http://www3.interscience.wiley.com/cgi-bin/abstract/112476870
High histologic and overall response to dose intensification of
ifosfamide, carboplatin, and etoposide with cyclophosphamide,
doxorubicin, and vincristine in patients with high-risk ewing sarcoma
family tumors
The Bambino Gesù Children's Hospital experience
Giuseppe Maria Milano, M.D. 1 *, Raffaele Cozza, M.D. 1, Ilaria Ilari,
M.D. 1, Luigi De Sio, M.D. 1, Renata Boldrini, M.D. 2, Alessandro
Jenkner, M.D. 1, Maretta De Ioris, M.D. 1, Alessandro Inserra, M.D. 3,
Carlo Dominici, M.D. 1 4, Alberto Donfrancesco, M.D. 1
1Division of Pediatric Oncology, Ospedale Pediatrico Bambino
Gesù-IRCCS, Rome, Italy
2Division of Pathology, Ospedale Pediatrico Bambino Gesù-IRCCS, Rome,
Italy
3Division of Pediatric Surgery, Ospedale Pediatrico Bambino Gesù-IRCCS,
Rome, Italy
4Department of Pediatrics, La Sapienza University, Rome, Italy
email: Giuseppe Maria Milano (milano_gm@hotmail.com)
*Correspondence to Giuseppe Maria Milano, Dipartimento di
Oncoematologia Pediatrica e Servizio Immunotrasfusionale, UO di
Oncologia, Ospedale Pediatrico Bambino Gesù-IRCCS, Piazza Sant'Onofrio
4, Rome, 00165, Italy
Fax: (011) 396 68592242
Keywords
Ewing sarcoma family tumors • chemotherapy • dose intensification •
histologic response • tumor necrosis • survival
Abstract
BACKGROUND
Ewing sarcoma (ES) and extraosseous ES/primitive neuroectodermal tumors
(PNET) share histopathologic features of the ES family of tumors
(ESFT). The authors report on their results from a regimen of
ifosfamide, carboplatin, and etoposide (ICE) with cyclophosphamide,
doxorubicin, and vincristine (CAV) dose intensification in patients
with high-risk ESFT.
METHODS
Since 1990, patients with ESFT and with 1 or more of the following risk
factors were reviewed: tumor volume > 200 mL, tumor site with a poor
prognosis, and pulmonary and/or bone marrow metastases.
RESULTS
Thirty-six patients with ESFT who were involved in the study were
divided into 2 arms of 18 patients each. One group received treatment
with various regimens, and the other group received treatment with ICE
plus CAV. The disease was brought under control more rapidly in the
latter patients, for whom surgery was more easily feasible, and up to
90% of patients achieved a major response, with an estimated 3-year
overall survival rate of 67% ± 12%.
CONCLUSIONS
The current results showed that ICE plus CAV was tolerated well and was
effective in the studied subset of tumors, indicating that dose
intensification correlates with better disease control, a high
percentage of necrosis, and conservative surgery in patients with
high-risk ESFT. Cancer 2006. © 2006 American Cancer Society.