Clinical outcomes of adult patients with relapsed ewing sarcoma: A 30-year single-institution experience

Objectives: We aimed to determine the prognostic factors that influence the outcome of adult patients who have disease relapse after treatment for localized Ewing sarcoma.

Methods: We retrospectively searched for the records of patients aged 18 years and older with localized Ewing sarcoma at Mayo Clinic, Rochester, Minnesota, from 1977 to 2007, who had disease relapse after initial treatment. Patient records were reviewed to analyze factors affecting survival.

Results: A total of 49 patients were identified. The 5-year postrelapse survival rate was 30%. Significant factors affecting the 5-year postrelapse survival rate included site of initial relapse (local vs. distant, 55% vs. 22%, P = 0.045); time to relapse (< 2 vs. ≥2 y from original diagnosis, 12% vs. 50%, P = 0.003); and second remission with complete surgical resection versus definitive radiotherapy to the recurrent disease (48% vs. 13%, P < 0.001). None of these factors were significant on multivariate modeling.

Conclusions: Adult patients with Ewing sarcoma who have disease relapse after primary treatment of localized disease will continue to have recurrences regardless of the modality of salvage therapy. Those that have relapse locally or >2 years after the initial diagnosis and are able to achieve a second remission with definitive surgical or radiation therapy have better survival than those who have disease relapse distantly or before the 2-year time point.