NEOADJUVANT CHEMOTHERAPY FOR EWINGS-SARCOMA OF BONE - NO BENEFIT OBSERVED AFTER ADDING IFOSFAMIDE AND ETOPOSIDE TO VINCRISTINE, ACTINOMYCIN, CYCLOPHOSPHAMIDE, AND DOXORUBICIN IN THE MAINTENANCE PHASE - RESULTSOF 2 SEQUENTIAL STUDIES

BACKGROUND, IFosfamide (IF) alone or combined with etoposide (ET) was reported to be effective in the treatment of patients with Ewing's sar coma who relapsed after treatment with the VACA regimen, which consist ed of vincristine (VC), actinomycin (AC), cyclophosphamide (CP), and d oxorubicin (AD). The purpose of this article is to report the results achieved in a new neoadjuvant protocol in which IF and ET were added t o the conventional VACA regimen and administered to patients with loca lized disease. METHODS. In this study, eighty-two patients were treate d between May 1988 and October 1991. Chemotherapy consisted of two ind uction cycles of VC/CP/AD followed by alternating cycles of VC/AD/CP, VC/IF/AC, IF/ET, and VC/CP/AC after local treatment. Twenty-two patien ts (27%) were treated with surgery only, 22 (27%) underwent surgery fo llowed by radiation therapy, and 38 (46%) received radiotherapy only. RESULTS. At a median follow-up of 6.7 years (range, 4-9 years), 43 pat ients (52%) remained continuously disease free, and 39 relapsed (34 wi th metastases, 4 with local recurrence and metastases, and 1 with a lo cal recurrence). These results were similar to those obtained at the s ame institute in a previous neoadjuvant study (March 1983 and April 19 88) that included 108 patients treated with the conventional 4-drug re gimen. The 5-year disease free and overall survival in the current stu dy were 54% and 59%, respectively, and in the first study were 50% and 56%, respectively. CONCLUSIONS. The comparison of these two sequentia l studies, although not randomized, referred to homogeneous groups of patients observed at the same institution who were treated by the same medical team. No advantage was observed when IF and ET were added to the VACA regimen. (C) 1998 American Cancer Society.