Prognosis and Outcome of Adult Patients with Ewing Sarcoma (Local Experience)

Objective: Aim of this work is to assess clinical features, outcome and prognosis of adult patients diagnosed with Ewing Sarcoma (ES). Patients, Methods and Results: The records of 53 adult patients treated with Euro-Ewing protocol at Kuwait cancer control center (KCCC) over a period of 5 years were reviewed. Mean age was 26.9 ± 1.25 years. Thirty percent of patients presented with metastatic disease, and 65% of tumors were centrally located and 50% were ≥ 8 cm. All patients received initially VIDE protocol. 13.5% achieved complete remission (CR), and 57.7% achieved partial response (PR). Approximately 1/3 of patients underwent surgery which was adequate in 76% of them, and all patients received local radiotherapy. Post local treatment 56% of patients received VAC and 44% received VAI protocol. Mean treatment duration was 11 months ± 0.54. Median follow-up duration was 38.39 (33.49 - 43.28) months At the end of follow up 20% of patients relapsed locally and 36% distally. Median PFS was 46.9 months (95% CI 41.42 - 52.39), Median OS was 55.43 ms (95% CI 30.71 - 75.74);survivals at 3 and 5 years were 88%, 46% respectively. Conclusion: In this series metastases at presentation and wide surgical margins were the most important prognostic factors. Multimodality therapy is necessary for this rare disease.

Retrospective Analysis of Adjuvant Therapy in Intermediate and High Risk Endometrial Cancer Patients

Introduction: Endometrial cancer is the most common gynecologic malignancy in developed countries. The most significant prognostic factors are tumor stage, histological grade and type, depth of myometrial invasion, lympho-vascular space or nodal involvement. The optimal adjuvant therapy in high and intermediate risk endometrial cancer is still controversial. Aim of the work: Evaluating the impact of adjuvant chemotherapy in addition to radiotherapy on prognosis of high and intermediate risk endometrial cancer. Patients and methods: Forty six patients with high and intermediate risk endometrial cancer presenting to Kuwait Cancer Control Center (KCCC) underwent total abdominal hysterectomy, bilateral salpingo-ophorectomy, and 18 patients underwent lymphadenectomy (39.1%). All patients received adjuvant chemotherapy followed by adjuvant radiotherapy. According to GOG risk stratification, 28 patients (60.9%) were high risk, 6 (13%) high intermediate and 12 (26.1%) low intermediate. At the end of follow up period, 34.71% of patients relapsed, 21.71% locally and 13% systemic. Median PFS was 38.06 months(ms) (95% CI 36.94 - 39.18 ms). There was a statistically significant effect of lympho-vascular space invasion (LVSI), grade and near statistically significant effect of patients age on PFS (p = 0.01, 0.05, 0.06 respectively). Median OS for all patients was not reached;estimated survival at 3 years was 87.5%. There was no statistically significant effect of age, pathological subtype, grade, LVSI on survival (p = 0.35, 0.95, 0.53 and 0.09 respectively). On stratifying patients into high and intermediate risk based on GOG risk stratification, there was a statistically significant difference on PFS and near statistically significant difference on OS between those groups (p = 0.02 and 0.09 respectively). Conclusion: The most effective adjuvant treatment regimen for patients with intermediate and high risk endometrial cancer is still an area of controversy. Sequential chemotherapy and radiotherapy is both efficacious and well tolerated. Large-scale randomized controlled trials are necessary in the future.