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Results of Treatment for Soft Tissue Sarcoma in Childhood and Adolescence: A Final Report of the German Cooperative Soft Tissue Sarcoma Study CWS-86

From the Department of Oncology/Haematology, Olga Hospital, Stuttgart; Institute of Paidopathology, University of Kiel, Kiel; Charite-Virchow-Klinikum, Berlin; University Children's Hospital, Düsseldorf; Department of Radiology, University of Regensburg, Regensburg; Department of Oncology/Haematology, University of Tübingen, Tübingen; Department of Radiotherapy, Katharinen Hospital, Stuttgart, Germany; and St Anna Kinderspital, Vienna, Austria.

Address reprint requests to Ewa Koscielniak, MD, Department of Oncology/Haematology, Olga Hospital, Bismarckstrasse 8, D-70176 Stuttgart 1, Germany; email cws.study{at}olgahospital.s.shuttle.de

PURPOSE: The goal of the second German Soft Tissue Sarcoma Study CWS-86 (1985 to 1990) was to improve the prognosis in children and adolescents with soft tissue sarcoma by means of a clinical trial comprising intensive chemotherapy and risk-adapted local therapy.

PATIENTS AND METHODS: There were 372 eligible patients. A staging system based on the postsurgical extent of disease was used. Chemotherapy consisted of vincristine, dactinomycin, doxorubicin, and ifosfamide. Radiotherapy was administered early at 10 to 13 weeks simultaneously with the second chemotherapy cycle (32 Gy or 54.4 Gy). The single dose was reduced to 1.6 Gy and given twice daily (accelerated hyperfractionation).

RESULTS: The event-free survival (EFS) and overall survival rates at 5 years were 59% ± 3% and 69% ± 3%, respectively. The 5-year EFS rate according to stage was as follows: stage I, 83% ± 5%; stage II, 69% ± 6%; stage III, 57% ± 4%; and stage IV, 19% ± 6%. The outcome for patients with stage III disease who required radiotherapy was much better in the CWS-86 study compared with the CWS-81 study (5-year EFS, 60% ± 5% v 44% ± 6%; P = .053). The most common treatment failure was isolated local relapse, with 14% of patients relapsing at the primary tumor site.

CONCLUSION: The improved design of the study incorporating risk-adapted radiotherapy allowed treatment to be reduced for selected groups of patients without compromising survival.

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