title: Hypoalbuminaemia is an independent predictor of poor outcome in metastatic Ewing's sarcoma family of tumours: a single institutional experience of 150 cases treated with uniform chemotherapy protocol.
abstract: OBJECTIVE
  Data on metastatic Ewing's sarcoma family of tumours (ESFT) with uniform chemotherapy protocol are minimal.
  
  
  METHODS
  This was a single institutional patient review of patients treated between June 2003 and November 2011 and evaluated on an intent-to-treat analysis. All patients received uniform chemotherapy: neoadjuvant chemotherapy (NACT), surgery and/or radiotherapy as local treatment followed by adjuvant chemotherapy. Local treatment was offered if the patient achieved a complete response and/or a partial response at both the primary and the metastatic site.
  
  
  RESULTS
  In total, 150/374 (40%) ESFT patients were metastatic, with a median age of 15 years (range: 2-50); a tumour diameter of 10 cm (range: 1.8-26). Most common metastatic sites were lung only (53; 35%), bone only (35; 23%) and combined bone/lung (25; 17%). Twenty patients underwent surgery; 55 patients received radical radiotherapy after NACT. After a median follow-up of 26.1 months (range: 1.6-101.6), 5 year event-free survival (EFS), overall survival and local control rate (LCR) were 9.1 ± 3.3%, 16.9 ± 5.2% and 31.8 ± 7.9%, respectively. Univariate analysis showed serum albumin ≤3.4 g/dl (P < 0.001) to predict inferior EFS. Tumour size >8 cm (P = 0.05), haemoglobin ≤10 g/dl (P = 0.04), hypoalbuminaemia (P = 0.003) and radical radiotherapy as local treatment (P = 0.03) predicted inferior overall survival. No factor significantly predicted LCR, although age ≤15 years (P = 0.08) and radical radiotherapy as local treatment (P = 0.09) had a trend towards inferior LCR. Hypoalbuminaemia was the only prognostic factor to predict EFS on multivariate analysis.
  
  
  CONCLUSIONS
  This was the largest study of metastatic ESFT from Asia and identified a unique prognostic factor. In view of dismal prognosis with conventional chemotherapy in metastatic ESFT with hypoalbuminaemia, palliative intent therapy may be a potential therapeutic alternative for this subgroup of patients, especially in resource-challenged situations.
authors.affiliation: Department of Medical Oncology, Dr B.R. Ambedkar Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India.
authors.forename: B
authors.initials: B
authors.lastname: Biswas
authors.affiliation: Department of Orthopedics, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India.
authors.forename: S
authors.initials: S
authors.lastname: Rastogi
authors.affiliation: Department of Orthopedics, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India.
authors.forename: S A
authors.initials: SA
authors.lastname: Khan
authors.affiliation: Department of Surgical Oncology, Dr B.R. Ambedkar Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India.
authors.forename: N K
authors.initials: NK
authors.lastname: Shukla
authors.affiliation: Department of Surgical Oncology, Dr B.R. Ambedkar Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India.
authors.forename: S V S
authors.initials: SV
authors.lastname: Deo
authors.affiliation: Department of Pediatric Surgery, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India.
authors.forename: S
authors.initials: S
authors.lastname: Agarwala
authors.affiliation: Department of Radiotherapy, Dr B.R. Ambedkar Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India.
authors.forename: D N
authors.initials: DN
authors.lastname: Sharma
authors.affiliation: Department of Radiodiagnosis, Dr B.R. Ambedkar Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India.
authors.forename: S
authors.initials: S
authors.lastname: Thulkar
authors.affiliation: Department of Biostatistics, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India.
authors.forename: S
authors.initials: S
authors.lastname: Vishnubhatla
authors.affiliation: Department of Medical Oncology, Dr B.R. Ambedkar Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India.
authors.forename: S
authors.initials: S
authors.lastname: Pathania
authors.affiliation: Department of Medical Oncology, Dr B.R. Ambedkar Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India. Electronic address: sambakh@hotmail.com.
authors.forename: S
authors.initials: S
authors.lastname: Bakhshi
mesh_terms: D000293:Adolescent; D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects*; D019046:Bone Marrow Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000556:secondary; D001859:Bone Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000556:secondary; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D034141:Hypoalbuminemia / Q000139:chemically induced / Q000401:mortality*; D008175:Lung Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000556:secondary; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy / Q000009:adverse effects*; D009367:Neoplasm Staging; D011379:Prognosis; D011446:Prospective Studies; D012512:Sarcoma, Ewing / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology; D015996:Survival Rate; D055815:Young Adult
keywords: Hypoalbuminaemia; metastatic; outcome; primitive neuroectodermal tumour; prognostic factors