Prognostic factors and outcome of relapsed / progressive pediatric ewing sarcoma, National Cancer Institute, single institute experience / Reem Ragab Hegazy ; Supervised Mohamed Fawzy Ibrahim , Moatasem Elayadi , Azza Mohamed Nasr

Thesis (M.Sc.) - Cairo University - National Cancer Institute - Department of Pediatric Oncology

Background: Ewing sarcoma is the second most common malignant bone tumor in children and adolescents. Despite more intensive chemotherapy regimens and improved local control therapy there is still a considerable rate of recurrence. The prognosis of refractory or recurrent Ewing sarcoma remains dismal.Purpose: This study attempts to identify different prognostic factors predicting survival after relapse /progression in Ewing sarcoma patients treated at Pediatric Oncology Department, National Cancer Institute, Cairo University.Methods: A retrospective study included 50 relapsed/progressive Ewing sarcoma patients with complete medical records, All patients treated at National Cancer Institute, Cairo University who developed disease recurrence/progression during the period from 1st of January 2008 to the end of December 2018.Results: During the study period, 32/50 patients (64%) had disease recurrence and18/50 patients (36%) developed disease progression on treatment with a median follow up period of 7.4 months 43 patients (86%) died, median overall survival (OS) was 7.56 months while the cumulative OS was 64% at 6 months and 32.6% at 1year.Thecumulative event free survival (EFS) at 6months and 1year was 41.3%, 22.3%,respectively. Patients with disease recurrence had better outcome than patients who develop disease progression (p-value 0.019). Recurrence > 2 years from initial diagnosis was seen in 15 patients (30%) and predicted a significantly better outcome (p-value <0.001).Half of patients developed metastatic recurrence/progression with 10/25 patients (40%) having isolated pulmonary recurrence, 10/25 patients (40%) were metastatic to bone, 3/25 patients (12%) were metastatic to lung & bone, and 2/25 patients (8%) were metastatic to bone & brain. The remaining patients included 11/50 patients (22%) who had local disease recurrence/progression, and 14 patients (28%) who had combined (local/metastatic) recurrence/progression, Patients who had local recurrence/progression showed better outcome than patients who had metastatic or combined recurrence/progression (P-value =0.052)

Issued also as CD