ABSTRACT
71 children with sarcomas were treated in a prospective pilot study to determine whether granulocyte colony stimulating factor (G-CSF) permits compression of the interval between chemotherapy cycles. Patients had Ewing's sarcoma/primitive neuroectodermal tumour (PNET), rhabdomyosarcoma, non-rhabdo soft tissue sarcomas or other advanced soft tissue tumours. The chemotherapy alternated vincristine-doxorubicin-cyclophosphamide and ifosfamide-etoposide, with G-CSF between courses. Therapy had two phases: induction (six cycles) and continuation (six cycles), which included primary tumour treatment with surgery and/or radiation. Chemotherapy cycles began every 14 days, or upon absolute neutrophil count (ANC) and platelet count recovery. The median chemotherapy cycle interval was 16 (11-48) days in the induction phase, with a median average relative dose intensification (ARDI) of 1.27 compared with every-21-day therapy. In the continuation phase, the median cycle interval was 21 days, with a median ARDI of 1.10. Radiation therapy prolonged chemotherapy intervals, whilst erythropoietin shortened them. Toxicity was modest for such chemotherapy. Event-free survival is comparable with or superior to that in recent large studies. G-CSF permits intensification of this regimen through interval compression. The impact of this approach on efficacy remains to be determined in a randomised trial.
Subject(s)
Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Bone Neoplasms/drug therapy , Granulocyte Colony-Stimulating Factor/therapeutic use , Sarcoma, Ewing/drug therapy , Sarcoma/drug therapy , Adolescent , Adult , Child , Child, Preschool , Cyclophosphamide/administration & dosage , Doxorubicin/administration & dosage , Drug Administration Schedule , Etoposide/administration & dosage , Female , Humans , Ifosfamide/administration & dosage , Infant , Male , Pilot Projects , Prospective Studies , Rhabdomyosarcoma/drug therapy , Survival Analysis , Vincristine/administration & dosageABSTRACT
Evaluated distress during invasive procedures in childhood leukemia. Child and parent distress, assessed by questionnaires and ratings, were compared in two arms of a randomized, controlled prospective study, one a pharmacologic only (PO) (n = 45) and the other a combined pharmacologic and psychological intervention (Cl) (n = 47), at 1, 2, and 6 months after diagnosis. The cross-sectional control group (CC) consisted of parents of 70 patients in first remission prior to the prospective study. Mothers' and nurses' ratings of child distress indicated less child distress in the Cl group than the PO. When contrasted with the CC group, the Cl group showed lower levels of child distress. Data showed decreases over time in distress and concurrent improvements in quality of life and parenting stress and supported an inverse association between distress and child age.