EORTC/GTO adjuvant chemotherapy program for primary Ewing's sarcoma: results at 5 years

VM-26 and dimethyl triazeno imidazole carboxamide in Ewing's sarcoma

Twenty-seven patients with biopsy proven Ewing's sarcoma were randomised to receive one of two adjuvant chemotherapy regimens for two years. Group A were given monthly courses of vincristine, adriamycin and dimethyl triazeno imidazole carboxamide (DIC); Group B received monthly courses of VM-26, adriamycin and DIC. Chemotherapy was commenced after biopsy confirmation of disease. The primary tumour was treated with irradiation to 3,000-5,000 rad and by resection in three patients. With a median follow-up of 26 months, 52% of patients are disease free. Ten patients died, seven from recurrent disease and three from complications of treatment. There was a significant difference in disease free survival rate of patients with long bone lesions (11/12) compared with patients with flat bone lesions (6/15). The disease free survival rate of Groups A and B was similar. Our results suggest that in combination chemotherapy for Ewing's sarcoma, vincristine and VM-26 have similar anti-tumour activity.

Adjuvant therapies of postsurgical minimal residual disease

The review summarizes the most recent results obtained with present combined adjuvant strategy for the treatment of resectable cancer. Recent important randomized clinical trials, either unicentric or polycentric, are discussed. As far as pediatric tumors are concerned post-surgical adjuvant chemotherapy was proved to play a useful role in prolonging the disease-free survival in Wilms tumor, rhabdomyosarcoma, Ewing sarcoma. Results obtained in the treatment of medulloblastoma and osteogenic sarcoma need further investigations. In adult neoplasms the most important results with combined modality approach are presently being obtained in breast cancer and probably in melanoma. No consistent improvement by adjuvant chemotherapy has been observed in colorectal cancer.