Neoadjuvant chemotherapy for localized Ewing sarcoma of bone: Experience at the Istituto Ortopedico Rizzoli

G. Bacci, P. Picci, M. Avella, S. Ferrari, E. Barbieri, M. Manfrini, R. Casadei, A. Cazzola, P. Rosito, A. Battistini, M. Campanacci

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From June 1983 to December 1983 ninety-eight patients with localized Ewing's sarcoma were treated with a neoadjuvant protocol of chemotherapy that consisted of an initial nine-week period of polychemotherapy (vincristine, adriamycin and cyclophosphamidel followed by local therapy and additional chemotherapy (vincristine, adriamycin, cyclophosphamide and dactinomycin) for approximatively one year. As local treatment, when feasible, all patients were offered surgery (83 cases).Sixty-four patients accepted and 19 refused. These patients, like the l5 patients where surgery was not considered feasible, were treated with radiation therapy alone (50- 60 Gy). In the remaining patients an amputation was performed in 4 cases and a resection in 60. In resected patients when a wide margin was achieved (35 cases) no further local treatment was performed, when surgery was marginal or intralesional (25 cases) radiotherapy at lower doses (40-45 Gy) was delivered. At a mean follow-up of 5 years (3-8), 51 patients remained continuously disease-free, 46 relapsed (26 with metastases and 20 with metastases and local recurrences) and one patient had a radiation-induced sarcoma. Two factors seem to be correlated to prognosis: the site of initial lesion (only 35% of the pelvic lesions remained CDF vs 61% of the extremity lesions) and the type of local treatment (61% of CDFS for patients locally treated with surgery or surgery followed by radiotherapy vs 35% for the patients treated with radiation therapy alone). These results are identical to the results obtained in our institution in 59 patients previously treated with the same drugs delivered as 'adjuvant'chemotherapy. The authors conclude that neoadjuvant chemotherapy in localized Ewing sarcoma, even if widely used today, seems to be less effective than traditional adjuvant chemotherapy.

Original languageEnglish
Pages (from-to)335-342
Number of pages8
JournalCancer Journal (United States)
Issue number5
Publication statusPublished - 1991

ASJC Scopus subject areas

  • Cancer Research
  • Oncology


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