Survival after recurrence of Ewing's sarcoma family of tumors
Survival after recurrence of Ewing's sarcoma family of tumors
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DOI：
10.1200/jco.2005.05.105
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发表时间：
2005-07-01
影响因子：
45.3
通讯作者：
Hawkins, DS
中科院分区：
文献类型：
--
作者：
Barker, LM;Pendergrass, TW;Hawkins, DS
目的复发性尤文氏肉瘤家族肿瘤(ESFT)患者总体生存率较低，大剂量治疗(HDT)的相对效益存在较大争议。大多数复发仅为转移性(39例)或局部转移性(10例)。27名患者(49%)对二线治疗部分或完全有效，中位有效时间为27个月(范围从5个月到119个月以上)。所有复发患者的5年CIS率为23%(95%CI，11%至35%)。单因素分析显示，OS改善与二线治疗有效与无反应(分别为46%与0%；P<；0.0001)、RFI>；=24个月与不到24个月(分别为48%与12%；P=0001)、初诊时无转移与有无转移(分别为31%与12%；P=05)相关。因为接受HDT的所有13名患者都有反应性复发，所以我们进行了多因素分析。死亡风险的降低与二线治疗(相对风险0.14；95%CI，0.05~0.40)、RFI>；=24个月(相对风险0.29；95%CI，0.13~0.66)和接受HDT(相对风险0.26；95%CI，0.08~0.85)有关。结论HDT作为复发ESFT的巩固治疗似乎与OS的改善有关，即使在调整了RFI和二线治疗的反应后也是如此。(C)2005年，由美国临床肿瘤学会提供。
Purpose The overall survival (CIS) of patients with relapsed Ewing's sarcoma family of tumors (ESFT) is poor, and the relative benefit of high-dose therapy (HDT) is controversial.Patients and Methods We retrospectively identified 55 consecutive ESFT patients with adequate medical records for review, who were treated at Children's Hospital and Regional Medical Center and who developed disease recurrence between January 1, 1985 and December 31, 2002.Results The median relapse-free interval (RFI) from diagnosis to first recurrence was 17 months (range, 5 to 90 months). Most recurrences were metastatic only (39 patients) or local and metastatic (10 patients). Twenty-seven patients (49%) achieved a partial or complete response to second-line treatment, with a median duration of response of 27 months (range, 5 to 119+ months). The 5-year CIS rate for all relapsed patients was 23% (95% CI, 11 % to 35%). By univariate analysis, improved OS was associated with response to second-line treatment versus no response (46% v 0%, respectively; P < .0001), RFI >= 24 months versus less than 24 months (48% v 12%, respectively; P = 0001), and no metastases at initial diagnosis versus presence of metastases (31 % v 12%, respectively; P = 05). Because all 13 patients who received HDT also had responsive relapse, we performed a multivariate analysts. Reduced risk of death was associated with response to second-line therapy (relative risk, 0.14; 95% CI, 0.05 to 0.40), RFI >= 24 months (relative risk, 0.29; 95% CI, 0.13 to 0.66), and receiving HDT (relative risk, 0.26; 95% CI, 0,08 to 0.85),Conclusion HDT as consolidation therapy for relapsed ESFT seems to be associated with improved OS, even after adjusting for RFI and response to second-line treatment. (c) 2005 by American Society of Clinical Oncology.