Danielle Klingberg, Susie Bae, Deborah Di-Xin Zhou, Hao-Wen Sim, Ruilin Cai, Antoinette Anazodo, Peter Grimison, Craig Lewis, Yeh Chen Lee
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引用次数: 0
Abstract
Background
Ewing's family sarcoma (EFS) is an aggressive malignancy with a peak incidence in adolescents. Multimodal treatment involves surgery and/or radiotherapy, and chemotherapy typically with VDC/IE (vincristine, doxorubicin, and cyclophosphamide alternating with ifosfamide and etoposide). There is a paucity of data for the treatment of adults, with protocols extrapolated from the pediatric setting. This study aimed to assess patterns of care, chemotherapy tolerability across age groups, and outcomes from four Australian sarcoma centers.
Methods
ANZSA ACCORD sarcoma database and medical records were used to identify and collect data of patients aged ≥ 10 years with EFS who received VDC/IE between 2010 and 2020. Survival outcomes were analyzed based on chemotherapy received dose intensity (RDI). Clinical predictors of RDI were explored using logistic regression.
Results
Of 146 patients with EFS, 76 received VDC/IE. The majority had localized disease (65%). Seventy-one percent completed scheduled chemotherapy, with some requiring dose reduction (29%), delay > 7 days (65%), or cycle omission (4%). Hematological toxicity was the main reason for dose reduction/delay. Fifty-seven percent patients achieved an acceptable RDI ≥85%. Compared to those aged 10–19, the odds ratio for acceptable RDI aged 40–59 was 0.20 (95% CI 0.04−0.86, p = 0.04). RDI was an independent prognostic factor for overall survival, after accounting for age, gender, Ewing's type, primary site, and stage (adjusted HR 0.25 [95% CI 0.10−0.63], p = 0.004).
Conclusion
Survival outcomes in EFS were associated with chemotherapy RDI. Older adults more commonly required dose reduction or early cessation of treatment due to toxicity. VDC/IE chemotherapy should be carefully tailored in adults > 40 years.
背景:尤因氏家族肉瘤(EFS)是一种侵袭性恶性肿瘤,以青少年发病率最高。多模式治疗包括手术和/或放疗,以及典型的VDC/IE化疗(长春新碱、阿霉素、环磷酰胺与异环磷酰胺和依托泊苷交替)。成人治疗的数据缺乏,其方案是从儿科环境中推断出来的。本研究旨在评估四个澳大利亚肉瘤中心的护理模式、不同年龄组的化疗耐受性和结果。方法:使用ANZSA ACCORD肉瘤数据库和医疗记录,识别和收集2010 - 2020年期间接受VDC/IE治疗的年龄≥10岁的EFS患者的数据。根据化疗剂量强度(RDI)分析生存结果。应用logistic回归分析RDI的临床预测因素。结果:146例EFS患者中,76例接受了VDC/IE。多数为局部病变(65%)。71%的患者完成了化疗计划,其中一些患者需要减少剂量(29%),延迟7天(65%)或周期遗漏(4%)。血液学毒性是导致剂量减少/延迟的主要原因。57%的患者达到可接受RDI≥85%。与10-19岁的患者相比,40-59岁可接受RDI的优势比为0.20 (95% CI 0.04-0.86, p = 0.04)。考虑到年龄、性别、尤因氏型、原发部位和分期后,RDI是总生存率的独立预后因素(调整后危险度为0.25 [95% CI 0.10-0.63], p = 0.004)。结论:EFS患者的生存结果与化疗RDI相关。由于毒性,老年人更常需要减少剂量或早期停止治疗。在40岁以上的成人中,VDC/IE化疗应谨慎定制。
期刊介绍:
Asia–Pacific Journal of Clinical Oncology is a multidisciplinary journal of oncology that aims to be a forum for facilitating collaboration and exchanging information on what is happening in different countries of the Asia–Pacific region in relation to cancer treatment and care. The Journal is ideally positioned to receive publications that deal with diversity in cancer behavior, management and outcome related to ethnic, cultural, economic and other differences between populations. In addition to original articles, the Journal publishes reviews, editorials, letters to the Editor and short communications. Case reports are generally not considered for publication, only exceptional papers in which Editors find extraordinary oncological value may be considered for review. The Journal encourages clinical studies, particularly prospectively designed clinical trials.