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Raciborska A.,Klinika Chirurgii Onkologicznej Dzieci i Mlodziezy
Medycyna wieku rozwojowego | Year: 2013

Patients with metastatic, progressive or recurrent Ewing sarcoma have a poor prognosis. In addition to increasing the intensity of conventional chemotherapy, the combination of irinotecan and temozolomide has been proposed as an effective salvage regimen for some pediatric malignancies. To evaluate the effect of two different salvage regimens on the final outcome of patients with refractory Ewing sarcoma. During the period 2008-2012, twenty-two patients (age between 2.9 -19.3 years) with recurrent or refractory Ewing sarcoma were treated with the combination of vincristine, irinotecan and temozolomide (VIT regimen), and twenty patients were treated with the combination of cisplatin, doxorubicin, cyclophosphamide and teniposide (PACE regimen). All patients had standard tumour imaging and laboratory evaluation. All toxicities were documented. The WHO criteria were used to evaluate response. Statistical analysis was performed using STATA 10.0 for Windows. Results distributions were estimated using the method of Kaplan-Meier. The log-rang test was used to compare the groups. A total of 91 cycles of VIT and 65 cycles of PACE were administered. For VIT therapy the overall response rate was 68.1%. Median time to progression was 3.0 months. Five patients are alive with no evidence of disease with a median follow-up of 10.3 months. For PACE therapy the overall response rate was 75%. Median time to progression was 3.5 months. Four patients are alive with no symptoms of disease with a median follow-up of 17.6 months. The 2 years overall survival probability after recurrence was 29.94%; no differences were detected between therapy groups. Toxicity for PACE was significantly higher. The effectiveness of VIT regimen in refractory Ewing Sarcoma is comparable to conventional chemotherapy. The VIT regimen has less associated toxicities than the PACE regimen.


Karwacki M.W.,Klinika Chirurgii Onkologicznej Dzieci i Mlodziezy | Wozniak W.,Klinika Chirurgii Onkologicznej Dzieci i Mlodziezy | Lugowska I.,Klinika Chirurgii Onkologicznej Dzieci i Mlodziezy | Rychlowska-Pruszynska M.,Klinika Chirurgii Onkologicznej Dzieci i Mlodziezy
Nowotwory | Year: 2010

The study summarizes the treatment results of a newly introduced protocol for high-grade osteosarcoma, combining high dose of methotrexate alternating with doxorubicin and cisplatin. The efficacy of preoperative chemotherapy, evaluated as a proportion of necrotic cells assessed in a primary tumor map, was compared with results achieved in historical studies comprising two modalities: doxorubicin and high dose of methotrexate (the so-called "SFOP" protocol) or doxorubicin and cisplatin (the so-called "EORTC" protocol) only. Additionally, we performed a comparative analysis of early toxicity of all the three protocols. Apart from statistically insignificant differences between the results of all the three protocols, we have demonstrated that the efficacy of the currently introduces protocol exceeds that of the SFOP protocol and is comparable to the EORTC protocol (48.5% vs. 44% and 49%, respectively), with only two cycles of cardiotoxic doxorubicin applied in the current protocol. The proportion of limb saving procedures in the current protocol (82%) was comparable to SFOP (85%) and exceeded that achieved in the EORTC protocol (48%). Progression of tumor mass was observed in 4% of patients treated according to the EORTC protocol, in 10% of currently assessed patients and in 44% of patients treated according to the SFOP protocol. Acute toxicity of cytostatics requiring withholding ongoing chemotherapy was considerably less common in the SFOP group (36%), when compared to current protocol (2.5%) and the EORTC protocol (0%). The results of this pilot study demonstrate the comparable or even higher efficacy and safety of the currently introduced protocol as compared to the historical treatment protocols in patients with high-grade osteosarcoma. The comprehensive results of the study and the final assessment of the safety and the efficacy of the currently introduced protocol calls for a long observation period and a larger patient group.

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