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Adolescent-Adult Non-metastatic Ewing Sarcoma- Experience from a large developing country
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  • Jyoti Bajpai,
  • Goutam Panda,
  • Arun Chandrasekharan,
  • Prabhat Bhargava,
  • Sujay Srinivas,
  • Siddhartha Laskar,
  • Sonal Dandekar,
  • Smruti Mokal,
  • Bharat Rekhi,
  • Nehal Khanna,
  • Nandini Menon,
  • Vijay Patil,
  • Vanita Noronha,
  • Amit Joshi,
  • Kumar Prabhash,
  • Sripad Banavali,
  • Sudeep Gupta
Jyoti Bajpai
Tata Memorial Centre
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Goutam Panda
Tata Memorial Centre
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Arun Chandrasekharan
Tata Memorial Hospital
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Prabhat Bhargava
Tata Memorial Centre
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Sujay Srinivas
Tata Memorial Centre
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Siddhartha Laskar
Tata Memorial Centre
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Sonal Dandekar
Tata Memorial Centre
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Smruti Mokal
Tata Memorial Centre
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Bharat Rekhi
Tata Memorial Centre
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Nehal Khanna
Tata Memorial Centre
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Nandini Menon
Tata Memorial Centre
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Vijay Patil
Tata Memorial Centre
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Vanita Noronha
Tata Memorial Centre
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Amit Joshi
Tata Memorial Centre
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Kumar Prabhash
Tata Memorial Centre
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Sripad Banavali
Tata Memorial Centre
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Sudeep Gupta
Tata Memorial Centre
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Abstract

Background Outcomes of Ewing sarcoma (ES) in low and middle income countries lags behind the rest of the world owing to multiple tumoral, logistical and socio-economic factors. The data of outcomes and toxicity in these countries is sparse, especially in the adolescent and adult (AA) population and merits exploration Procedure This was a retrospective analysis of prospectively collected data of non-metastatic AA-ES patients, who received standard institutional combination chemotherapy regimen (EFT-2001) along with surgery or definitive radiotherapy. Various cohorts were analyzed for treatment-related toxicities, event- free survival (EFS) and overall survival (OS). Results There were 235 patients (primary safety cohort, PSC) with median age of 23 years. One hundred and ninety six were treatment naïve (primary efficacy cohort, PEC) and of these 119 had surgery. In PEC, at a median follow up of 36.4 months, estimated 5 year EFS and OS were 60.9% (95% CI 53.1% - 69.9%) and 84.5% (95% CI 77.7% - 91.9%), respectively. Of these, 158 complying with intended treatment, had an estimated 5 year EFS of 63.1% (95% CI 54.8%-72.6%). In multivariate analysis, good prognostic factors included longer symptom duration, ≥ 99% necrosis and treatment completion. Among PSC, grade 3-4 toxicities were febrile-neutropenia (50.6%), anemia (55.3%), peripheral neuropathy (15.7%), with 3 (1.3%) chemo-toxic deaths. Conclusions The outcomes of AA non-metastatic ES patients treated with EFT-2001 regimen were comparable to those reported by others, with acceptable toxicity and can be considered as standard-of-care, especially in LMICs.

Peer review status:ACCEPTED

13 Feb 2021Submitted to Pediatric Blood & Cancer
13 Feb 2021Submission Checks Completed
13 Feb 2021Assigned to Editor
15 Feb 2021Reviewer(s) Assigned
10 Mar 2021Review(s) Completed, Editorial Evaluation Pending
13 Mar 2021Editorial Decision: Revise Major
01 Apr 2021Submission Checks Completed
01 Apr 2021Assigned to Editor
01 Apr 20211st Revision Received
05 Apr 2021Reviewer(s) Assigned
07 Apr 2021Review(s) Completed, Editorial Evaluation Pending
09 Apr 2021Editorial Decision: Accept