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.