VAC                                             ewing_sarcoma(59)
 _________________________________________________________________
  vincristine..... 2.0 mg/sqm IV day 1.
  actinomycin..... 2.0 mg/sqm IV day 1.
  cytoxan......... 1,200 mg/sqm IV day 1.
  FREQUENCY....... Repeat cycle every 28 days.

  reference...
    Kinsella TJ.  Triche TJ.  Dickman PS.  Costa J.  Tepper JE.  
    Glaubiger D. Extraskeletal Ewing's sarcoma: results of 
    combined modality treatment. Journal of Clinical Oncology.  
    1(8):489-95, 1983 Aug. 
  abstract...
    Eleven patients with extraskeletal Ewing's sarcoma (EES) were 
    treated with combined modality therapy at the National Cancer 
    Institute. The diagnosis of EES was reserved for lesions that 
    were identical to Ewing's sarcoma of bone by light and 
    electron microscopy. Diagnostic work-up to rule out a skeletal 
    primary included bone scan, localized views of adjacent bone, 
    and bone tomography. Seven patients presented with an 
    extremity primary and four patients had a truncal primary. No 
    patients had evidence of metastases at presentation. Patients 
    were treated with combined modality therapy consisting of 
    high-dose local irradiation and vincristine, actinomycin D, 
    and cyclophosphamide chemotherapy following a biopsy or local 
    excision. No attempt was made to excise widely the primary 
    tumor mass. Gross tumors generally responded rapidly to the 
    combined modality treatment. Of 11 patients, seven (64%) 
    remain disease free, with a follow-up of three to seven years 
    from completion of therapy. Long-term local control was 
    established in nine of 11 patients (82%). Autopsy findings on 
    two patients with local failure showed no tumor involvement of 
    adjacent bone. Attempts at gross resections by radical 
    surgical procedures do not routinely appear to be necessary in 
    light of the high local control rates with high-dose 
    irradiation.