title: A single institution experience of combined modality management of extra skeletal Ewings sarcoma.
abstract: BACKGROUND
  Extraskeletal Ewings sarcoma are rare tumors for which there is no consensus on optimal management.
  
  
  METHODS
  A retrospective review of the clinical features, treatment and outcome of patients with extraskeletal Ewings sarcoma who reported to a single institution between January 1992-December 2003 is reported.
  
  
  RESULTS
  A total of 19 patients with extraskeletal Ewings sarcoma were identified. Of these, 4 patients had metastatic disease at presentation and 15 patients with non-metastatic disease received combined modality treatment with primary combination chemotherapy followed by local treatment with radiotherapy or surgery. Disease free survival and overall survival for patients with non metastatic disease after combined modality treatment were 60% and 30% respectively. The significant predictors for prolonged disease free survival and overall survival were high haemoglobin (p = 0.002), low lactate dehydrogenase (p = 0.028), chemotherapy with Vincristine, Adriamycin, Cyclophosphamide, Ifosfamide and Etoposide regime (p = 0.008) and complete response to chemotherapy (p = 0.001).
  
  
  CONCLUSIONS
  Aggressive combination chemotherapy followed by complete surgery or radiotherapy to a dose of more than 50 Gy is essential to confer optimal outcome for patients with extraskeletal Ewings sarcoma.
authors.affiliation: Division of Clinical Oncology, Royal Marsden Hospital, Sutton, Surrey, SM2 5PT, UK. drvramachandran@gmail.com
authors.forename: Ramachandran
authors.initials: R
authors.lastname: Venkitaraman
authors.forename: Mathew K
authors.initials: MK
authors.lastname: George
authors.forename: S Ganapathy
authors.initials: SG
authors.lastname: Ramanan
authors.forename: T G
authors.initials: TG
authors.lastname: Sagar
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage*; D001707:Biopsy, Needle; D002423:Cause of Death; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009367:Neoplasm Staging; D010386:Pelvic Neoplasms / Q000188:drug therapy / Q000401:mortality / Q000473:pathology; D011379:Prognosis; D016016:Proportional Hazards Models; D012186:Retroperitoneal Neoplasms / Q000188:drug therapy / Q000401:mortality / Q000473:pathology; D012189:Retrospective Studies; D018570:Risk Assessment; D012512:Sarcoma, Ewing / Q000188:drug therapy* / Q000401:mortality* / Q000473:pathology; D013125:Spinal Neoplasms / Q000188:drug therapy / Q000401:mortality / Q000473:pathology; D016019:Survival Analysis; D013899:Thoracic Neoplasms / Q000188:drug therapy / Q000401:mortality / Q000473:pathology; D055815:Young Adult