| Abstract: |
Background. The outcome for patients with Ewing sarcoma family of tumors (ESFTs) of bone with metastases at diagnosis remains poor despite new approaches to treatment. We evaluated whether a dose-intensity chemotherapy regimen improved survival for patients with ESFTs of bone with metastases at diagnosis. Methods. We entered 60 patients with metastatic ESFTs of bone onto a single arm trial of a new intensive therapy. Treatment consisted of 51-weeks of chemotherapy and local control of the primary with radiation, surgery, or both. The chemotherapeutic protocol included two alternating blocks: one with vincristine (2 mg/m2), doxorubicin (90 mg/m2), and cyclophosphamide (2,200 mg/m2); and the second with ifosfamide (2,800 mg/m2/day x 5 days) and etoposide (100 mg/m2/day x 5 days). Results. Of the 60 patients with metastatic ESFTs of bone enrolled onto this single arm trial, 12 had metastasis to lung only, 7 to bone marrow or bone only, 38 to multiple sites, 2 in other sites and 3 not specified. There were three toxic deaths. Six patients (6-year cumulative incidence: 9%) developed second malignant neoplasms and died. The 6-year overall event-free survival (EFS) was 28% (standard error (SE) 6%) and survival (S) was 29% (SE 6%). Conclusion. An intensified treatment regimen using higher doses of cyclophosphamide, ifosfamide, and doxorubicin increased toxicity and risk of second malignancy without improving EFS and S. © 2007 Wiley-Liss, Inc. |
| Keywords: |
adolescent; adult; cancer survival; child; controlled study; treatment outcome; treatment response; bone neoplasms; child, preschool; survival rate; major clinical study; clinical trial; constipation; doxorubicin; diarrhea; drug efficacy; drug safety; side effect; bone metastasis; cancer patient; drug megadose; follow-up studies; antineoplastic agent; controlled clinical trial; liver toxicity; lung toxicity; nephrotoxicity; sensory neuropathy; neoplasm recurrence, local; etoposide; nausea; randomized controlled trial; stomatitis; vomiting; antineoplastic combined chemotherapy protocols; peripheral neuropathy; drug administration schedule; risk factors; cyclophosphamide; vincristine; continuous infusion; dose-response relationship, drug; hematuria; ifosfamide; abdominal pain; alanine aminotransferase blood level; aspartate aminotransferase blood level; ewing sarcoma; fever; intensive care; alanine aminotransferase; aspartate aminotransferase; bilirubin; gastrointestinal toxicity; prothrombin time; lung metastasis; infant; patient compliance; dactinomycin; glucose blood level; glucose; diastolic blood pressure; systolic blood pressure; neoplasms, second primary; second cancer; cancer control; mesna; alkylating agents; drug dose increase; sodium; sodium blood level; sarcoma, ewing's; injections, subcutaneous; granulocyte colony stimulating factor; bilirubin blood level; neuroectoderm tumor; proteinuria; mood disorder; potassium; neuroectodermal tumors, primitive; bone marrow metastasis; weight change; bone tumors; electrolyte; vital capacity; potassium blood level; dose intensity; metastatic ewing sarcoma; metastatic pnet; oxazaphosphorine chemotherapy; electrolyte blood level
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