SHORT COMMUNICATION Journal of the College of Physicians and Surgeons Pakistan 2020, Vol. 30(04): 446-447 446 Feasibility of Compressed Chemotherapy Pediatric Ewing Sarcoma Regimen In Pakistan Haleema Saeed, Rishm Ali and Saadiya Javed Khan Department of Paediatric Oncology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan ABSTRACT A retrospective chart review was conducted to determine the feasibility of interval-compressed chemotherapy regimen in pediatric Ewing sarcoma (ES) patients treated at Department of Pediatric Oncology, Shaukat Khanum Memorial Trust Cancer Hospital, Lahore, Pakistan, from June 2017 to December 2018. Data was collected regarding demographics, treatment duration and timing, complica- tions and outcome. Completion of treatment within 8 months as considered on time. There were 24 patients (male: female ratio = 1.4:1, average age = 10.2 ±5.3 years. Involved sites were extremity in 13 (54%), pelvis in 4 (16.6%), and spine in 3 (12.5%) patients. Twenty patients (83.3%) completed chemotherapy on time. The mean duration of treatment was 7.2 ±1.2 months. Only three patients (12%) exceeded 8 months of duration of treatment. There was an average of 2.5 febrile neutropenia events per patient. Seventeen (70.8%) patients are alive at the time of review. Two patients died of sepsis, one developed cardiac failure, and one died of progressive disease. This single-institution review showed that patients can tolerate interval-compressed chemotherapy protocol regimen for ES with adequate supportive care. Key Words: Ewing sarcoma, chemotherapy, Compressed regimen, feasibility, Pediatrics. How to cite this article: Saeed H, Ali R, Khan SJ. Feasibility of Compressed Chemotherapy Pediatric Ewing Sarcoma Regimen In Pakistan. J Coll Physicians Surg Pak 2020; 30(04):446-447. DOI: https://doi.org/10.29271/jcpsp.2020.04.446. EwingsarcomaESisthesecondmostcommonbonetumorinchil- dren with overall survival of 70% for non-metastatic ES in devel- oped countries. 1 Survival in low-middle-income countries (LMICs) is still inferior. This can be improved with adherence to protocol therapy and improvement of supportive care. 2 The aim of this study was to determine the feasibility of switching our current EE99 protocol to the Children’s Oncology Group (COG AEWS 0031) compressed chemotherapy protocol, which is now the standard of care in North America. 3 We believe that if we can deliver chemotherapy in 2-weekly cycles without increasing morbidityandmortality,thiscanbeadvantageousinLMICswhere inpatient bed limitations and logistical issues of seeking treat- ment far away from home can be addressed with this shorter protocol. A retrospective review was conducted for patients with a diag- nosis of ES who presented to the Department of Pediatric Oncology, Shaukat Khanum Memorial Trust Cancer Hospital, Lahore, Pakistan, from June 2017 to December 2018. All patients with histologically proven diagnosis of ES who had received treatment with compressed cycle chemotherapy consisting of alternating VDC (Vincristine, Doxorubicin, Cyclo- phosphamide) and IE (Ifosphamide, Etoposide) during the studyperiodwereincluded.Exclusioncriterionincludedtreat- Correspondence to: Dr. Saadiya Javed Khan, Department of Paediatric Oncology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan E-mail: saadiyakhan@hotmail.com ..................................................... Received: May 10, 2019; Revised: September 05, 2020; Accepted: September 05, 2020 DOI: https://doi.org/10.29271/jcpsp.2020.04.446 mentwithdifferenttreatmentregimenandfailuretoinitiatetreat- ment. Medical records of all eligible patients were retrospectively reviewed after seeking approval from the Institutional Review Board (IRB) at our Hospital. Patients were followed till December 2018. Expected duration of treatment was 7 months. After allowing time for local control, completion of therapy within 8 months was considered to be on-time. Twenty-four patients were seen during June 2017 to December 2018 (Table I). Male to female ratio was 1.4: 1. Mean age was 10.2 years (range 8 months to 16 years). The average tumor volume was 485 mL (range 5-1978 mL). Table I: Patient characteristics. Age 10.2 years (+ 5.3 years) Gender (M:F) 1.4:1 Stage Non-metastatic Metastatic 87.5% (n=21) 12.5% (n=3) Location Upper limb Lower limb Pelvis Spine Chest Face 20.8% (n=5) 33.3% (n=8) 16.7% (n=4) 12.5% (n=3) 8.3% (n=2) 8.3% (n=2) AllpatientsreceivedtreatmentwithalternatingcyclesofVDCand IE every 15 days. G-CSF was started 24 hours after last dose of chemotherapy and was continued till ANC was above 1000/µL after nadir. Of the 24 patients, 87% (n=21) were able to complete therapy on time (Figure1).Meandurationoftreatmentwas7.2±1.2months.Only