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Cancer Chemotherapy Regimen for Ewing's Sarcoma

 T-9                                             ewing_sarcoma(58)
  adriamycin...... 20 mg/sqm IV on days 1, 2 and 3; 

                   and on days 42, 43, and 44.
  methotrexate.... 12 mg/sqm IV on days 1, 2, and 3;

                   and on days 42, 43, and 44.
  cytoxan......... 1,200 mg/sqm IV on days 1 and 42; and

                   500 mg/sqm IV on days 22, 23, and 24.
  actinomycin..... 0.5 mg/sqm IV on days 22, 23, and 24.
  bleomycin....... 10 U/sqm IV on days 22, 23, and 24.
  vincristine..... 2 mg/sqm IV on days 1, 8, 15, 22, and 29.
  FREQUENCY....... Repeat cycle on day 64 (9 weeks). Continue for 
                   5 cycles, with adriamycin deleted from the 
                   fifth cycle after a total cummulative dose of 
                   480 mg/sqm.

    Rosen G.  Caparros B.  Nirenberg A.  Marcove RC.  Huvos AG.  
    Kosloff C.  Lane J.  Murphy ML. Ewing's sarcoma: ten-year 
    experience with adjuvant chemotherapy. Cancer.  47(9):2204-13, 
    1981 May 1. 
    Since May 1970, 67 consecutive patients with primary 
    (nonmetastatic) Ewing's sarcoma were treated with adjuvant 
    chemotherapy (CT) in addition to radiation therapy (RT) or 
    surgery for the primary tumor. The first 19 patients were 
    treated with four-drug sequential CT (T-2). The second 
    protocol was a seven-drug induction combination CT (T-6) 
    followed by T-2 maintenance CT; in both protocols CT was 
    continued for 18 months. The current protocol (T-9) consists 
    of combination CT given continuously for a period of 9 months. 
    Of the entire group of 67 patients, 47 (70%) had axial and 
    proximal lesions (pelvis, spine, rib, humerus, and femur) and 
    20 (30%) had distal lesions (forearm, leg, and foot); 53/67 
    (79%) are surviving free of disease 12--118 months (median 41 
    months) from the start of treatment. Fifteen of 23 (65%) 
    patients with axial lesions, 19/24 (79%) patients with 
    proximal lesions, and 19/20 (95%) patients with distal lesions 
    are free of disease. Disease-free survivors include 28/39 
    (72%) male patients and 25/28 (89%) female patients. 
    Thirty-four patients had RT, and 33 had surgery or surgery and 
    RT, in addition to chemotherapy, for local treatment. The 
    disease-free survival rate was 76% in the RT group and 82% in 
    the surgery group; failure in the RT group was attributable to 
    local recurrence in 7/34 (21%) patients. Recent experience 
    with T-9 CT has demonstrated that CT given prior to RT or 
    surgery can cause a great reduction in the size of the primary 
    tumor while allowing the pathologically-eroded bone to heal 
    prior to the initiation of RT; this also allows the high-risk 
    patient with an axial primary (pelvis or spine) to tolerate 
    the aggressive CT needed to prevent distant metastases. In 
    addition to dramatically increasing survival in patients with 
    Ewing's sarcoma, combination CT has helped achieve permanent 
    local control. The superior survival rates for all sites of 
    primary tumor are attributable to the early use of aggressive 
    combination CT. 

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