Nuances in the Treatment of Ewing Sarcoma of the Head and Neck in a Low-Middle-Income Country Setting: A Multi-Disciplinary Approach.

Abstract

Ewing sarcoma of the head and neck (ES-HN) is a rare subsite of ES, where therapeutic outcomes need to be explored further. This retrospective study includes ES-HN patients registered at our center between 2003 and 2019. Demographic details and treatment outcomes were recorded from the hospital database. Prognostic factors for survival were identified by Cox regression. Eighty-five patients were included. Metastatic disease was seen in nine patients (10.59%). Local therapy included radiotherapy alone (n = 38; 44.7%), surgery plus radiotherapy (n = 15; 17.6%), or surgery alone (n = 8; 9.4%). The median overall survival (OS) was 37.4 months. On multivariable analysis, osseous primary (HR 0.40; p = 0.009) and male sex (HR 0.43; p = 0.023) were associated with superior OS. Leucocytosis (HR 3.46; p = 0.001) was associated with inferior OS. ES-HN has favorable biology with metastases being rare at baseline. However, leucocytosis, extra-osseous disease, and female sex are poor prognostic factors. In resource-challenged settings, difficulties in administering local therapy may contribute to inferior outcomes.