Treatment of Ewings sarcoma with two different protocols

Sokolov, T.; Stoianova, A.; Mumdjiev, I.; Mihova, A.

Since 1985, 54 with localized Ewing's sarcoma of bone were treated at the Onco-Orthopedics Clinic of the Sofia University Hospital (Sofia, Bulgaria). Thirty-two patients received the classical four-drug combination with doxorubicin, dactinomycin, vincristine, and cyclophosphamid. The last 22 patients were treated with six-drug protocols where cisplatinium and ifosfamid were added to the standard four-drug regimens. Local treatment was adapted to the age of the patient and the location and volume of the tumor. Fourteen patients received radiotherapy alone, 24 postoperative radiotherapy and 16 surgery alone as local treatment. At a mean follow-up of 6 years, the disease free survival rate reached 44%. Eleven patients had a good local response and 25 developed metastatic disease. Statistical analysis confirmed the deleterious effect of pelvic localizations and large tumor volume on prognosis and demonstrated the dramatic improvement obtained with the six-drug protocol (5-year disease free survival 61% versus 23%) and surgery (61% versus 25%).