Ifosfamide, Doxorubicin and Dacarbazine Chemotherapy, and Adjunctive Laparoscopic Cystoprostatectomy and External Beam Radiotherapy for Prostatic Embryonal Rhabdomyosarcoma
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No AccessJournal of UrologyCLINICAL UROLOGY: Case Reports1 Dec 2002Ifosfamide, Doxorubicin and Dacarbazine Chemotherapy, and Adjunctive Laparoscopic Cystoprostatectomy and External Beam Radiotherapy for Prostatic Embryonal Rhabdomyosarcomais corrected byErrata H. CHALCHAL, T.H.P. TAI, E. TSE, E.C. ALPORT, and M. SALIM H. CHALCHALH. CHALCHAL More articles by this author , T.H.P. TAIT.H.P. TAI More articles by this author , E. TSEE. TSE More articles by this author , E.C. ALPORTE.C. ALPORT More articles by this author , and M. SALIMM. SALIM More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(05)64195-XAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "Ifosfamide, Doxorubicin and Dacarbazine Chemotherapy, and Adjunctive Laparoscopic Cystoprostatectomy and External Beam Radiotherapy for Prostatic Embryonal Rhabdomyosarcoma." The Journal of Urology, 168(6), p. 2545 References 1 : Prostate embryonal rhabdomyosarcoma in adults. A clinicopathologic review. Cancer1992; 69: 755. Crossref, Medline, Google Scholar 2 : The Intergroup Rhabdomyosarcoma Study. I. A final report. Cancer1988; 61: 209. Crossref, Medline, Google Scholar From the Allan Blair Cancer Centre, University of Saskatchewan, Regina, Saskatchewan, Canada© 2002 by American Urological Association, Inc.FiguresReferencesRelatedDetailsCited by Kieran K and Shnorhavorian M (2016) Current standards of care in bladder and prostate rhabdomyosarcomaUrologic Oncology: Seminars and Original Investigations, 10.1016/j.urolonc.2015.12.012, VOL. 34, NO. 2, (93-102), Online publication date: 1-Feb-2016. Related articlesJournal of Urology9 Nov 2018Errata Volume 168Issue 6December 2002Page: 2545 Advertisement Copyright & Permissions© 2002 by American Urological Association, Inc.Keywordsprostatic neoplasmsradiotherapyprostatectomydrug therapy, combinationrhabdomyosarcoma, embryonalMetricsAuthor Information H. CHALCHAL More articles by this author T.H.P. TAI More articles by this author E. TSE More articles by this author E.C. ALPORT More articles by this author M. SALIM More articles by this author Expand All Advertisement PDF downloadLoading ...Keywords:
Cystoprostatectomy
External beam radiotherapy
Embryonal rhabdomyosarcoma
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D’Ambrosio et al1 report the results of a large retrospective study assessing the activity of doxorubicin-based chemotherapy in patients with advanced leiomyosarcoma. This work is outstanding because of the large number of cases (303 patients), the well-known quality of the European Organisation for Research and Treatment of Cancer database, and the use of propensity score–matched analysis.1 Seventy-one of these 303 patients received a combination of ifosfamide and doxorubicin, and 41 of these 71 patients were included in the propensity score–matched subanalysis. This study allows an analysis of the activity of 3 commonly used regimens: doxorubicin alone, doxorubicin and dacarbazine, and ifosfamide and doxorubicin. It is striking to see that the combination of ifosfamide and doxorubicin is systematically associated with poor outcomes. In the matched population, the objective response rate was 25.6% with doxorubicin, 19.5% with ifosfamide and doxorubicin, and 30.9% with doxorubicin and dacarbazine. Progression-free survival was 4.8 months with doxorubicin, 8.2 months with ifosfamide and doxorubicin, and 9.2 months with doxorubicin and dacarbazine. Overall survival was 30.3 months with doxorubicin, 36.8 months with ifosfamide and doxorubicin, and 21.9 months with doxorubicin and dacarbazine. The outcome differences between doxorubicin and the combination of ifosfamide and doxorubicin did not reach the level of significance.1 Nevertheless, 10 years earlier, the French Sarcoma Group conducted a retrospective study of 147 patients with advanced leiomyosarcoma. We also found that the addition of ifosfamide was associated with poor overall survival (hazard ratio, 1.42; P = .028).2 We know that retrospective data or merged data coming from different trials must be interpreted with caution, but these findings are a matter of concern. Despite its inconvenient administration, which requires hyperhydration and the use of uromitexan, since the 2002 Van Oosterom trial demonstrating the activity of ifosfamide in advanced soft-tissue sarcoma, ifosfamide has been largely used in curative-intent and palliative settings.3 Ifosfamide is part of common first-line combination regimens used in soft-tissue sarcoma management (doxorubicin with ifosfamide, epirubicin with ifosfamide, doxorubicin and dacarbazine with ifosfamide, and so forth).4 Because of recent large randomized clinical trials, there is debate regarding the use of the anthracycline-ifosfamide combination for the neoadjuvant treatment of localized soft-tissue sarcoma.4 Regarding the results of both studies, the key question is whether we have to avoid ifosfamide administration in patients with localized leiomyosarcoma receiving perioperative chemotherapy. This has to be properly investigated because the benefit of neoadjuvant chemotherapy in sarcoma is highly debated. Furthermore, the term leiomyosarcoma encompasses different clinicopathological entities, including uterine leiomyosarcoma, soft-tissue leiomyosarcoma, and great vessel leiomyosarcoma, that could respond differently to ifosfamide. Furthermore, recent extensive molecular analysis has stressed the extraordinary molecular heterogeneity of leiomyosarcoma.5, 6 As a result, the sensitivity of leiomyosarcoma to ifosfamide is likely a more complex issue. From our point of view, this is the second time that a deleterious effect of ifosfamide in leiomyosarcoma management has been demonstrated, and this fact should not be ignored by medical oncologists. No specific funding was disclosed. The authors made no disclosures.
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Abstract The prognosis of uterine leiomyosarcoma (LMS) is notoriously poor and a standard chemotherapy for patients with uterine LMS has not yet been established. Here, we describe two patients with recurrent LMS of the uterus who were treated with mesna, doxorubicin, ifosfamide and dacarbazine chemotherapy; one achieved complete and the other partial remission.
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Forty-three adult patients with locally advanced or metastatic soft tissue sarcoma entered a pilot study of combination chemotherapy comprising 50 mg of doxorubicin/m2 by intravenous bolus, 850 mg of dacarbazine/m2 by 1-hour infusion, and 5 g of ifosfamide/m2 by 24-hour infusion with mesna uro-protection. The overall response rate in 40 assessable patients was 25% with two complete remissions. Twenty-four episodes of infection occurred in 148 courses (16%). These infections were usually associated with neutropenia (granulocyte count <0.5 × 109/L), which occurred in 70% of the courses. These results do not differ from those elicited by each agent alone, and may reflect inadequacies of dose intensity or scheduling, or evaluation in a study population with adverse prognostic factors. [J Natl Cancer Inst 81:1496–1499, 1989]
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Background: Doxorubicin and ifosfamide are the most active drugs in the treatment of adult advanced soft tissue sarcoma. For patients not or no longer responding to these cytostatic agents no widely accepted salvage chemotherapy is known. Patients and Methods: Between 1986 and 1995 100 adult patients with advanced soft tissue sarcoma were treated with a combination of doxorubicin and ifosfamide. After transient response or primary failure to this combination, salvage chemotherapy was administered to 22 patients. 14 patients were treated with dacarbazine (DTIC) 1,200 mg/m2 as a 20-min infusion every 3 weeks, and 8 patients received a combination of carboplatin 300 mg/m2 as a 1-hour infusion on days 1 and 2 and VP-16 300 mg/m2 as a 1-hour infusion on days 1 and 2 every 3 weeks. Results: Treatment with DTIC led to stable disease in 2 patients and progressive disease in 12 patients. The combination of carboplatin/VP-16 resulted in stable disease in 1 patient and progressive disease in 7 patients. Overall, no remission was seen in 22 patients. Conclusions: Although the number of patients treated by us was small, neither DTIC nor carboplatin/VP-16 seem to be effective salvage chemotherapy regimens in adult patients with advanced soft tissue sarcoma pretreated with doxorubicin/ifosfamide.
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No AccessJournal of UrologyLetter to the Editor1 Jun 1982Eleven-Year Survival Following Cystoprostatectomy for Embryonal Rhabdomyosarcoma of the Prostate Ciro Servadio and Dan Shmueli Ciro ServadioCiro Servadio More articles by this author and Dan ShmueliDan Shmueli More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(17)54296-2AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "Eleven-Year Survival Following Cystoprostatectomy for Embryonal Rhabdomyosarcoma of the Prostate." The Journal of Urology, 127(6), p. 1200 © 1982 by The American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 127Issue 6June 1982Page: 1200 Advertisement Copyright & Permissions© 1982 by The American Urological Association Education and Research, Inc.MetricsAuthor Information Ciro Servadio More articles by this author Dan Shmueli More articles by this author Expand All Advertisement PDF downloadLoading ...
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Chemotherapy combined with other therapeutic modalities is the main option for advanced and metastatic soft tissue sarcoma(STS). So far there is no standard regimen for STS yet. Adrimycin, ifosfamide, and dacarbazine are the most effective agents at present. The purpose of this clinical trial was to evaluate the efficacy and toxicity of MAID regimen (mesna/ifosfamide + Adriamycin + dacarbazine) in the treatment of advanced soft tissue sarcoma.Twenty-two patients with advanced STS were treated by MAID(Adriamycin 60 mg/m2, ifosfamide 6,000 mg/m2, and dacarbazine 1,000 mg/m2). These drugs were administered as continuous intravenous infusion for 72 hours while mesna was infused continuously for 96 hours.Partial response rate was 36.4% without complete remission. The duration of response ranged from 2-10 months with median of 4.6 months. Main toxicities were myelosuppression, gastrointestinal toxicity and alopecia. Percentage of leucopenia, nausea/vomiting, and alopecia in WHO grade III and IV were 63.6%, 27.3%, and 50%, respectively.The response rate of MAID for advanced STS was not satisfactory with evident myelosuppression. Further study on new anti-cancer agents and regimen are needed.
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