title: Impact of treatment protocol on outcome of localized Ewing's sarcoma.
abstract: BACKGROUND
  The outcome of localized Ewing's sarcoma has improved with multi-disciplinary approach. Survivals of Ewing's sarcoma from the Asian countries differed between centers.
  
  
  METHODS
  We retrospectively analyzed the records of newly diagnosed localized Ewing's sarcoma patients from 2002 to 2012. The patients were analyzed in three groups; Group 1(2002-2004) who received non-ifosfomide based regimens, Group 2(2005-2008) who received VDC/IE for 12 cycles, and Group 3(2009-2012), who received VDC/IE for 17 cycles. The groups were compared for their baseline characteristics, treatment protocol and outcome.
  
  
  RESULTS
  Seventy three patients were included in the study. The median age of presentation was 15 years, with slight male predominance. Axial primary was seen in 62%. The median RFS of the three groups was 26.4, 31.4 and 36.8 months respectively (P= 0.0018). The median OS was 27.9, 35 and 43 months respectively (P= 0.0007). At a median follow-up of 35 months, the 3 year RFS and OS for the three treatment groups were 17%, 31%, 60% and 35%, 45% and 70% respectively. Larger tumor size, axial primary, high LDH were associated with poorer survival. Radiotherapy was associated with inferior local control and survival.
  
  
  CONCLUSIONS
  We found that the survival of our ESFT patients improved over time with intensified multiagent chemotherapy and with lesser time to local therapy. But the results were still inferior to those reported in literature. We had majority of patients presenting in axial site and radiotherapy as the predominant mode of local control. The outcome may further improve with surgery as local control procedure.
authors.affiliation: Department of Medical Oncology, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India.
authors.forename: Srividya
authors.initials: S
authors.lastname: Nasaka
authors.affiliation: Department of Medical Oncology, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India.
authors.forename: Sadashivudu
authors.initials: S
authors.lastname: Gundeti
authors.affiliation: Department of Medical Oncology, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India.
authors.forename: Ranga Raman
authors.initials: RR
authors.lastname: Ganta
authors.affiliation: Department of Medical Oncology, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India.
authors.forename: Ravi Sankar
authors.initials: RS
authors.lastname: Arigela
authors.affiliation: Department of Pathology, Center for Cancer Research, UTHSC, Memphis, Tennessee, USA.
authors.forename: Vijay Gandhi
authors.initials: VG
authors.lastname: Linga
authors.affiliation: Department of Medical Oncology, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India.
authors.forename: Lakshmi Srinivas
authors.initials: LS
authors.lastname: Maddali
keywords: Localized Ewing's sarcoma; locoregional therapy; multiagent chemotherapy