Interval compressed vincristine, doxorubicin, cyclophosphamide alternating with ifosfamide, etoposide in patients with advanced Ewing’s and other Small Round Cell Sarcomas

Retrospective review of 16 patients treated at a single centre with VDC/IE. Dose received, treatment delay, toxicity and clinical outcome were recorded for each cycle up to a maximum of 14 cycles.A total 193 cycles of VDC/IE were administered to 10 patients with EFT, 4 with DSRCT and 2 with UHGRCS. Median age was 22 years with 75% over 18 years. Metastases were present in 14 patients. The mean duration of each cycle was 16.7 days. Febrile neutropenia occurred in 14 % of cycles, and grade 3/4 haematologic toxicity including anaemia and thrombocytopenia in 16 % and 11 % of cycles respectively. Seven patients had a dose reduction. Five patients discontinued VDC/IE early due to toxicity.This schedule of VDC/IE is feasible in patients with EFT and DSRCT including adults and those with metastases. Its comparison with other standard regimens for these diseases is justified.The Ewing’s family of tumours (EFT) are the second most common malignant bone tumour seen in children and young people [1,2]. Histologically, they are characterized by small round blue cells with immunohistochemical staining for CD99 and neural markers. A reciprocal translocation between chromosomes 11 and 22 is evident in more than 85% of these tumours [3,4]. The family of small round blue cell sarcomas also includes desmoplastic small round cell tumour (DSRCT), a rare soft tissue sarcoma characteristically presenting in young males with extensive multifocal intraabdominal disease. Similar chemotherapy approaches to those utilized for EFT are used, albeit with less satisfactory results as progression and ultimately death due to disease is almost universal [5-7].Since the introduction of multimodality treatment in EFT, survival has improved from 10% to 75 % in patients with localized disease [8-11]. Since the 1980’s, chemotherapy regimens have evolved both in Europe and the United States to include anthracyclines and alkylating agents with only modest variations in dose and schedule [9,10,12-15]. To cont