High-risk Ewing's sarcoma: end-intensification using autologous bone marrow transplantation.
Because of retrospective analysis showing survival to be related to primary tumor size, in February 1982 a study to test this hypothesis prospectively was begun at the University of Florida. Patients with primary tumors 8 cm or less in maximum diameter and no metastases received adjuvant chemotherapy consisting of vincristine, cyclophosphamide, doxorubicin, and dactinomycin plus radiotherapy or surgery (standard-risk protocol). All others received a similar regimen followed by end-intensification with high-dose melphalan and autologous bone marrow transplantation (Protocol HR-2). Because of poor results of HR-2, another high-risk protocol (HR-3) was initiated in January 1985. Patients on HR-3 received 2 cycles of chemotherapy containing vincristine, cyclophosphamide, and doxorubicin followed by local radiation therapy and maintenance chemotherapy. At the end of this therapy, autologous bone marrow transplantation (ABMT) was performed, using a preparatory regimen of total body irradiation and intensive chemotherapy. The 2-year disease-free survival rate was 70% for the standard-risk protocol, 20% for HR-2, and 80% for HR-3. The follow-up on HR-3 is still short, but the results are promising enough to warrant further clinical trials.
Marcus
R B
RB
University of Florida College of Medicine, Gainesville.
Graham-Pole
J R
JR
Springfield
D S
DS
Fort
J A
JA
Gross
S
S
Mendenhall
N P
NP
Elfenbein
G J
GJ
Weiner
R S
RS
Enneking
W F
WF
Million
R R
RR
D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D016026:Bone Marrow Transplantation; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D008297:Male; D012512:Sarcoma, Ewing / Q000188:drug therapy / Q000532:radiotherapy / Q000628:therapy*; D014916:Whole-Body Irradiation