title: No benefit of ifosfamide in Ewing's sarcoma: a nonrandomized study of the French Society of Pediatric Oncology.
abstract: OBJECTIVE
  To undertake a new protocol with the goals of improving the chemotherapeutic treatment of pediatric Ewing's sarcoma by introducing ifosfamide, and to widen the indications for surgical resection of Ewing's tumor to obtain better local control and to reduce radiation doses.
  
  
  METHODS
  The French Society of Pediatric Oncology initiated its first cooperative Ewing's sarcoma study in 1978, using a four-drug regimen (cyclophosphamide, dactinomycin, Adriamycin [doxorubicin; Farmitalia Carlo Erba, Rueil-Malmaison, France], and vincristine). Ninety-five patients were included, and, at 5 years, the disease-free survival reached a plateau of 51%. After encouraging responses of recurrent soft tissue or bone sarcomas to ifosfamide, a second study began in 1984 using a new chemotherapy regimen in which cyclophosphamide was replaced by ifosfamide. Sixty-five patients were treated.
  
  
  RESULTS
  By February 1992, the median follow-up was 5.8 years. The estimated 5-year disease-free survival was 52%. We observed unexpected cardiac toxicity. Three patients experienced acute cardiac failure that was lethal in two cases. The acute toxicity of ifosfamide prompted us to stop the protocol. Retrospectively, the lack of efficacy reinforced our decision.
  
  
  CONCLUSIONS
  We conclude that ifosfamide did not improve the outcome of the patients despite the fact that these two treatment regimens were not randomized.
authors.affiliation: Institut Gustave Roussy, Villejuif, France.
authors.forename: O
authors.initials: O
authors.lastname: Oberlin
authors.forename: J L
authors.initials: JL
authors.lastname: Habrand
authors.forename: J M
authors.initials: JM
authors.lastname: Zucker
authors.forename: M
authors.initials: M
authors.lastname: Brunat-Mentigny
authors.forename: M J
authors.initials: MJ
authors.lastname: Terrier-Lacombe
authors.forename: J
authors.initials: J
authors.lastname: Dubousset
authors.forename: J C
authors.initials: JC
authors.lastname: Gentet
authors.forename: C
authors.initials: C
authors.lastname: Schmitt
authors.forename: D
authors.initials: D
authors.lastname: Ponvert
authors.forename: C
authors.initials: C
authors.lastname: Carrié
mesh_terms: D001859:Bone Neoplasms / Q000188:drug therapy* / Q000532:radiotherapy / Q000601:surgery; D002648:Child; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007069:Ifosfamide / Q000009:adverse effects / Q000627:therapeutic use*; D008297:Male; D011379:Prognosis; D012008:Recurrence; D012512:Sarcoma, Ewing / Q000188:drug therapy* / Q000532:radiotherapy / Q000601:surgery; D016019:Survival Analysis; D016896:Treatment Outcome
chemical_list: D007069:Ifosfamide