Dose-intensified compared with standard chemotherapy for nonmetastatic ewing sarcoma family of tumors: A children's oncology group study

Linda Granowetter*, Richard Womer, Meenakshi Devidas, Mark Krailo, Chenguang Wang, Mark Bernstein, Neyssa Marina, Patrick Leavey, Mark Gebhardt, John Healey, Robert Cooper Shamberger, Allen Goorin, James Miser, James Meyer, Carola A.S. Arndt, Scott Sailer, Karen Marcus, Elizabeth Perlman, Paul Dickman, Holcombe E. Grier

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

260 Scopus citations

Abstract

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.

Original languageEnglish (US)
Pages (from-to)2536-2541
Number of pages6
JournalJournal of Clinical Oncology
Volume27
Issue number15
DOIs
StatePublished - May 20 2009

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

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