Originally published as JCO Early Release 10.1200/JCO.2008.19.1478 on April 6 2009

This Article Full Text Full Text (PDF) Purchase Article View Shopping Cart Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Save to my personal folders Download to citation manager Rights & Permissions Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Granowetter, L. Articles by Grier, H. E. Search for Related Content PubMed PubMed Citation Articles by Granowetter, L. Articles by Grier, H. E. Social Bookmarking                            What's this?

Dose-Intensified Compared With Standard Chemotherapy for Nonmetastatic Ewing Sarcoma Family of Tumors: A Children's Oncology Group Study

From the Division of Pediatric Oncology, Columbia Presbyterian College of Physicians and Surgeons; Department of Surgery, Orthopedic Service, Memorial Sloan-Kettering Cancer Center, New York, NY; Division of Oncology and Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, PA; Children's Oncology Group–Data Center, College of Medicine Center, University of Florida, Gainesville, FL; Statistics, Children's Oncology Group–Operations Center, Arcadia; Pediatric Hematology/Oncology, Stanford University Medical Center, Palo Alto; Department of Pediatrics, City of Hope National Medical Center, Duarte, CA; Department of Biostatistics, Division of Pediatric Hematology-Oncology, IWK Health Centre, Halifax, Nova Scotia, Canada; Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX; Orthopedics, Dana-Farber Cancer Institute and Children's Hospital, Boston, MA; Departments of General Surgery and Pediatric Oncology, and Division of Radiation Oncology, Dana-Farber Cancer Institute and Children's Hospital, Boston, MA; Pediatric Hem-Oncology, Mayo Clinic, Rochester, MN; Department of Radiation Oncology, University of North Carolina at Chapel Hill, Chapel Hill, NC; Pathology, Children's Memorial Medical Center at Chicago, Chicago, IL; and Department of Pathology, Phoenix Children's Hospital, Phoenix, AZ.

Corresponding author: Linda Granowetter, MD, Department of Pediatrics, Division of Oncology, Columbia University Medical Center, 161 Fort Washington Ave Irving-7, New York, NY 10032; e-mail: lg519{at}columbia.edu.

Purpose The Ewing sarcoma family of tumors (ESFT) is a group of malignant tumors of soft tissue and bone sharing a chromosomal translocation affecting the EWS locus. The Intergroup INT-0091 demonstrated the superiority of a regimen of vincristine, cyclophosphamide, doxorubicin (VDC), and dactinomycin alternating with ifosfamide and etoposide (IE) over VDC for patients with nonmetastatic ESFT of bone. The goal of this study was to determine whether a dose-intensified regimen of VDC alternating with IE would further improve the outcome for patients with nonmetastatic ESFT of bone or soft tissue.

Methods Patients with previously untreated, nonmetastatic ESFT of bone or soft tissue were eligible. They were randomly assigned to receive standard doses of VDC/IE over 48 weeks or a dose-intensified regimen of VDC/IE over 30 weeks.

Results Four hundred seventy-eight patients met eligibility requirements: 231 patients received the standard regimen; 247 patients received the intensified regimen. The 5-year event-free survival (EFS) and overall survival rates for all eligible patients were 71.1% (95% CI, 67.7% to 75.0%) and 78.6% (95% CI, 74.6% to 82.1%), respectively. There was no significant difference (P = .57) in EFS between patients treated with the standard (5-year EFS, 72.1%; 95% CI, 65.8% to 77.5%) or intensified regimen (5-year EFS, 70.1%; 63.9% to 75%). Patients with soft tissue tumors accounted for 20% of the study population; there was no difference in outcome between patients with soft tissue and bone primary sites.

Conclusion Dose escalation of alkylating agents as tested in this trial did not improve the outcome for patients with nonmetastatic ESFT of bone or soft tissue.

Authors' disclosures of potential conflicts of interest and author contributions are found at the end of this article.

CiteULike    Complore    Connotea    Del.icio.us    Digg    Facebook    Reddit    Technorati    Twitter    What's this?