# Characteristics and Outcome of Children and Adolescents Diagnosed With Ewing Sarcoma Treated at a Tertiary Cancer Center in India: A Single-Institution Experience

## TL;DR

This study examines the outcomes of children and adolescents with Ewing sarcoma in India, finding that complete tumor removal combined with chemotherapy and radiotherapy improves survival.

## Contribution

The study provides insights into treatment outcomes for Ewing sarcoma in a low-middle income country setting using a uniform treatment protocol.

## Key findings

- Complete tumor resection with negative margins significantly improves survival when combined with chemotherapy and radiotherapy.
- Three-year overall survival and progression-free survival rates were 55% and 40%, respectively.
- Successful early therapy, such as achieving complete response, is crucial for better outcomes in Ewing sarcoma patients.

## Abstract

Introduction: Ewing sarcoma (ES) is a malignant, aggressive tumor most frequently diagnosed among pediatric and adolescent populations. Patients with ES in low-middle income countries (LMIC) have dismal outcomes. The aim of this study is to evaluate the outcomes in children and adolescents with ES treated using a multimodal uniform treatment protocol.

Methods: A retrospective analysis was conducted on 54 children and adolescents <18 years of age diagnosed with ES who received treatment from January 2021 to December 2022 at a tertiary cancer center in Western India. Data were retrieved from the hospital database, including clinical and medical records.

Results: The study included 32 males (59%) and 22 females (41%) with a male-to-female ratio of 1.45:1. The median age of presentation was 13 years (ranging from four to 17 years). Localized disease was observed in 36 patients (67%) and metastatic disease in 18 patients (33%). Extremities were the most common primary sites (35 patients, 65%). Among the patients, 15 (28%) achieved complete response (CR), seven (13%) had persistent disease, 25 (46%) had incomplete response, and seven (13%) experienced disease progression on chemotherapy. The median (IQR) OS was 36 months (30-42 months), with three-year overall survival (OS) and progression-free survival (PFS) rates of 55% and 40%, respectively.

Conclusion: In ES, complete resection of tumors with negative margins (i.e., R0 resection) significantly improves outcomes when combined with chemotherapy and radiotherapy. Survival is greatly increased upon achieving CR, highlighting the significance of successful early therapy. For this patient population to have better outcomes, further research and closing disparities in healthcare in LMICs are essential.