Results of treatment for soft tissue sarcoma in childhood and adolescence:A final report of the German cooperative soft tissue sarcoma study CWS-86

Purpose: The goal of the second German Soft Tissue Sarcoma Study CWS-86 (19 85 to 1990) was to improve the prognosis in children and adolescents with s oft tissue sarcoma by means of a clinical trial comprising intensive chemot herapy and risk-adapted local therapy, Patients and Methods: There were 372 eligible patients, A staging system ba sed on the postsurgical extent of disease was used. Chemotherapy consisted of vincristine, dactinomycin, doxorubicin, and ifosfamide. Radiotherapy was administered early at 10 to 13 weeks simultaneously with the second chemot herapy cycle (32 Oy or 54.4 Gy). The single dose was reduced to 1.6 Oy and given twice daily (accelerated hyperfractionation), Results: The event-free survival (EFS) and overall survival rates at 5 year s were 59% +/- 3% and 69% +/- 3%, respectively The 5-year EFS rate accordin g to stage was as follows: stage 1, 83% +/- 5%; stage 11, 69% +/- 6%; stage ill, 57% +/- 4%;and stage IV, 19% +/- 6%. The outcome for patients with st age III disease who required radiotherapy was much better in the CWS-86 stu dy compared with the CWS-81 study (5-year EFS, 60% +/- 5% v 44% +/- 6%; P = .053). The most common treatment failure was isolated local relapse, with 1 4% of patients relapsing at the primary tumor site, Conclusion: The improved design of the study incorporating risk-adapted rad iotherapy allowed treatment to be reduced for selected groups of patients w ithout compromising survival. J Clin Oncol 17:3706-3719. (C) 1999 by Americ an Society of Clinical Oncology.