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High-dose chemother...
High-dose chemotherapy and blood autologous stem-cell rescue compared with standard chemotherapy in localized high-risk ewing sarcoma : Results of Euro-E.W.I.N.G.99 and Ewing-2008
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- Whelan, Jeremy (författare)
- University College London
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- Le Deley, Marie Cecile (författare)
- Centre Oscar Lambret
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- Dirksen, Uta (författare)
- University Hospital Essen
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- Teuff, Gwénaël Le (författare)
- Institut Gustave Roussy
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- Brennan, Bernadette (författare)
- Royal Manchester Children's Hospital
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- Gaspar, Nathalie (författare)
- Institut Gustave Roussy
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- Hawkins, Douglas S. (författare)
- Seattle Children’s Hospital
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- Amler, Susanne (författare)
- University of Münster
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- Bauer, Sebastian (författare)
- University Hospital Essen
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- Bielack, Stefan (författare)
- Klinikum Stuttgart Olgahospital
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- Blay, Jean Yves (författare)
- Centre Léon Bérard
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- Burdach, Stefan (författare)
- Comprehensive Cancer Center München (CCC München)
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- Castex, Marie Pierre (författare)
- Toulouse University Hospital
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- Dilloo, Dagmar (författare)
- University Hospital Bonn
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- Eggert, Angelika (författare)
- Charité - University Medicine Berlin
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- Gelderblom, Hans (författare)
- Leiden University Medical Centre
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- Gentet, Jean Claude (författare)
- La Timone University Hospital
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- Hartmann, Wolfgang (författare)
- University Hospital Münster
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- Hassenpflug, Wolf Achim (författare)
- University Medical Center Hamburg-Eppendorf
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- Hjorth, Lars (författare)
- Lund University,Lunds universitet,Skåne University Hospital
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- Jimenez, Marta (författare)
- UNICANCER - Fédération des Centres de lutte contre le cancer
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- Klingebiel, Thomas (författare)
- University Hospital Frankfurt
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- Kontny, Udo (författare)
- Universitätsklinikum der RWTH Aachen
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- Kruseova, Jarmila (författare)
- University Hospital Motol
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- Ladenstein, Ruth (författare)
- St. Anna Children's Hospital
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- Laurence, Valerie (författare)
- Curie Institute, Paris
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- Lervat, Cyril (författare)
- Centre Oscar Lambret
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- Marec-Berard, Perrine (författare)
- Pediatric Hematology and Oncology Institute (IHOPE)
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- Marreaud, Sandrine (författare)
- European Organisation for Research and Treatment of Cancer
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- Michon, Jean (författare)
- Curie Institute, Paris
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- Morland, Bruce (författare)
- Birmingham Children's Hospital
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- Paulussen, Michael (författare)
- Children’s and Adolescents’ Hospital, Datteln
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- Ranft, Andreas (författare)
- University Hospital Essen
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- Reichardt, Peter (författare)
- HELIOS Klinikum Berlin-Buch
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- Van Den Berg, Hendrik (författare)
- Academic Medical Center of University of Amsterdam (AMC)
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- Wheatley, Keith (författare)
- University of Birmingham
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- Judson, Ian (författare)
- Institute of Cancer Research London
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- Lewis, Ian (författare)
- National Health Service Trust, NHS England
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- Craft, Alan (författare)
- University of Newcastle upon Tyne
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- Juergens, Heribert (författare)
- University Hospital Münster
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- Oberlin, Odile (författare)
- Institut Gustave Roussy
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(creator_code:org_t)
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Euro-EW.I.N.G.99
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- 2018
- 2018
- Engelska 10 s.
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Ingår i: Journal of Clinical Oncology. - 0732-183X. ; 36:31, s. 3110-3119
- Relaterad länk:
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http://dx.doi.org/10...
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https://lup.lub.lu.s...
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https://doi.org/10.1...
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Abstract
Ämnesord
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- Purpose For over 30 years, the place of consolidation high-dose chemotherapy in Ewing sarcoma (ES) has been controversial. A randomized study was conducted to determine whether consolidation high-dose chemotherapy improved survival in patients with localized ES at high risk for relapse. Methods Randomization between busulfan and melphalan (BuMel) or standard chemotherapy (vincristine, dactinomycin, and ifosfamide [VAI], seven courses) was offered to patients if they were younger than 50 years of age with poor histologic response (≥ 10% viable cells) after receiving vincristine, ifosfamide, doxorubicin, and etoposide (six courses); or had a tumor volume at diagnosis >200 mL if unresected, or initially resected, or resected after radiotherapy. A 15% improvement in 3-year eventfree survival (EFS) was sought (hazard ratio [HR], 0.60). Results Between 2000 and 2015, 240 patients classified as high risk (median age, 17.1 years) were randomly assigned to VAI (n = 118) or BuMel (n = 122). Seventy-eight percent entered the trial because of poor histologic response after chemotherapy alone. Median follow-up was 7.8 years. In an intent-to-treat analysis, the risk of event was significantly decreased by BuMel comparedwith VAI: HR, 0.64 (95%CI, 0.43 to 0.95; P = .026); 3- and 8-year EFS were, respectively, 69.0%(95% CI, 60.2%to 76.6%) versus 56.7%(95%CI, 47.6%to 65.4%) and 60.7%(95%CI, 51.1%to 69.6%) versus 47.1%(95%CI, 37.7% to 56.8%). Overall survival (OS) also favored BuMel: HR, 0.63 (95% CI, 0.41 to 0.95; P = .028); 3- and 8-year OS were, respectively, 78.0% (95% CI, 69.6% to 84.5%) versus 72.2% (95% CI, 63.3% to 79.6%) and 64.5%(95%CI, 54.4% to 73.5%) versus 55.6%(95%CI, 45.8%to 65.1%). Results were consistent in the sensitivity analysis. Two patients died as a result of BuMel-related toxicity, one after standard chemotherapy. Significantly more BuMel patients experienced severe acute toxicities from this course of chemotherapy compared with multiple VAI courses. Conclusion BuMel improved EFS and OS when given after vincristine, ifosfamide, doxorubicin, and etoposide induction in localized ES with predefined high-risk factors. For this group of patients, BuMel may be an important addition to the standard of care.
Ämnesord
- MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Cancer och onkologi (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Cancer and Oncology (hsv//eng)
- MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Pediatrik (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Pediatrics (hsv//eng)
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Whelan, Jeremy
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Le Deley, Marie ...
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Dirksen, Uta
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Teuff, Gwénaël L ...
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Brennan, Bernade ...
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Gaspar, Nathalie
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Hawkins, Douglas ...
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Amler, Susanne
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Bauer, Sebastian
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Bielack, Stefan
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Blay, Jean Yves
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Burdach, Stefan
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Castex, Marie Pi ...
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Dilloo, Dagmar
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Eggert, Angelika
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Gelderblom, Hans
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Gentet, Jean Cla ...
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Hartmann, Wolfga ...
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Hassenpflug, Wol ...
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Hjorth, Lars
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Jimenez, Marta
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Klingebiel, Thom ...
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Kontny, Udo
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Kruseova, Jarmil ...
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Ladenstein, Ruth
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Laurence, Valeri ...
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Lervat, Cyril
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Marec-Berard, Pe ...
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Marreaud, Sandri ...
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Michon, Jean
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Morland, Bruce
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Paulussen, Micha ...
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Ranft, Andreas
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Reichardt, Peter
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Van Den Berg, He ...
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Wheatley, Keith
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Judson, Ian
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Lewis, Ian
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Craft, Alan
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Juergens, Heribe ...
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Oberlin, Odile
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