Sarah S. Donaldson, M.D.

Publication Details

  • Vincristine, Actinomycin, and Cyclophosphamide Compared With Vincristine, Actinomycin, and Cyclophosphamide Alternating With Vincristine, Topotecan, and Cyclophosphamide for Intermediate-Risk Rhabdomyosarcoma: Children's Oncology Group Study D9803 JOURNAL OF CLINICAL ONCOLOGY Arndt, C. A., Stoner, J. A., Hawkins, D. S., Rodeberg, D. A., Hayes-Jordan, A. A., Paidas, C. N., Parham, D. M., Teot, L. A., Wharam, M. D., Breneman, J. C., Donaldson, S. S., Anderson, J. R., Meyer, W. H. 2009; 27 (31): 5182-5188


    The purpose of this study was to compare the outcome of patients with intermediate-risk rhabdomyosarcoma (RMS) treated with standard VAC (vincristine, dactinomycin, and cyclophosphamide) chemotherapy to that of patients treated with VAC alternating with vincristine, topotecan, and cyclophosphamide (VAC/VTC).Patients were randomly assigned to 39 weeks of VAC versus VAC/VTC; local therapy began after week 12. Patients with parameningeal RMS with intracranial extension (PME) were treated with VAC and immediate x-ray therapy. The primary study end point was failure-free survival (FFS). The study was designed with 80% power (5% two-sided alpha level) to detect an increase in 5-year FFS from 64% to 75% with VAC/VTC.A total of 617 eligible patients were entered onto the study: 264 were randomly assigned to VAC and 252 to VAC/VTC; 101 PME patients were nonrandomly treated with VAC. Treatment strata were embryonal RMS, stage 2/3, group III (33%); embryonal RMS, group IV, less than age 10 years (7%); alveolar RMS or undifferentiated sarcoma (UDS), stage 1 or group I (17%); alveolar RMS/UDS (27%); and PME (16%). At a median follow-up of 4.3 years, 4-year FFS was 73% with VAC and 68% with VAC/VTC (P = .3). There was no difference in effect of VAC versus VAC/VTC across risk groups. The frequency of second malignancies was similar between the two treatment groups.For intermediate-risk RMS, VAC/VTC does not significantly improve FFS compared with VAC.

    View details for DOI 10.1200/JCO.2009.22.3768

    View details for Web of Science ID 000271274300013

    View details for PubMedID 19770373

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