Ian Joseph Cohen1,2, Helen Toledano3,4, Jerry Stein3,4, Yehuda Kollender4,5, Eyal Fenig4,6, Osnat Konen4,7, Zvi Bar-Sever4,8, Josephine Issakov4,9, Meora Feinmesser4,10, Smadar Avigad4,11, Shifra Ash3,4. 1. The Rina Zaizov Hematology-Oncology Division, Schneider Children's Medical Center of Israel, Petach Tikva, Israel. icohen@tau.ac.il. 2. Sackler faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. icohen@tau.ac.il. 3. The Rina Zaizov Hematology-Oncology Division, Schneider Children's Medical Center of Israel, Petach Tikva, Israel. 4. Sackler faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. 5. Unit of Orthopedic Oncology, Tel Aviv Medical Center, Tel Aviv, Israel. 6. Department of Radiotherapy, Rabin Medical Center, Beilinson Hospital, Petach Tikva, Israel. 7. Department of Pediatric Radiology, Schneider Children's Medical Center of Israel, Petach Tikva, Israel. 8. Department of Nuclear Medicine, Schneider Children's Medical Center of Israel, Petach Tikva, Israel. 9. Institute of Pathology, Sourasky Tel Aviv Medical Center, Tel Aviv, Israel. 10. Institute of Pathology, Beilinson Hospital, Petach Tikva, Israel. 11. Molecular Oncology, Felsenstein Medical Research Center, Beilinson Hospital, Petach Tikva, Israel.
Abstract
PURPOSE: We report the unexpected absence of early relapse (before 30 months) in 24 consecutive patients with isolated limb primary Ewing sarcoma treated with an intensified pilot protocol, SCMCIE94. METHODS: Clinical data for the study were collected retrospectively from the patient files. The protocol included 6 courses of chemotherapy, split radiation, and limb salvage surgery. This SCMCIE94 protocol had been used in almost all the patients described in an earlier report, in whom those with non-pelvic isolated tumors and low/absent CD56 expression in Ewing sarcoma tumor cells were all long-term survivors. RESULTS: The 5-year (10-year) event-free survival rate for the patients with isolated limb primary Ewing sarcoma was 78.95 ± 8.3% (68.6 ± 10.0%) and the overall survival rate was 90.7 ± 6.2% (71.1 ± 11.2%). There were no relapses before 30 months in any of these patients. CONCLUSION: The intensified SCMCIE94 pilot protocol has been shown previously to cure patients with localized CD56-negative non-pelvic Ewing sarcoma. The present study shows that among all patients with localized extremity disease who were treated with this protocol, there were no cases of early relapse. Although our cohort was small, the difference in results from studies using other protocols is so striking, that it would seem reasonable to assume it is attributable to the changes made in the protocol itself rather than risk factors. Late relapses of isolated limb CD56-positive Ewing sarcoma suggest minimal residual disease warranting additional therapeutic approaches such as autologous stem cell rescue after Busulfan Melfelan.
PURPOSE: We report the unexpected absence of early relapse (before 30 months) in 24 consecutive patients with isolated limb primary Ewing sarcoma treated with an intensified pilot protocol, SCMCIE94. METHODS: Clinical data for the study were collected retrospectively from the patient files. The protocol included 6 courses of chemotherapy, split radiation, and limb salvage surgery. This SCMCIE94 protocol had been used in almost all the patients described in an earlier report, in whom those with non-pelvic isolated tumors and low/absent CD56 expression in Ewing sarcoma tumor cells were all long-term survivors. RESULTS: The 5-year (10-year) event-free survival rate for the patients with isolated limb primary Ewing sarcoma was 78.95 ± 8.3% (68.6 ± 10.0%) and the overall survival rate was 90.7 ± 6.2% (71.1 ± 11.2%). There were no relapses before 30 months in any of these patients. CONCLUSION: The intensified SCMCIE94 pilot protocol has been shown previously to cure patients with localized CD56-negative non-pelvic Ewing sarcoma. The present study shows that among all patients with localized extremity disease who were treated with this protocol, there were no cases of early relapse. Although our cohort was small, the difference in results from studies using other protocols is so striking, that it would seem reasonable to assume it is attributable to the changes made in the protocol itself rather than risk factors. Late relapses of isolated limb CD56-positive Ewing sarcoma suggest minimal residual disease warranting additional therapeutic approaches such as autologous stem cell rescue after BusulfanMelfelan.