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Five-year results in Ewing's sarcoma. The Scandinavian Sarcoma Group experience with the SSG IX protocol
I Elomaa1, C P Blomqvist, G Saeter
1Department of Oncology, University Hospital, Helsinki, Finland. inkeri.elomaa@helsinki.fi
European Journal of Cancer (Oxford, England : 1990)
|April 29, 2000
Summary
The SSG IX protocol improved Ewing sarcoma outcomes compared to SSG IV, showing higher local control and survival rates. Further studies are needed to confirm the protocol's therapeutic efficacy.
Area of Science:
- Pediatric Oncology
- Orthopedic Oncology
- Medical Oncology
Background:
- The Scandinavian Sarcoma Group (SSG) IV protocol for Ewing sarcoma yielded suboptimal local control (74%) and metastasis-free survival (MFS) (43%).
- A need existed to improve treatment efficacy for Ewing sarcoma patients.
Purpose of the Study:
- To evaluate the efficacy of the SSG IX protocol in improving local control and survival rates for Ewing sarcoma.
- To assess the toxicity profile of the SSG IX protocol.
Main Methods:
- The SSG IX protocol involved four chemotherapy cycles of VAI (vincristine, doxorubicin, ifosfamide) alternating with PAI (cisplatin, doxorubicin, ifosfamide).
- Local therapy included surgery (amputation or wide excision) or hyperfractionated accelerated radiotherapy (42-60 Gy) for inoperable or non-radically operated patients.
- Eighty-eight patients with Ewing sarcoma were enrolled, with tumors located centrally, in extremities, or other sites.
Main Results:
- The SSG IX protocol achieved a 5-year MFS of 58% and overall survival (OS) of 70% for non-metastatic (M0) patients.
- Local recurrence was observed in 10% of patients, and distant metastases developed in 33% of M0 patients.
- Favorable survival rates (90%) were noted for non-metastatic extremity tumors and those treated with wide surgical margins. Complete tumor necrosis post-chemotherapy correlated with better OS (P=0.003).
Conclusions:
- The SSG IX protocol demonstrated improved local control and survival rates compared to the historical SSG IV protocol.
- The treatment regimen was associated with acceptable toxicity (gastrointestinal G1-2, hematological G3-4).
- While promising, definitive conclusions on the SSG IX protocol's superior therapeutic efficacy require further investigation beyond historical comparisons.