High-dose induction chemoradiotherapy followed by autologous bone marrow transplantation as consolidation therapy in rhabdomyosarcoma, extraosseous Ewing's sarcoma, and undifferentiated sarcoma Journal Article


Authors: Boulad, F.; Kernan, N. A.; LaQuaglia, M. P.; Heller, G.; Lindsley, K. L.; Rosenfield, N. S.; Abramson, S. J.; Gerald, W. L.; Small, T. N.; Gillio, A. P.; Gulati, S. C.; O'Reilly, R. J.; Ghavimi, F.
Article Title: High-dose induction chemoradiotherapy followed by autologous bone marrow transplantation as consolidation therapy in rhabdomyosarcoma, extraosseous Ewing's sarcoma, and undifferentiated sarcoma
Abstract: Purpose: To improve response and survival rates in patients with high- risk rhabdomyosarcoma (RMS), extraosseous Ewing's sarcoma, and undifferentiated sarcoma, we used a short course of induction with multiagent chemotherapy, hyperfractionated radiotherapy, and surgery when possible. Consolidation was with intensive chemotherapy and autologous bone marrow transplantation (ABMT). Patients and Methods: Twenty-six patients (21 with RMS, three with undifferentiated sarcoma, and two with extraosseous Ewing's sarcoma) were entered onto the protocol between June 1990 and March 1994. Induction consisted of ifosfamide, etoposide, doxorubicin, doctinomycin, cyclophosphamide, and vincristine, and a split course of hyperfractionated radiotherapy. Patients who attained a complete response (CR) or good partial response (GPR) received consolidation with high-dose melphalan and etoposide followed by ABMT. Results: Of 26 previously untreated patients 19 (73%) achieved a CR (n = 13) or GPR (n = 6) at the completion of induction and underwent ABMT. Two-year overall survival (OS) was 56% (95% confidence interval [CI], 36% to 76%) and progression-free survival (PFS) was 53% for the whole group (95% CI, 33% to 73%). Conclusion: Consolidation of response by myeloablative chemotherapy was well tolerated. Split-course hyperfractionated radiotherapy did not increase the rate of local control. The results of this short-course therapy were comparable to previous therapies of 1 to 2 years' duration. Induction and consolidation chemotherapy, as well as radiation dose, could be further intensified, since no death due to toxicity occurred among these patients.
Keywords: adolescent; adult; cancer chemotherapy; cancer survival; child; clinical article; aged; aged, 80 and over; child, preschool; disease-free survival; cancer surgery; survival rate; clinical trial; doxorubicin; skin toxicity; cancer radiotherapy; combined modality therapy; drug megadose; antineoplastic agent; infection; etoposide; stomatitis; antineoplastic combined chemotherapy protocols; radiotherapy dosage; cyclophosphamide; melphalan; vincristine; clinical protocol; radiation injury; ifosfamide; ewing sarcoma; fever; sarcoma; gastrointestinal toxicity; infant; radiation dose fractionation; dactinomycin; neoplasms, germ cell and embryonal; mesna; rhabdomyosarcoma; bone marrow transplantation; sarcoma, ewing's; transplantation, autologous; hemorrhagic cystitis; hematologic disease; intravenous drug administration; autologous bone marrow transplantation; humans; human; male; female; priority journal; article
Journal Title: Journal of Clinical Oncology
Volume: 16
Issue: 5
ISSN: 0732-183X
Publisher: American Society of Clinical Oncology  
Date Published: 1998-05-01
Start Page: 1697
End Page: 1706
Language: English
PUBMED: 9586881
PROVIDER: scopus
DOI: 10.1200/JCO.1998.16.5.1697
DOI/URL:
Notes: Article -- Export Date: 12 December 2016 -- Source: Scopus
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MSK Authors
  1. Nancy Kernan
    377 Kernan
  2. Trudy Small
    198 Small
  3. Farid Boulad
    251 Boulad
  4. Glenn Heller
    295 Heller
  5. Nancy S Rosen
    27 Rosen
  6. William L Gerald
    367 Gerald
  7. Richard O'Reilly
    480 O'Reilly
  8. Fereshteh   Ghavimi
    14 Ghavimi