Ewing sarcoma in patients over 40 years of age: a prospective analysis of 31 patients treated at a single institution



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.


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.


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).


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.

Tumori 2016; 102(5): 481 - 487




Marilena Cesari, Alberto Righi, Luca Cevolani, Emanuela Palmerini, Daniel Vanel, Davide M. Donati, Silvia Cammelli, Marco Gambarotti, Cristina Ferrari, Anna Paioli, Alessandra Longhi, Massimo E. Abate, Piero Picci, Stefano Ferrari

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Financial support: No financial support was received for this submission.
Conflict of interest: None of the authors has conflict of interest with this submission.

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  •  Chemotherapy Section, Rizzoli Orthopedic Institute, Bologna - Italy
  •  Department of Surgical Pathology, Rizzoli Orthopedic Institute, Bologna - Italy
  •  Department of Orthopedic Surgery, Rizzoli Orthopedic Institute, Bologna - Italy
  •  Department of Musculoskeletal Oncology, Rizzoli Orthopedic Institute, Bologna - Italy
  •  Department of Radiotherapy, S. Orsola-Malpighi Hospital, Bologna - Italy

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