Ewing's Sarcoma of the Head and Neck: Outcomes of 101 Patients Treated at a Tertiary Cancer Center

Abstract

Objective

This retrospective study evaluates the disease profile, treatment response, long term outcomes, and prognostic factors for patients ES of the head and neck region treated with curative intent and a homogeneous treatment protocol at our institute.

Methods

From January 2005 to December 2020, 101 patients in the age group of 2months – 42years (Median 14years) were analysed after institutional ethics committee approval.

Results

Out of 101 patients, 62 (61%) were males and the mean tumour size was 5cms. All patients received multi-modality treatment, EFT 2001 systemic chemotherapy (CTh) and local treatment comprising of either surgery (Sx, n = 10), radiation therapy (RT, n = 43) or both (n =47) followed by maintenance CTh. One patient died during Induction CTh due to toxicity. RT alone was offered in cases where Sx was either not feasible or was deemed to be associated with significant morbidity. After a median follow-up of 61 months, the 5-year local control (LC), event free survival (EFS) and overall survival (OS) were 84.4%, 74% and 88.2% respectively. At last follow up, 77 (76%) patients were alive and disease free. Ten patients had local relapse only, 8 had distant metastases and 5 had both local plus distant relapse. The choice of local treatment (5-year OS - RT (89.9%) vs Sx plus RT(86.1%), p = 0.51) did not affect outcomes. On univariate analysis, stage, raised platelet-to-lymphocyte ratio and partial response to RT were significant prognostic factors for OS. There were no ≥ Grade 4 acute or late toxicities owing to local treatment modality.

Conclusion

Multi-modality treatment using a combination of CTh, Sx and RT results in optimal disease control with acceptable toxicities. Definitive RT should be considered when surgery is not feasible or associated with significant morbidity.