Posters— Pediatric Oncology

TREATMENT OF PELVIC EWING’S SARCOMA WITH MULTIDISCIPLINARY TREATMENT

N. Delepine^l, G. Delepine,F. Delepine², S. Alkallaf, H. Cornille¹, T Sokolov³- ¹Oncologic Paediatric Unit. Avicenne University Hospital - 125 Bd de Stalingrad - 93009 Bobigny Cedex- France -E..mail: nicole.delepine@avc.ap-hop-paris.fr / ²Bone Tumor Center - Sofia - Bulgarie /³CHU de Rouen - orthopaedic department

Introduction: Despite the improved survival of patients with Ewing’s sarcoma, pelvic location remains a bad prognostic factor. This retrospective analysis tries to point out the reasons of such a situation, and to evaluate the impact of modem comprehensive approach on prognosis.

Material and methods: From 1977/2 to 1998/6, 53 patients have been treated by our group for Ewing’s sarcoma of pelvic bones. 32 were males, 21 females aged 6 to 35 years (median 16.3). At first screening, 15 patients had already metastases and 38 presented with localised disease. Treatment included chemotherapy for all patients according to the current protocol at the time of presentation : four drugs (Vincristine - Dactinomycin - Cyclophosphamide - Doxorubicin, five drugs (Vincristine - Doxorubicin - Cyclophosphamide - Dactinomycine + ifosfamide) or six drugs association (Ifosfamide - Vincristine - Doxorubicin - Cyclophosphamide - Dactinomycine + Etoposide or Cisplatinium). Local treatment used radiotherapy alone for 24 patients, surgery alone in 18 and a combination in 11. All patients have been followed up every 3 months for 2 years, every 6 months for 2 other years and then yearly.

Results: With a median follow up of ten years, the 5 year actuarial event free survival rate for all patients is 31 % ; 13 % for primary metastatic patients and 40 % for patients seen with localised disease (p<0.001). In primary localised tumor the major prognostic factors are the adequacy of surgical resection (p<0.01) and the high dose intensity of chemotherapy, particularly during the induction (p<0.05). Patients treated by radiotherapy had a 44 % risk of local recurrence 17 % life expectancy, and a 13 months median survival compared to an 80 % life expectancy and 80 months median survival for patients after wide resection.

Conclusion: 1. Primary metastatic patients require new approach 2. Early wide resection of the primary and adequate dose intensity of a 6 drugs chemotherapy give best results in pelvic Ewing’s despite large tumoral volume or even incomplete response to preoperative chemotherapy.