Cb. Pratt et al., TREATMENT OF UNRESECTABLE OR METASTATIC PEDIATRIC SOFT-TISSUE SARCOMAS WITH SURGERY, IRRADIATION, AND CHEMOTHERAPY - A PEDIATRIC-ONCOLOGY-GROUP STUDY, Medical and pediatric oncology, 30(4), 1998, pp. 201-209
Background. The objectives of this study were to compare vincristine/a
ctinomycin D/cyclophosphamide/adriamycin (VACA) with VACA plus imidazo
le carboxamide (DTIC) (VACAD) therapy in regards to complete/partial r
esponse and event free survival rates in children and adolescents with
metastatic non-rhabdomyosarcoma soft tissue sarcomas (NRSTS) or previ
ously chemotherapy-naive recurrent NRSTS or locally persistent gross r
esidual tumor after surgery and radiation therapy. Procedures. Between
1986 and March 1994, 75 patients entered this randomized study compar
ing VACA and VACAD, given at 3 week intervals. Sixty-one patients were
considered eligible and received chemotherapy and radiation therapy t
o the primary tumor and areas of metastases. Thirty-six patients had r
egional unresected (Group III) disease, and 25 had metastatic disease
(Group IV) at time of accession. Thirty-six patients received VACA (11
were not randomized), and 25 received VACAD. Results. With a median f
ollow-up oi greater than 4 years, overall and event-free survival for
all eligible patients are 30.6% and 18.4%, respectively (S.E: 9.5% and
6.8%). There was insufficient evidence that DTIC offered any advantag
e to event free survival, bur there was evidence for better outcome fo
r patients in Group III disease in comparison to patients with Group I
V disease, and for patients with a Grade 1 and 2 histology in comparis
on to Grade 3 lesions. Conclusions. Combination chemotherapy with VACA
and VACAD were insufficient to prevent recurrent or progressive disea
se in children and adolescents with high stage NRSTS. The use of vincr
istine/ifosfamide/doxorubicin with cytokine support is under study. (C
) 1998 Wiley-Liss, Inc.