Nuances in the Treatment of Ewing Sarcoma of the Head and Neck in a Low–Middle-Income Country Setting: A Multi-Disciplinary Approach

Background

Ewing sarcoma of the head and neck (ES-HN) is a rare subsite of ES, where therapeutic outcomes need to be explored further.

Methods

This retrospective study includes ES-HN patients registered at our center between 2003 and 2019. Demographic details and treatment outcomes were recorded from the hospital database. Prognostic factors for survival were identified by Cox regression.

Results

Eighty-five patients were included. Metastatic disease was seen in nine patients (10.59%). Local therapy included radiotherapy alone (n = 38; 44.7%), surgery plus radiotherapy (n = 15; 17.6%), or surgery alone (n = 8; 9.4%). The median overall survival (OS) was 37.4 months. On multivariable analysis, osseous primary (HR 0.40; p = 0.009) and male sex (HR 0.43; p = 0.023) were associated with superior OS. Leucocytosis (HR 3.46; p = 0.001) was associated with inferior OS.

Conclusions

ES-HN has favorable biology with metastases being rare at baseline. However, leucocytosis, extra-osseous disease, and female sex are poor prognostic factors. In resource-challenged settings, difficulties in administering local therapy may contribute to inferior outcomes.