Ataergin Selmin, Ozet Ahmet, Solchaga Luis, Turan Mustafa, Beyzadeoglu Murat, Oysul Kaan, Arpaci Fikret, Komurcu Seref, Surenkok Serdar, Ozturk Mustafa
Faculty of Medicine, Department of Medical Oncology and Bone Marrow Transplantation, GATA (Gulhane), Etlik, 06018 Ankara, Turkey.
Med Oncol. 2009;26(3):276-86. doi: 10.1007/s12032-008-9115-6. Epub 2008 Nov 7.
The outcome of Ewing's sarcoma depends on the anatomical site of the tumor. Studies conducted in high-risk patients are limited. We evaluated the outcome of high-risk Ewing's sarcoma patients that received long-term treatment protocol. Twenty-five patients (22 males, 3 females) with poor prognostic features were treated according to long-term Ewing's sarcoma protocol. Central-axis localization, inadequacy or unavailability of surgical resection, older than 15 years of age, are accepted as high-risk factors. The median age of patients was 23 years (range, 18-55). The tumor localization was pelvis (9), femur (1), tibia (1), fibula (1), maxilla (1), clavicle (1), vertebrae (5), metatarse (1), and ribs (5). Neoadjuvant chemotherapy was applied between weeks 0 and 6, local therapy on week 9, and adjuvant maintenance chemotherapy between weeks 11 and 41. All patients received neoadjuvant and adjuvant maintenance chemotherapy. Local therapy consisted of radiotherapy (32%), surgery alone (12%), or surgery and radiotherapy (56%). The median total treatment period was 10 months. The median follow-up was 25 months (range, 7-89). Three-year cumulative OS and DFS rates were 43% (95% CI, 28.5-57.85) and 40% (95% CI 23.63-52.19), respectively. The most common grade III/IV toxicities observed during the treatment protocol were neutropenia (16%) and gastrointestinal toxicities (16%). Our study indicated that long-term multiagent combination chemotherapy may result in better outcome in adult high-risk patients undergoing adequate surgical resection of the tumor and local radiotherapy. Further randomized studies are needed to assess the efficacy of this treatment protocol in patients with adequate surgical margins.
尤因肉瘤的预后取决于肿瘤的解剖部位。针对高危患者开展的研究有限。我们评估了接受长期治疗方案的高危尤因肉瘤患者的预后。25例（22例男性，3例女性）具有不良预后特征的患者按照尤因肉瘤长期方案接受治疗。中心轴定位、手术切除不充分或无法进行手术切除、年龄超过15岁被视为高危因素。患者的中位年龄为23岁（范围18 - 55岁）。肿瘤部位为骨盆（9例）、股骨（1例）、胫骨（1例）、腓骨（1例）、上颌骨（1例）、锁骨（1例）、椎骨（5例）、跖骨（1例）和肋骨（5例）。新辅助化疗在第0至6周进行，局部治疗在第9周进行，辅助维持化疗在第11至41周进行。所有患者均接受新辅助和辅助维持化疗。局部治疗包括放疗（32%）、单纯手术（12%）或手术加放疗（56%）。中位总治疗期为10个月。中位随访时间为25个月（范围7 - 89个月）。三年累积总生存率和无病生存率分别为43%（95%CI，28.5 - 57.85）和40%（95%CI 23.63 - 52.19）。在治疗方案期间观察到的最常见的III/IV级毒性反应为中性粒细胞减少（16%）和胃肠道毒性（16%）。我们的研究表明，长期多药联合化疗可能使接受了充分肿瘤手术切除和局部放疗的成年高危患者获得更好的预后。需要进一步的随机研究来评估该治疗方案在手术切缘充分的患者中的疗效。
