The German Pediatric Oncology (GPO) Cooperative Study on Ewing’s Sarcoma

1988 
In 1981, the GPO cooperative Ewing’s Sarcoma study (CESS-81) was initiated (1). Patients under the age of 25, with histologically proven diagnosis and without evidence of metastases, received four 9-week cycles of 4-drug chemotherapy with vincristine, actinomycin D, cyclosphosphamide and adriamycin (VACA), administered as outlined in Figure 1. Local therapy was done after the first two cycles and consisted of either: 1) extracompartmental surgery, 2) wide resection followed by radiation, or 3) radiation therapy without surgery. The radiation dose was 60 Gy for the tumor bulk, including a 5 cm safety margin, and the dose for the remainder of the tumor bearing compartment as well as after non-radical surgery was 36 Gy. The decision for local therapy was individualized. A total of 93 eligible patients were registered on protocol from January 1, 1981 to February 28, 1985, from 54 participating institutions in West Germany, Austria, Switzerland and the Netherlands.
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