Nonmetastatic Ewing family tumors: High-dose chemotherapy with stem cell rescue in poor responder patients. results of the Italian Sarcoma Group/Scandinavian Sarcoma Group III protocol

S. Ferrari, K. Sundby Hall, R. Luksch, A. Tienghi, T. Wiebe, F. Fagioli, T. A. Alvegard, A. Brach del Prever, A. Tamburini, M. Alberghini, L. Gandola, M. Mercuri, R. Capanna, S. Mapelli, A. Prete, M. Carli, P. Picci, E. Barbieri, G. Bacci, S. Smeland

Research output: Contribution to journalArticle

Abstract

Background: High-dose chemotherapy (HDT) was added to conventional chemotherapy in Ewing sarcoma family tumor (EFT) patients, poor responders (PRs) to induction chemotherapy in order to improve their survival. Patients and methods: Patients aged ≤40 years with nonmetastatic Ewing sarcoma (ES) received vincristine (V), doxorubicin (A), cyclofosfamide (C), actinomycin (Ac), ifosfamide (I) and etoposide (E) (VACAc-IE regimen) as induction chemotherapy. As maintenance treatment, good responders (GR) received nine cycles of VACAc-IE regimen. PRs received three cycles of VAC-IE, mobilizing cycle with CE and HDT with Busulfan and Melphalan with stem cell support. Results: Three hundred patients [median age 15 years (3-40 years)] entered the study. One patient refused local treatment, 242 (81%) underwent surgery [with radiotherapy (RT) in 80] and 57 (19%) RT alone. No toxic deaths were recorded. Overall GR were 146 (49%). Twenty-eight PR did not receive HDT. At a median follow-up of 64 months (21-116 months), 5-year overall and event-free survival (EFS) were 75% and 69%, respectively. Five-year EFS was 75% for GR, 72% for PR treated with HDT and 33% for PR who did not receive HDT. Conclusions: High-dose therapy added to the VACA-IE regimen in PR patients is feasible and effective. Selected groups of patients with ES can benefit from HDT.

Original languageEnglish
Pages (from-to)1221-1227
Number of pages7
JournalAnnals of Oncology
Volume22
Issue number5
DOIs
Publication statusPublished - 2011

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Ewing's Sarcoma
Sarcoma
Stem Cells
Drug Therapy
Induction Chemotherapy
Disease-Free Survival
Radiotherapy
Busulfan
Ifosfamide
Melphalan
Poisons
Vincristine
Etoposide
Doxorubicin
Therapeutics
Survival

Keywords

  • Chemotherapy-induced necrosis
  • Ewing sarcoma
  • High-dose chemotherapy

ASJC Scopus subject areas

  • Oncology
  • Hematology

Cite this

Nonmetastatic Ewing family tumors : High-dose chemotherapy with stem cell rescue in poor responder patients. results of the Italian Sarcoma Group/Scandinavian Sarcoma Group III protocol. / Ferrari, S.; Hall, K. Sundby; Luksch, R.; Tienghi, A.; Wiebe, T.; Fagioli, F.; Alvegard, T. A.; del Prever, A. Brach; Tamburini, A.; Alberghini, M.; Gandola, L.; Mercuri, M.; Capanna, R.; Mapelli, S.; Prete, A.; Carli, M.; Picci, P.; Barbieri, E.; Bacci, G.; Smeland, S.

In: Annals of Oncology, Vol. 22, No. 5, 2011, p. 1221-1227.

Research output: Contribution to journalArticle

Ferrari, S, Hall, KS, Luksch, R, Tienghi, A, Wiebe, T, Fagioli, F, Alvegard, TA, del Prever, AB, Tamburini, A, Alberghini, M, Gandola, L, Mercuri, M, Capanna, R, Mapelli, S, Prete, A, Carli, M, Picci, P, Barbieri, E, Bacci, G & Smeland, S 2011, 'Nonmetastatic Ewing family tumors: High-dose chemotherapy with stem cell rescue in poor responder patients. results of the Italian Sarcoma Group/Scandinavian Sarcoma Group III protocol', Annals of Oncology, vol. 22, no. 5, pp. 1221-1227. https://doi.org/10.1093/annonc/mdq573
Ferrari, S. ; Hall, K. Sundby ; Luksch, R. ; Tienghi, A. ; Wiebe, T. ; Fagioli, F. ; Alvegard, T. A. ; del Prever, A. Brach ; Tamburini, A. ; Alberghini, M. ; Gandola, L. ; Mercuri, M. ; Capanna, R. ; Mapelli, S. ; Prete, A. ; Carli, M. ; Picci, P. ; Barbieri, E. ; Bacci, G. ; Smeland, S. / Nonmetastatic Ewing family tumors : High-dose chemotherapy with stem cell rescue in poor responder patients. results of the Italian Sarcoma Group/Scandinavian Sarcoma Group III protocol. In: Annals of Oncology. 2011 ; Vol. 22, No. 5. pp. 1221-1227.
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abstract = "Background: High-dose chemotherapy (HDT) was added to conventional chemotherapy in Ewing sarcoma family tumor (EFT) patients, poor responders (PRs) to induction chemotherapy in order to improve their survival. Patients and methods: Patients aged ≤40 years with nonmetastatic Ewing sarcoma (ES) received vincristine (V), doxorubicin (A), cyclofosfamide (C), actinomycin (Ac), ifosfamide (I) and etoposide (E) (VACAc-IE regimen) as induction chemotherapy. As maintenance treatment, good responders (GR) received nine cycles of VACAc-IE regimen. PRs received three cycles of VAC-IE, mobilizing cycle with CE and HDT with Busulfan and Melphalan with stem cell support. Results: Three hundred patients [median age 15 years (3-40 years)] entered the study. One patient refused local treatment, 242 (81{\%}) underwent surgery [with radiotherapy (RT) in 80] and 57 (19{\%}) RT alone. No toxic deaths were recorded. Overall GR were 146 (49{\%}). Twenty-eight PR did not receive HDT. At a median follow-up of 64 months (21-116 months), 5-year overall and event-free survival (EFS) were 75{\%} and 69{\%}, respectively. Five-year EFS was 75{\%} for GR, 72{\%} for PR treated with HDT and 33{\%} for PR who did not receive HDT. Conclusions: High-dose therapy added to the VACA-IE regimen in PR patients is feasible and effective. Selected groups of patients with ES can benefit from HDT.",
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T2 - High-dose chemotherapy with stem cell rescue in poor responder patients. results of the Italian Sarcoma Group/Scandinavian Sarcoma Group III protocol

AU - Ferrari, S.

AU - Hall, K. Sundby

AU - Luksch, R.

AU - Tienghi, A.

AU - Wiebe, T.

AU - Fagioli, F.

AU - Alvegard, T. A.

AU - del Prever, A. Brach

AU - Tamburini, A.

AU - Alberghini, M.

AU - Gandola, L.

AU - Mercuri, M.

AU - Capanna, R.

AU - Mapelli, S.

AU - Prete, A.

AU - Carli, M.

AU - Picci, P.

AU - Barbieri, E.

AU - Bacci, G.

AU - Smeland, S.

PY - 2011

Y1 - 2011

N2 - Background: High-dose chemotherapy (HDT) was added to conventional chemotherapy in Ewing sarcoma family tumor (EFT) patients, poor responders (PRs) to induction chemotherapy in order to improve their survival. Patients and methods: Patients aged ≤40 years with nonmetastatic Ewing sarcoma (ES) received vincristine (V), doxorubicin (A), cyclofosfamide (C), actinomycin (Ac), ifosfamide (I) and etoposide (E) (VACAc-IE regimen) as induction chemotherapy. As maintenance treatment, good responders (GR) received nine cycles of VACAc-IE regimen. PRs received three cycles of VAC-IE, mobilizing cycle with CE and HDT with Busulfan and Melphalan with stem cell support. Results: Three hundred patients [median age 15 years (3-40 years)] entered the study. One patient refused local treatment, 242 (81%) underwent surgery [with radiotherapy (RT) in 80] and 57 (19%) RT alone. No toxic deaths were recorded. Overall GR were 146 (49%). Twenty-eight PR did not receive HDT. At a median follow-up of 64 months (21-116 months), 5-year overall and event-free survival (EFS) were 75% and 69%, respectively. Five-year EFS was 75% for GR, 72% for PR treated with HDT and 33% for PR who did not receive HDT. Conclusions: High-dose therapy added to the VACA-IE regimen in PR patients is feasible and effective. Selected groups of patients with ES can benefit from HDT.

AB - Background: High-dose chemotherapy (HDT) was added to conventional chemotherapy in Ewing sarcoma family tumor (EFT) patients, poor responders (PRs) to induction chemotherapy in order to improve their survival. Patients and methods: Patients aged ≤40 years with nonmetastatic Ewing sarcoma (ES) received vincristine (V), doxorubicin (A), cyclofosfamide (C), actinomycin (Ac), ifosfamide (I) and etoposide (E) (VACAc-IE regimen) as induction chemotherapy. As maintenance treatment, good responders (GR) received nine cycles of VACAc-IE regimen. PRs received three cycles of VAC-IE, mobilizing cycle with CE and HDT with Busulfan and Melphalan with stem cell support. Results: Three hundred patients [median age 15 years (3-40 years)] entered the study. One patient refused local treatment, 242 (81%) underwent surgery [with radiotherapy (RT) in 80] and 57 (19%) RT alone. No toxic deaths were recorded. Overall GR were 146 (49%). Twenty-eight PR did not receive HDT. At a median follow-up of 64 months (21-116 months), 5-year overall and event-free survival (EFS) were 75% and 69%, respectively. Five-year EFS was 75% for GR, 72% for PR treated with HDT and 33% for PR who did not receive HDT. Conclusions: High-dose therapy added to the VACA-IE regimen in PR patients is feasible and effective. Selected groups of patients with ES can benefit from HDT.

KW - Chemotherapy-induced necrosis

KW - Ewing sarcoma

KW - High-dose chemotherapy

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