CHEMOTHERAPY IN THE MANAGEMENT OF INFANTILE FIBROSARCOMA

Infantile fibrosarcoma (IF) has traditionally been treated with surger y, which may have considerable morbidity. Chemotherapy has been sugges ted in order to reduce the need for extensive surgery. Nine children w ith histologically confirmed IF who received chemotherapy are describe d. Six children were treated with chemotherapy initially, two followin g conservative surgery, and one following recurrence after surgery. Al l received vincristine (V) and actinomycin D (A), and six received add itional drugs including ifosfamide (I), cyclophosphamide (C), adriamyc in (Ad), etoposide (E), and cisplatinum (CDDP). Objective responses we re achieved in eight: three responded completely (CR), two responded p artially (PR), which allowed conservative surgery, one had stable dise ase, one had an initial PR, but subseqUently had tumour recurrence 1 m onth after cessation of treatment, necessitating further surgery and c hemotherapy, and one had an initial PR but died following local and re gional metastases. One child had no response to chemotherapy but is al ive with stable residual disease. Thus, five of nine children achieved a CR-three with chemotherapy alone. With the inclusion of chemotherap y as part of their treatment, five children, for whom curative surgery may have resulted in amputation, remain alive with limbs intact. Chem otherapy including V and A should be given to infants with fibrosarcom a in whom curative surgery would be mutilating. (C) 1993 Wiley-Liss, I nc.