High-dose therapy for patients with primary multifocal and early relapsed Ewing's tumors:: Results of two consecutive regimens assessing the role of total-body irradiation
High-dose therapy for patients with primary multifocal and early relapsed Ewing's tumors:: Results of two consecutive regimens assessing the role of total-body irradiation
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DOI：
10.1200/jco.2003.12.039
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发表时间：
2003-08-15
影响因子：
45.3
通讯作者：
Juergens, H
中科院分区：
文献类型：
--
作者：
Burdach, S;Meyer-Bahlburg, A;Juergens, H
目的：在过去的十年中，转移性和复发性尤因肿瘤（ETs）的风险分层一直是争论的问题。骨或骨髓转移或早期或多次复发的患者是ET的最危险组，其预后比原发性肺转移或晚期复发的患者差。在本文中，本Meta欧洲组间合作尤文氏肉瘤研究（MetaEICESS）（串联美伐兰/依托泊苷[TandemME]）的结果与之前的研究（超美伐兰/依托泊苷[HyperME]）的结果进行了比较，均为5年，在同一高危层的患者人群中确定毒性。患者和方法：在54例符合条件的患者中，26例按照HyperME方案治疗，28例按照TandemME方案治疗。患者在HyperME中接受6个周期的合作Ewing肉瘤研究治疗，在TandemME中接受6个周期的EICESS治疗作为诱导化疗。患者还接受了累及腔室照射进行局部强化和骨髓廓清全身强化巩固，HyperME采用超分割全身照射（TBI）联合melphalan/依托泊苷，TandemME采用两次melphalan/依托泊苷，然后进行自体干细胞移植。结果：HyperME和TandemME的无事件生存率（EFS） SD分别为22% +/- 8%和29% +/- 9%。合并症死亡率分别为23%和4%。结论：TandemME在大多数晚期ETs （AETs）中提供了一个体面的长期缓解率，尽管仍然不令人满意，短期治疗和可接受的毒性。在这种情况下，脑外伤不需要维持EFS水平，但与高毒性死亡率相关。未来在未选择的患者中进行的前瞻性研究有必要评估未选择的AET患者组的高剂量治疗。
Purpose : Risk stratification of metastatic and relapsed Ewing's tumors (ETs) has been a matter of debate during the last decade. Patients with bone or bone marrow metastases or early or multiple relapses constitute the worst risk group in ET and have a poorer prognosis than patients with primary lung metastases or late relapses. In this article, the results of the present Meta European Intergroup Cooperative Ewing Sarcoma Study (MetaEICESS) (tandem melphalan/etoposide [TandemME]) were compared with the result of the previous study (hyper melphalan/etoposide [HyperME]), both at 5 years, in a patient population within the same high-risk stratum to determine toxicity.Patients and Methods: Among 54 eligible patients, 26 were treated according to the HyperME protocol, and 28 were treated according to TandemME protocol. Patients received six cycles of the Cooperative Ewing Sarcoma Study treatment in HyperME and six cycles of the EICESS treatment in TandemME as induction chemotherapy. Patients also received involved-compartment irradiation for local intensification and myeloablative systemic intensification consolidation with hyperfractionated total-body irradiation (TBI) combined with melphalan/etoposide in HyperME or two times the melphalan/etoposide in TandemME followed by autologous stem-cell transplantation.Results: The event-free survival (EFS) rate SD in HyperME and TandemME was 22% +/- 8% and 29% +/- 9%, respectively. The dead of complication rate was 23% in HyperME and 4% in TandemME.Conclusion: TandemME offers a decent, albeit still not satisfactory, rate of long-term remissions in most advanced ETs (AETs), with short-term treatment and acceptable toxicity. TBI was not required to maintain EFS level in this setting but was associated with a high rate of toxic death. Future prospective studies in unselected patients are warranted to evaluate high-dose therapy in an unselected group of patients with AET.