Hypoalbuminaemia is an Independent Predictor of Poor Outcome in Metastatic Ewing's Sarcoma Family of Tumours: A Single Institutional Experience of 150 Cases Treated with Uniform Chemotherapy Protocol

• Published in: Clinical oncology (Royal College of Radiologists (Great Britain)) 2014-11, Vol.26 (11), p.722-729
• Main Authors: Biswas, B, Rastogi, S, Khan, S.A, Shukla, N.K, Deo, S.V.S, Agarwala, S, Sharma, D.N, Thulkar, S, Vishnubhatla, S, Pathania, S, Bakhshi, S
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Antineoplastic Combined Chemotherapy Protocols - adverse effects; Bone Marrow Neoplasms - drug therapy; Bone Marrow Neoplasms - mortality; Bone Marrow Neoplasms - secondary; Bone Neoplasms - drug therapy; Bone Neoplasms - mortality; Bone Neoplasms - secondary; Child; Child, Preschool; Female; Follow-Up Studies; Hematology, Oncology and Palliative Medicine; Humans; Hypoalbuminaemia; Hypoalbuminemia - chemically induced; Hypoalbuminemia - mortality; Lung Neoplasms - drug therapy; Lung Neoplasms - mortality; Lung Neoplasms - secondary; Male; metastatic; Middle Aged; Neoadjuvant Therapy - adverse effects; Neoplasm Staging; outcome; primitive neuroectodermal tumour; Prognosis; prognostic factors; Prospective Studies; Radiology; Sarcoma, Ewing - drug therapy; Sarcoma, Ewing - mortality; Sarcoma, Ewing - pathology; Survival Rate; Young Adult
• ISSN: 0936-6555; 1433-2981
• DOI: 10.1016/j.clon.2014.05.006

Abstract Aims Data on metastatic Ewing's sarcoma family of tumours (ESFT) with uniform chemotherapy protocol are minimal. Materials and methods This was a single institutional patient review of patients treated between June 2003 and November 2011 and evaluated on an intent-to-treat analysis. All patients received uniform chemotherapy: neoadjuvant chemotherapy (NACT), surgery and/or radiotherapy as local treatment followed by adjuvant chemotherapy. Local treatment was offered if the patient achieved a complete response and/or a partial response at both the primary and the metastatic site. Results In total, 150/374 (40%) ESFT patients were metastatic, with a median age of 15 years (range: 2–50); a tumour diameter of 10 cm (range: 1.8–26). Most common metastatic sites were lung only (53; 35%), bone only (35; 23%) and combined bone/lung (25; 17%). Twenty patients underwent surgery; 55 patients received radical radiotherapy after NACT. After a median follow-up of 26.1 months (range: 1.6–101.6), 5 year event-free survival (EFS), overall survival and local control rate (LCR) were 9.1 ± 3.3%, 16.9 ± 5.2% and 31.8 ± 7.9%, respectively. Univariate analysis showed serum albumin ≤3.4 g/dl ( P  8 cm ( P  = 0.05), haemoglobin ≤10 g/dl ( P  = 0.04), hypoalbuminaemia ( P  = 0.003) and radical radiotherapy as local treatment ( P  = 0.03) predicted inferior overall survival. No factor significantly predicted LCR, although age ≤15 years ( P  = 0.08) and radical radiotherapy as local treatment ( P  = 0.09) had a trend towards inferior LCR. Hypoalbuminaemia was the only prognostic factor to predict EFS on multivariate analysis. Conclusion This was the largest study of metastatic ESFT from Asia and identified a unique prognostic factor. In view of dismal prognosis with conventional chemotherapy in metastatic ESFT with hypoalbuminaemia, palliative intent therapy may be a potential therapeutic alternative for this subgroup of patients, especially in resource-challenged situations.