title: Myeloablative therapy against high risk Ewing's sarcoma: A single institution experience and literature review.
abstract: BACKGROUND
  Attempts to improve survival outcomes of patients with high risk Ewing's sarcoma (ES) have focused on chemotherapy dose intensification strategies.
  
  
  OBJECTIVE
  The objective of this study is to retrospectively evaluate clinical characteristics and outcome of pediatric patients with high risk ES treated at a single institution.
  
  
  METHODS
  From 1995 to 2008, seventeen patients (male:female, 14:3) were treated with dose-intensive therapy in our institution. Median age at diagnosis was 10 years (range: 2-15). Seven patients had metastases at diagnosis (lung in 6 cases and bone in one case). Eleven patients presented with unresectable disease. Fifteen (88.2%) received the Spanish Society of Pediatric Oncology protocol which includes six cycles of vincristine, doxorubicin, ifosfamide and etoposide. Two out of the six cases that were resectable received postoperative radiation. In addition, eleven patients received definitive radiation therapy. Finally, twelve (70.5%) out of 17 patients received myeloablative therapy with melphalan/etoposide. The rest of patients (N = 5) received busulfan/melphalan.
  
  
  RESULTS
  Median follow-up was 78 months (range: 15-155 months). Initial responses were complete in all patients, but 9 of them developed progression disease. Seven patients became long-term event-free survivors. No patient died of toxicity after transplantation. The 2- and 5-year overall survival rates for all patients were 93% and 73%, respectively. Event-free survival rates were 74% and 54% at 2 and 5 years, respectively.
  
  
  CONCLUSIONS
  This single-institution experience suggests that myeloablative therapy against high risk ES is effective and safe.
authors.affiliation: Virgen del Rocío University Hospital, Department of Radiation Oncology, Sevilla, Spain.
authors.forename: Jose Luis
authors.initials: JL
authors.lastname: Lopez
authors.affiliation: Virgen del Rocío University Hospital, Department of Hematology, Sevilla, Spain.
authors.forename: Concepcion
authors.initials: C
authors.lastname: Pérez
authors.affiliation: Virgen del Rocío University Hospital, Department of Pediatric Oncology, Sevilla, Spain.
authors.forename: Catalina
authors.initials: C
authors.lastname: Marquez
authors.affiliation: Virgen del Rocío University Hospital, Department of Radiation Oncology, Sevilla, Spain.
authors.forename: Patricia
authors.initials: P
authors.lastname: Cabrera
authors.affiliation: Virgen del Rocío University Hospital, Department of Hematology, Sevilla, Spain.
authors.forename: Jose Maria
authors.initials: JM
authors.lastname: Perez
authors.affiliation: Virgen del Rocío University Hospital, Department of Pediatric Oncology, Sevilla, Spain.
authors.forename: Gema Lucia
authors.initials: GL
authors.lastname: Ramirez
authors.affiliation: Virgen del Rocío University Hospital, Department of Radiation Oncology, Sevilla, Spain.
authors.forename: Rafael
authors.initials: R
authors.lastname: Ordoñez
authors.affiliation: Methodology Unit- Fundación Pública Andaluza para la Gestión de la Investigación en Salud de Sevilla, Spain.
authors.forename: Juan Manuel
authors.initials: JM
authors.lastname: Praena-Fernandez
authors.affiliation: Virgen del Rocío University Hospital, Department of Radiation Oncology, Sevilla, Spain.
authors.forename: Maria Jose
authors.initials: MJ
authors.lastname: Ortiz
keywords: Ewing's sarcoma; Myeloablative therapy; Outcome