Journal of Clinical Oncology, Vol 15, 1553-1559, Copyright © 1997 by American Society of Clinical Oncology
Chemotherapy-induced tumor necrosis as a prognostic factor in localized Ewing's sarcoma of the extremities
P Picci, T Bohling, G Bacci, S Ferrari, L Sangiorgi, M Mercuri, P Ruggieri, M Manfrini, A Ferraro, R Casadei, MS Benassi, AF Mancini, P Rosito, A Cazzola, E Barbieri, A Tienghi, A Brach del Prever, A Comandone, P Bacchini and F Bertoni
Department of Pathology, Rizzoli Orthopedic Institute, Bologna, Italy. stafflab@oncolabrizzoli.tizeta.it
PURPOSE: This study was performed to assess the prognostic value of the
proposed histopathologic method to evaluate the response of the primary
tumor to preoperative chemotherapy in Ewing's sarcoma. PATIENTS AND
METHODS: The response to chemotherapy was evaluated from the specimens of
118 Ewing's sarcoma patients, who were preoperatively treated by
chemotherapy alone. Responses were graded I to III (macroscopic viable
tumor, microscopic viable tumor, and no viable tumor cells, respectively).
Follow-up data were available for all patients, with a mean follow-up
duration of 86 months (range, 30 to 158). RESULTS: A statistically highly
significant difference was observed in outcome among the three groups of
patients. For patients with total necrosis (grade III response), the
estimated 5-year disease-free survival rate was 95%, in contrast to 68% for
grade II responders and 34% for grade III responders (P < .0001). This
difference was also confirmed when any single group was compared with the
other groups. Among the parameters tested, patient age and the size of
tumor had some prognostic value. CONCLUSION: The proposed histopathologic
grading, to evaluate the effect of chemotherapy on the primary tumor, had
the strongest correlation to clinical outcome. This method could therefore
be used to identify patients with a high risk of recurrent disease. These
patients could be randomized to receive alternative postoperative
treatments to investigate whether more aggressive therapies will improve
outcome.
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