title: Ewing sarcoma in patients over 40 years of age: a prospective analysis of 31 patients treated at a single institution.
abstract: OBJECTIVE
  Patients with Ewing sarcoma who are 40 years old or older are usually excluded from clinical trials. For this reason, information on this subset of patients is limited.
  
  
  METHODS
  Clinical characteristics and treatment-related variables of patients aged 40 years or more, with a diagnosis of Ewing sarcoma, treated at the authors' institution had been prospectively collected since 1999.
  
  
  RESULTS
  Thirty-one patients were identified, with ages ranging from 40 to 70 years (median 45 years). Twenty-six (84%) had localized disease, 4 patients presented with lung metastases, and 1 patient had multiple metastases (bone, lung, abdominal nodes, and bone marrow). The primary tumors were skeletal in 19 (61%) patients, while 12 (39%) had extraskeletal disease. All patients received chemotherapy according to regimens similar to those adopted in younger patients, based on doxorubicin, cyclophosphamide, etoposide, vincristine, dactinomycin, and ifosfamide. All patients experienced grade 4 leukopenia (100%); red blood cells or platelets transfusions were needed in 50% and 16% of patients, respectively. Toxicity-related dose reduction was required in 13 patients (43%). The 5-year overall survival (OS) was 54% for the whole group. In patients with complete remission, 5-year disease-free survival was 57%. Survival was different for patients with skeletal and extraskeletal Ewing sarcoma (5-year OS: 64% vs 40%, p = 0.2).
  
  
  CONCLUSIONS
  In older patients, the incidence of extraskeletal Ewing sarcoma is high. Intensive chemotherapy treatment can be recommended in this group. The high chemotherapy toxicity can be justified by expected results, similar to those of younger patients.
authors.affiliation:  Chemotherapy Section, Rizzoli Orthopedic Institute, Bologna - Italy.
authors.forename: Marilena
authors.initials: M
authors.lastname: Cesari
authors.affiliation:  Department of Surgical Pathology, Rizzoli Orthopedic Institute, Bologna - Italy.
authors.forename: Alberto
authors.initials: A
authors.lastname: Righi
authors.affiliation:  Department of Orthopedic Surgery, Rizzoli Orthopedic Institute, Bologna - Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Cevolani
authors.affiliation:  Chemotherapy Section, Rizzoli Orthopedic Institute, Bologna - Italy.
authors.forename: Emanuela
authors.initials: E
authors.lastname: Palmerini
authors.affiliation:  Department of Musculoskeletal Oncology, Rizzoli Orthopedic Institute, Bologna - Italy.
authors.forename: Daniel
authors.initials: D
authors.lastname: Vanel
authors.affiliation:  Department of Orthopedic Surgery, Rizzoli Orthopedic Institute, Bologna - Italy.
authors.forename: Davide M
authors.initials: DM
authors.lastname: Donati
authors.affiliation:  Department of Radiotherapy, S. Orsola-Malpighi Hospital, Bologna - Italy.
authors.forename: Silvia
authors.initials: S
authors.lastname: Cammelli
authors.affiliation:  Department of Surgical Pathology, Rizzoli Orthopedic Institute, Bologna - Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Gambarotti
authors.affiliation:  Department of Musculoskeletal Oncology, Rizzoli Orthopedic Institute, Bologna - Italy.
authors.forename: Cristina
authors.initials: C
authors.lastname: Ferrari
authors.affiliation:  Chemotherapy Section, Rizzoli Orthopedic Institute, Bologna - Italy.
authors.forename: Anna
authors.initials: A
authors.lastname: Paioli
authors.affiliation:  Chemotherapy Section, Rizzoli Orthopedic Institute, Bologna - Italy.
authors.forename: Alessandra
authors.initials: A
authors.lastname: Longhi
authors.affiliation:  Chemotherapy Section, Rizzoli Orthopedic Institute, Bologna - Italy.
authors.forename: Massimo E
authors.initials: ME
authors.lastname: Abate
authors.affiliation:  Department of Surgical Pathology, Rizzoli Orthopedic Institute, Bologna - Italy.
authors.forename: Piero
authors.initials: P
authors.lastname: Picci
authors.affiliation:  Chemotherapy Section, Rizzoli Orthopedic Institute, Bologna - Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Ferrari
mesh_terms: D000328:Adult; D000368:Aged; D003131:Combined Modality Therapy / Q000009:adverse effects / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011446:Prospective Studies; D012512:Sarcoma, Ewing / Q000175:diagnosis* / Q000453:epidemiology / Q000401:mortality / Q000628:therapy*; D016019:Survival Analysis; D016896:Treatment Outcome