Combination chemotherapy (T-6) in the multidisciplinary treatment of Ewing's sarcoma.

Twenty-eight patients with primary Ewing's sarcoma (ES) and 10 with primary and metastatic ES were treated with intensive induction (T-6) and maintenance sequential chemotherapy (T-2). Local treatment for the primary tumor was surgery and/or radiation therapy (RT), and the choice depended on the patient's age and the location and size of the tumor. Patients with pulmonary metastases received bilateral pulmonary RT with 1,400 rad before T-2 maintenance chemotherapy. Most patients who were given T-65 induction chemotherapy before local therapy had healing of pathologically destroyed, tumor-bearing bones before the initiation of RT. None who had RT after T-6 chemotherapy developed pathologic fractures. Of the 28 with primary ES, 23 (82%) remained free of disease for more than 12 to over 46 months (median 22+ mo). Six of 10 with primary and metastatic disease are free of disease from more than 14 to over 34 months (median, 22+ mo). In addition to producing higher survival rates in the patients with poor prognoses, T-6 chemotherapy also improved the treatment of the primary tumor and achieved better function and, it is hoped, a lower local recurrence rate following RT. We found that the timing of T-6 chemotherapy and RT was crucial to obtaining a maximal response of the primary tumor and to maintaining patient tolerance for this aggressive treatment. The long rest required after patients were given 1,3-bis (2-chloroethyl)-1-nitrosourea makes its use in future protocols undesirable.