Ifosfamide-containing chemotherapy in Ewing's sarcoma: The second United Kingdom Children's Cancer Study Group and the Medical Research Council Ewing's tumor study
Ifosfamide-containing chemotherapy in Ewing's sarcoma: The second United Kingdom Children's Cancer Study Group and the Medical Research Council Ewing's tumor study
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DOI：
10.1200/jco.1998.16.11.3628
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发表时间：
1998-11-01
影响因子：
45.3
通讯作者：
Lewis, I
中科院分区：
文献类型：
--
作者：
Craft, A;Cotterill, S;Lewis, I
目的：研究异环磷酰胺替代环磷酰胺治疗尤文氏肉瘤的可能性，与第一次英国儿童癌症研究组（UKCCSG）尤文氏肿瘤研究（ET-I）中观察到的结果相比，异环磷酰胺治疗尤文氏肉瘤将改善生存率。在1987年至1993年期间，243名患者（138名男性或男孩）进入研究。中位年龄为13.5岁（范围1.5至27岁）。中位随访时间为58个月。化疗包括4个疗程的长春新碱2 mg/m2;异环磷酰胺9 g/m2;阿霉素60 mg/m2，每3周一次。原发性肿瘤的治疗采用手术和/或放疗，随后给予异环磷酰胺6 g/m2;多柔比星60 mg/m2;长春新碱2 mg/m2;总剂量为420 mg/m2后，用放线菌素D 1.5 mg/m2替代多柔比星。201例患者无转移，118例患者有中轴骨肿瘤，125例患者有肢体原发肿瘤。主要毒副反应为血液学和感染性，无中毒性死亡。总生存率为62%（95%置信区间[CI]，56 - 69），无复发生存率（RFS）为56%（95% CI，49 - 62）。对于诊断时无转移的患者，RFS率为62%，而对于有转移的患者，RFS率为23%。多因素分析显示年龄和部位对RFS有显著影响。盆腔部位的RFS率最差，为41%;其他轴向部位为55%;四肢肿瘤为73%。年龄小于10岁的患者RFS率为86%，而年龄较大的患者为55%。结论：ET-1的5年生存率为62%，而ET-1的5年生存率为44%，这可能是由于ET-1使用了较高剂量的异环磷酰胺而不是相对较低剂量的环磷酰胺所致。(C)1998年，美国临床肿瘤学会。
Purpose: to investigate the possibility that the substitution of ifosfamide for cyclophosphamide therapy for Ewing's sarcoma will improve survival over that seen in the first United Kingdom Children's Cancer Study Group (UKCCSG) Ewing's tumor study (ET-I).Patients and Methods: Between 1987 and 1993, 243 patients (138 men or boys) were entered onto the study The median age was 13.5 years (range, 1.5 to 27 years). The median follow-up was 58 months. Chemotherapy included four courses of vincristine 2 mg/m(2); ifosfamide 9 g/m(2); and doxorubicin 60 mg/m(2) administered every 3 weeks. Treatment of the primary tumor was with surgery and/or radiotherapy followed by ifosfamide 6 g/m(2); doxorubicin 60 mg/m(2); and vincristine 2 mg/m(2); with actinomycin D 1.5 mg/m(2) substituted for doxorubicin after a total dose of 420 mg/m(2).Results: Two hundred one patients had no metastases, One hundred eighteen patients had tumors of the axial skeleton and 125 patients had limb primary tumors. The major toxicities were hematologic and infective, but there were no toxic deaths. The overall survival rate was 62% (95% confidence interval [CI], 56 to 69) and relapse-free survival (RFS) 56% (95% CI, 49 to 62). For those with no metastases at diagnosis, the RFS rate was 62% and for those with metastases, 23%. Multivariate analysis showed age and site to have a significant effect on RFS. Pelvic sites had the worst RFS rate of 41%; other axial sites, 55%; and extremity tumors, 73%, Age younger than 10 years had an RFS rate of 86% versus 55% for older patients. The local relapse rate for axial tumors was 20% and for limb primary tumors was 2.4%,Conclusion: The 5-year survival rate of 62% is improved compared with the 44% survival rate achieved in ET-l, This is probably caused by the use of higher doses of ifosfamide compared with relatively low doses of cyclophosphamide in ET-1. (C) 1998 by American Society of Clinical Oncology.