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.