Risks of recurrence and survival after relapse in patients with Ewing tumor

Abstract

10012 Background: Ewing tumor treatment has resulted in long term survival rates of approx. 70% in localized, and 30% in metastatic disease. Survival following relapse has remained poor with survival rates well below 30%. Methods: All histological proven Ewing tumor patients from three consecutive GPOH trials since 1981 (CESS81 & CESS86 & EICESS92; N=1,549) were included to conduct a meta-analyses of time to and type of recurrence. The follow up has been recently updated in 2006 resulting in a maximum observation period of 25 years. The cumulative incidences of the types of first relapse excluding progress under therapy were computed with competing risk analysis. Multivariate stepwise regression analyses according to the Cox proportional hazard model researched the influences of time to and type of relapse on survival after relapse. Results: More than 70% of first recurrences occurred within 2 years, and 85% within 3 years from initial diagnosis. Most common relapses were systemic with a 3-year cumulative incidence of approx. 0.10 each for lung metastases, bone metastases and multisystem metastases including other sites, followed by local and combined relapses both with a 3-year cumulative incidence of approx. 0.05. Multivariate analyses identified both early (<2 years after diagnosis) and combined relapses as most unfavorable prognostic factors for survival after relapse, with hazard ratios >2.5 (p<.001). Comparing relapse types, patients with local relapses, and pulmonary metastases only, had a better prognosis. Conclusions: The risk of relapse is markedly reduced 2–3 years after diagnosis. The treatment strategies should take the time at risk for relapse into consideration. New strategies for treatment of relapses are needed in particular for the most unfavorable bone, multisystem and combined relapses. Supported by Deutsche Krebshilfe Grants DKH M43/92/Jü2, DKH 70–2551 Jü3, and EU BIOMED Grants BMH1-CT92–1341 and BMH4–983956 No significant financial relationships to disclose.