Ewing’s sarcoma :Optimal length of preoperative chimiotherapy
Delépine G., Cornille H., Alkallaf S , Tabbi A. Zahia L. DELEPINE N.
9 th EFORT congress
2008 may 29-31 Nice


Before chemotherapy the soft tissue extension is hypervascularized and often huge

Patients
From november 1985 to january 2006, 150 patients were followed or treated by our team.
Among them 80 fullfilled the inclusion criteria:
localized Ewing’s sarcoma
Previously untreated
Computed medical imaging before and after preop chemotherapy
Local treatment by our team with histologic analysis

RESPONSE EVALUATION
Evolution of tumoral volume (%)

Among these 80 patients,
42 patients received a short induction

6 weeks are enough for surgeon !

Standard treatment excluded radiotherapy

• In this protocol early extra tumoral en bloc resection without radiotherapy was the standard local treatment.
• It was performed in all cases without risk of neurological sequellaes.
• 3 patients with contaminated margins received postoperative radiotherapy

All limb tumors were resected
• Some cases of reconstructive procedures used after resection of femoral Ewing

All pelvic tumors were resected
• 16 Y old girl with a huge IIB tumor of iliac wing.
• En bloc resection after 6 weeks chemotherapy.
• Skeletal reconstruction using cement. Excellent oncologic and fonctionnal results with 15 years follow up

Even sacroiliac tumors
17 years remission after en bloc resection and reconstruction with cement

POSTOPERATIVE CHEMOTHERAPY
Postoperative chemotherapy alternated :
• 6 IPA (Ifosfamide 6 gr/sqm, Cisplatinum 125 mg/ m², Pirarubicine 35 mg/ m²)

• 3 Cyclophosphamide(150 mg/m² 7d)
+Pirarubicine (35 mg/m² d 8 )

• 12 weeks of Vincristine (2 mg/ m² x 12), Actinomycine D (2 mg/ m² x 6)
•
Valeur pronostique de la durée de la chimiothérapie préopératoire

CONCLUSION
• This serie shows the excellent long term prognosis of children with localized Ewing’s sarcoma treated by this protocol, with short (6 weeks) bidrug induction.
• and systematic conservative surgery.
• followed by six drugs postoperative chemotherapy

CONCLUSION 2
• This serie confirms the results of Hayes

• on patients treated by surgery : 10/11 operated patients were DFS

Therapy for localized ewing's sarcoma. Hayes J.Clin.oncol. 1989, 7, 2, 208-213.