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document
Multimodal therapy for the management of primary , nonmetastatic Ewing 's sarcoma of bone : an Intergroup Study . A randomized study of 264 children and adults with previously untreated localized Ewing 's sarcoma of bone was undertaken between 1973 and 1978 by 83 institutions of three national study groups : Children 's Cancer Study Group , Southwest Oncology Group , and Cancer and Leukemia Group B . The Intergroup Study was designed to determine if the addition of adriamycin ( ADR ) or bilateral pulmonary radiotherapy ( RT ) to vincristine , dactinomycin , and cyclophosphamide ( VAC therapy ) would improve survival and reduce local recurrences and metastases . All patients received RT to the primary lesion , and the survival rate after 3 years was 65 % . The most effective treatment regimen was VAC plus ADR ; 74 % of the patients were free of disease at 2 years . The lengths of disease-free status and survival of patients treated with VAC plus ADR or VAC plus RT did not differ . However , both regimens were significantly superior to treatment with VAC alone . The addition of ADR or bilateral pulmonary RT to VAC was highly advantageous to patients with nonpelvic primaries . Bone and lung were the major sites of distant relapse , but the addition of bilateral pulmonary RT showed no advantage over that of ADR in reducing the occurrence of lung metastases . These recent results should eliminate some of the pessimism that has accompanied a diagnosis of Ewing 's sarcoma , although distant metastases continued to be a major reason for failure in the control of this tumor . Survival of these patients can be improved through well-controlled clinical trials designed to determine optimal adjuvant chemotherapy and treatment of the primary lesion .
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Intervention_Pharmacological
addition of adriamycin ( ADR )
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Intervention_Control
or
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Intervention_Physical
bilateral pulmonary radiotherapy ( RT )
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Intervention_Control
to
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Intervention_Pharmacological
vincristine , dactinomycin , and cyclophosphamide ( VAC therapy )
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Outcome_Mortality
improve survival
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Outcome_Physical
and reduce local recurrences and metastases
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Outcome_Mortality
survival rate
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Outcome_Physical
lengths of disease-free status and survival of patients
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Outcome_Other
highly advantageous
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Outcome_Other
no advantage
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Outcome_Physical
occurrence of lung metastases .