High-dose induction chemoradiotherapy followed by autologous bone marrow transplantation as consolidation therapy in rhabdomyosarcoma, extraosseous Ewing's sarcoma, and undifferentiated sarcoma
High-dose induction chemoradiotherapy followed by autologous bone marrow transplantation as consolidation therapy in rhabdomyosarcoma, extraosseous Ewing's sarcoma, and undifferentiated sarcoma
复制标题
DOI：
10.1200/jco.1998.16.5.1697
复制
发表时间：
1998-05-01
影响因子：
45.3
通讯作者：
Ghavimi, F
中科院分区：
文献类型：
--
作者：
Boulad, F;Kernan, NA;Ghavimi, F
目的：为了提高高危横纹肌肉瘤（RMS）、骨外尤文氏肉瘤和未分化肉瘤患者的缓解率和生存率，我们采用了短期诱导，包括多药化疗、超分割放疗和手术（如可能）。巩固与强化化疗和自体骨髓移植（ABMT）。患者和方法：26例患者（21与RMS，三个未分化肉瘤，和两个骨外尤文氏肉瘤）进入1990年6月至1994年3月的协议。诱导治疗包括异环磷酰胺、依托泊苷、多柔比星、更生霉素、环磷酰胺和长春新碱，以及超分割放疗的分割疗程。获得完全缓解（CR）或良好部分缓解（GPR）的患者接受巩固与大剂量美法仑和依托泊苷随后ABMT.Results：26例既往未治疗的患者中，19例（73%）在诱导完成时达到CR（n = 13）或GPR（n = 6），并接受ABMT。全组2年总生存率（OS）为56%（95%可信区间[CI]，36%~ 76%），无进展生存率（PFS）为53%（95%CI，33%~ 73%）。分程超分割放疗并不能提高局部控制率。这种短期治疗的结果与以前1至2年的治疗相当。诱导和巩固化疗，以及辐射剂量，可以进一步加强，因为这些患者中没有死亡，由于他的毒性发生。(C)1998年，美国临床肿瘤学会。
Purpose: To improve response and survival rates in patients with high-risk rhabdomyosarcoma (RMS), extraosseous Ewing's sarcoma, and undifferentiated sarcoma, we used a short course of induction with multiagent chemotherapy, hyperfractionated radiotherapy, and surgery when possible. Consolidation was with intensive chemotherapy and autologous bone marrow transplantation (ABMT).Patients and Methods: Twenty-six patients (21 with RMS, three with undifferentiated sarcoma, and two with extraosseous Ewing's sarcoma) were entered onto the protocol between June 1990 and March 1994. Induction consisted of ifosfamide, etoposide, doxorubicin, dactinomycin, cyclophosphamide, and vincristine, and a split course of hyperfractionated radiotherapy. Patients who attained a complete response (CR) or good partial response (GPR) received consolidation with high-dose melphalan and etoposide followed by ABMT.Results: Of 26 previously untreated patients 19 (73%) achieved a CR (n = 13) or GPR (n = 6) at the completion of induction and underwent ABMT. Two-year overall survival (OS) was 56% (95% confidence interval [CI], 36% to 76%) and progression-free survival (PFS) was 53% for the whole group (95% CI, 33% to 73%).Conclusion: Consolidation of response by myeloablative chemotherapy was well tolerated. Split-course hyperfractionated radiotherapy did not increase the rate of local control. The results of this short-course therapy were comparable to previous therapies of 1 to 2 years' duration. Induction and consolidation chemotherapy, as well as radiation dose, could be further intensified, since no death due ta toxicity occurred among these patients. (C) 1998 by American Society of Clinical Oncology.