الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Ewing sarcoma (ES) is the second common bone tumor in children, with almost 25% presenting with metastatic disease. Treatment of ES requires multi-disciplinary team approach including pediatric oncology, radiation therapy (RTH), surgery.
Sixty-seven patients with ES were treated at Alexandria University Hospital between January 2013 and December 2021. We analyzed their records regarding clinical presentation, treatment received, survival outcome and prognostic factors.
Median age at diagnosis was 16 years, with slight male predominance (M:F ratio = 1.3:1). Most common affected site was long bones (44.8%) and 29 patients (70 %) had a tumor volume >200 cc. Metastatic disease at initial presentation was seen in 17 patients (25.4%).
Patients were treated according to Euro-Ewing 2012 R1 protocol. Until December 2019, 46 patient received Arm A (VIDE/VAC) regimen, then starting January 2020, 21 patients received Arm B (VDC/IE) regimen.
Fourteen patients (20.9%) had definitive radiotherapy as their local treatment while 53 patients (79.1%) had surgery of whom 33 patients (62%) had consolidative post-operative radiotherapy. In 28 patients (52.8%) tumor necrosis was ≥95%, this was in 37% of Arm A (13 patient) and in 83% of Arm B (15 patients). Two patients had disease progression while on chemotherapy and 28 patients (41.8%) experienced disease relapse with most common site of relapse in lung (23.9%) followed by bone (9%), and local relapse in two patients (3%) only.
Overall survival (OS) at 3and 5 years was 67.4% and 64.4%, respectively. The 5-year OS according to type of local control was 69.5% for patients who had surgery only, 15.3% for patients receiving RTH only and 80.8% for patients treated with combined surgery and RTH.