke Zhou
- Department of Orthopedics, West China Hospital of Sichuan University, Chengdu, China
| | - Xiaojun Shi
- Department of Orthopedics, West China Hospital of Sichuan University, Chengdu, China
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Xu J, Zhi X, Xie L, Sun X, Liu X, Liu K, Guo W. Long-term outcome and relapse patterns in Ewing sarcoma patients with extensive lung/pleural metastases after a complete response to systemic therapy. BMC Cancer 2022; 22:500. [PMID: 35524212 PMCID: PMC9074284 DOI: 10.1186/s12885-022-09618-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 04/25/2022] [Indexed: 12/04/2022] Open
Abstract
Background Ewing sarcoma (ES) is sensitive to systemic therapy, including chemotherapy and anti-angiogenesis Tyrosine Kinase Inhibitors(aaTKIs). However, the prognosis of patients with metastatic disease remains poor. Recurrence or distant metastasis after a complete response (CR) or near-CR due to systemic therapy is not rare. Methods We reviewed data from 187 ES patients between 2014–2019 treated at a single institute in China. Patients with extensive lung/pleural metastases (L/Pmeta) who had a CR or near-CR after first- or second-line chemotherapy with or without aaTKIs were retrospectively enrolled. Event-free survival (EFS) and overall survival (OS) were determined using the Kaplan–Meier method. For patients who had L/P recurrence, images were reviewed to define the exact location of each recurrent lesion, compared with the primary L/P lesion before chemotherapy and summarized as the relapse pattern. Results Seventeen patients and 21 cases of CR/nCR (5 by VDC/IE, 3 by VIT, and 13 by AVI) were finally analyzed. Median follow-up for surviving patients was 39.6 (range, 14.5–60.9) months. Median EFS and OS were 9.3 (95% confidence interval [CI], 2.0–16.6) months and 37.5 (95% CI, 21.8–53.1) months, respectively. The 2-year EFS was 19% and the 2-year OS was 70.6%, respectively. Most patients (82.4%) received whole lung irradiation (WLI). Lung/pleural relapse occurred in 71.4% (15/21) of CR/nCR cases. Most notably, all recurrent lesions exactly coincided with the original metastatic lesions before chemotherapy (exactly in situ) in 9 of the 15 recurrent cases, which was thus the major relapse pattern, whereas 42.9% had distant metastases other than L/Pmeta. Conclusions Survival of ES patients with extensive L/Pmeta remains poor, even if they have a CR after systemic therapy. Recurrence exactly in situ is the major relapse pattern. WLI is not sufficient to prevent local recurrence in lung or pleura. More aggressive local treatment for metastatic lesions is warranted.
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Affiliation(s)
- Jie Xu
- Musculoskeletal Tumor Center, Peking University People's Hospital, 11 Xizhimen South Street, Beijing, China
| | - Xin Zhi
- Radiology Department, Peking University People's Hospital, 11 Xizhimen South Street, Beijing, China
| | - Lu Xie
- Musculoskeletal Tumor Center, Peking University People's Hospital, 11 Xizhimen South Street, Beijing, China
| | - Xin Sun
- Musculoskeletal Tumor Center, Peking University People's Hospital, 11 Xizhimen South Street, Beijing, China
| | - Xingyu Liu
- Musculoskeletal Tumor Center, Peking University People's Hospital, 11 Xizhimen South Street, Beijing, China
| | - Kuisheng Liu
- Musculoskeletal Tumor Center, Peking University People's Hospital, 11 Xizhimen South Street, Beijing, China
| | - Wei Guo
- Musculoskeletal Tumor Center, Peking University People's Hospital, 11 Xizhimen South Street, Beijing, China.
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Zhang L, Xiong L, Wu LM, Shen WH, Zhou P, Lian CL, Zhang WT, Wu SG. The patterns of distant metastasis and prognostic factors in patients with primary metastatic Ewing sarcoma of the bone. J Bone Oncol 2021; 30:100385. [PMID: 34401227 PMCID: PMC8355910 DOI: 10.1016/j.jbo.2021.100385] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 07/21/2021] [Accepted: 07/21/2021] [Indexed: 10/25/2022] Open
Abstract
Background Ewing sarcoma (ES) of bone is accounting for the second most common type of primary bone cancer in children and adolescents. However, the patterns of distant metastasis (DM) and the effect of the sites of DM on survival outcomes were not investigated. Aims This study aimed to investigate the patterns of DM and the prognostic factors related to outcomes in primary metastatic ES of the bone. Methods Patients who were diagnosed with primary metastatic ES between 2010 and 2018 were identified from the Surveillance, Epidemiology, and End Results database. Kaplan-Meier analysis, log-rank tests, and Cox proportional-hazards regression models were used for statistical analyses. Results We identified 277 patients in this study and 95.3% of them (n = 264) receiving chemotherapy. A total of 371 sites of DM were observed. Lung was the most common distant metastatic site (n = 182, 49.1%), followed by bone (n = 139, 37.5%), distant lymph node (n = 26, 7.0%), liver (n = 14, 3.8%), and brain (n = 10, 2.7%). Three-year cause-specific survival (CSS) was 56.1% in the entire cohort. Older age (hazard ratio [HR] 2.210, P < 0.001) and bone metastasis (HR 1.903, P = 0.002) were the independent prognostic factors associated with inferior CSS. Similar results were found in those with bone-only metastasis (n = 80) or lung-only metastasis (n = 117), which showed that patients with bone-only metastasis had an inferior CSS compared to those with metastases only to the lung (HR 1.926, P = 0.005). Conclusions Lung and bone are the most frequently distant metastatic sites in patients with primary metastatic ES of bone. Bone metastasis is an independent risk factor for inferior survival.
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Affiliation(s)
- Lei Zhang
- Department of Orthopaedic Surgery, Xiamen Branch, Zhongshan Hospital, Fudan University, Xiamen 361000, People's Republic of China
| | - Lu Xiong
- Medical Center, Hainan General Hospital (Hainan Affiliated Hospital of Hainan Medical University), Haikou 570311, People's Republic of China
| | - Li-Mei Wu
- Department of Anesthesiology, The First Affiliated Hospital of Xiamen University, Xiamen 361003, People's Republic of China
| | - Wen-Hui Shen
- Department of Orthopaedic Surgery, Xiamen Branch, Zhongshan Hospital, Fudan University, Xiamen 361000, People's Republic of China
| | - Ping Zhou
- Department of Radiation Oncology, The First Affiliated Hospital of Xiamen University, Xiamen 361003, People's Republic of China
| | - Chen-Lu Lian
- Department of Radiation Oncology, The First Affiliated Hospital of Xiamen University, Xiamen 361003, People's Republic of China
| | - Wen-Tong Zhang
- Department of Orthopaedic Surgery, Xiamen Branch, Zhongshan Hospital, Fudan University, Xiamen 361000, People's Republic of China
| | - San-Gang Wu
- Department of Radiation Oncology, The First Affiliated Hospital of Xiamen University, Xiamen 361003, People's Republic of China
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Stachelek GC, Ligon JA, Vogel J, Levin AS, Llosa NJ, Ladle BH, Meyer CF, Terezakis SA, Morris CD, Ladra MM, Pratilas CA. Predictors of Recurrence and Patterns of Initial Failure in Localized Ewing Sarcoma: A Contemporary 20-Year Experience. Sarcoma 2021; 2021:6681741. [PMID: 33953640 PMCID: PMC8068528 DOI: 10.1155/2021/6681741] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 03/30/2021] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND The majority of patients with localized Ewing sarcoma will remain disease-free long term, but for those who suffer recurrence, successful treatment remains a challenge. Identification of clinicopathologic factors predictive of recurrence could suggest areas for treatment optimization. We sought to describe our experience regarding predictors of recurrence and patterns of first failure in patients receiving modern systemic therapy for nonmetastatic Ewing sarcoma. METHODS The medical records of pediatric and adult patients treated for localized Ewing sarcoma between 1999 and 2019 at Johns Hopkins Hospital were retrospectively analyzed. Local control was surgery, radiotherapy, or both. Recurrence-free survival (RFS) was calculated using the Kaplan-Meier method. Univariable and multivariable Cox proportional-hazards modeling was performed to obtain hazard ratios (HR) for recurrence. RESULTS In 94 patients with initially localized disease, there were 21 recurrences: 4 local, 14 distant, and 3 combined. 5-year and 10-year RFS were 75.6% and 70.5%, respectively. On multivariable analysis including age at diagnosis and tumor size, <95% tumor necrosis following neoadjuvant chemotherapy (NAC; HR 14.3, p = 0.028) and radiological tumor size change during NAC (HR 1.04 per 1% decrease in size change, p = 0.032) were independent predictors of recurrence. Among patients experiencing distant recurrence, pulmonary metastases were present in 82% and were the only identifiable site of disease in 53%. CONCLUSIONS Poor pathologic or radiologic response to NAC is predictive of recurrence in patients with localized Ewing sarcoma. Suboptimal tumor size reduction following chemotherapy provides a means to risk-stratify patients who do not undergo definitive resection. Isolated pulmonary recurrence was a common event.
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Affiliation(s)
- Gregory C. Stachelek
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - John A. Ligon
- Department of Pediatric Oncology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jennifer Vogel
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Adam S. Levin
- Department of Orthopedic Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Nicolas J. Llosa
- Department of Pediatric Oncology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Brian H. Ladle
- Department of Pediatric Oncology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Christian F. Meyer
- Department of Medical Oncology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Stephanie A. Terezakis
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Carol D. Morris
- Department of Orthopedic Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Matthew M. Ladra
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Christine A. Pratilas
- Department of Pediatric Oncology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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