Risk-Based Treatment for Non-Rhabdomyosarcoma Soft Tissue Sarcomas (NRSTS) in Patients Under 30 Years of Age
PRIMARY OBJECTIVES:
I. Define a risk-based treatment strategy comprising observation only, adjuvant
radiotherapy, or adjuvant chemoradiotherapy or neoadjuvant chemoradiotherapy, surgery, and
adjuvant chemotherapy with or without radiotherapy in young patients with
non-rhabdomyosarcoma soft tissue sarcoma (NRSTS).
II. Assess event-free and overall survival of patients treated with these regimens.
III. Assess the pattern of treatment failure in these patients.
SECONDARY OBJECTIVES:
I. Assess the feasibility of a neoadjuvant chemoradiotherapy approach in patients with - or
high-risk NRSTS.
II. Assess the imaging and pathologic responses to neoadjuvant chemoradiotherapy in patients
with intermediate- or high-risk NRSTS.
III. Correlate imaging and pathologic response with clinical outcomes in patients with
intermediate- or high-risk disease who undergo neoadjuvant chemoradiotherapy.
IV. Prospectively define clinical prognostic factors associated with event-free survival,
overall survival, local recurrence, and distant recurrence in these patients.
V. Correlate patient outcomes with findings of biologic studies performed on tissue
specimens collected on protocol COG-D9902 from these patients.
VI. Determine whether the diagnosis and histologic grade of NRSTS assigned by the enrolling
institution correlates with the diagnosis and histologic grade established by central expert
pathology reviewers.
VII. Compare the Pediatric Oncology Group (POG) and Fédération Nationale des Centres de
Lutte Contre le Cancer (French Federation of Cancer Centers [FNCLCC]) pathologic grading
systems to determine which better correlates with clinical outcomes.
OUTLINE: This is a multicenter study. Patients are divided into 3 risk groups according to
presence of metastatic disease (yes vs no), status of prior surgery (resected vs
unresected), grade of tumor (low vs high), and size of primary tumor (≤ 5 cm vs > 5 cm).
Patients are assigned to different treatment regimens based on disease extent (nonmetastatic
vs metastatic), tumor size (≤ 5 cm vs > 5 cm), extent of resection of primary tumor
(resected vs unresected), extent of resection of metastases (complete or microscopic
residual vs gross residual), microscopic tumor margins (negative vs positive), and tumor
grade (low vs high).
GROUP 1 (low risk [nonmetastatic, grossly resected disease, except high-grade tumor > 5
cm]): Patients with low-grade tumor with either negative or positive microscopic margins or
high-grade tumor ≤ 5 cm (in maximum diameter) with negative microscopic margins are assigned
to regimen A. Patients with high-grade tumor ≤ 5 cm (in maximum diameter) with positive
microscopic margins are assigned to regimen B.
REGIMEN A (observation only): Patients undergo observation only.
REGIMEN B (adjuvant radiotherapy): Beginning between 6-42 days after surgical resection,
patients undergo a total of 31 fractions of adjuvant radiotherapy.
GROUP 2 (intermediate risk [nonmetastatic, resected or unresected disease]): Patients with
grossly resected, high-grade tumor > 5 cm (in maximum diameter) are assigned to regimen C.
Patients with unresected tumor are assigned to regimen D.
REGIMEN C (adjuvant chemoradiotherapy): Patients receive ifosfamide IV over 3 hours on days
1-3 in weeks 1, 4, 7, 10, 13, and 16 and doxorubicin hydrochloride IV over 24 hours on days
1 and 2 in weeks 1, 4, 13, 16, and 19. Beginning in week 4, patients also undergo a total of
31 fractions of radiotherapy.
*NOTE: *Patients who receive brachytherapy will initiate radiotherapy in Week 1. If
brachytherapy is administered, chemotherapy should begin within 2 weeks of completion of
brachytherapy and the Weeks 1 and 19 doxorubicin should be given instead at Weeks 7 and 10.
REGIMEN D (neoadjuvant chemoradiotherapy, surgery, and adjuvant chemotherapy with or without
radiotherapy): Neoadjuvant chemoradiotherapy and surgery: Patients receive ifosfamide IV
over 3 hours on days 1-3 in weeks 1, 4, 7, and 10 and doxorubicin hydrochloride IV over 24
hours on days 1 and 2 in weeks 1 and 4. Beginning in week 4, patients also undergo a total
of 31 fractions of radiotherapy**. Patients undergo surgical resection in week 13.
NOTE: **Patients with primary hepatic tumors do not receive radiotherapy in week 4.
Adjuvant chemotherapy with or without radiotherapy: Patients receive ifosfamide IV over 3
hours on days 1-3 in weeks 16 and 19 and doxorubicin hydrochloride IV over 24 hours on days
1 and 2 in weeks 16, 19***, and 22. Beginning in week 16, patients achieving gross total
resection with positive microscopic margins undergo a total of 6 fractions of adjuvant
radiotherapy. Patients achieving less than total gross resection undergo a total of 11
fractions of adjuvant radiotherapy. Patients achieving total gross resection with negative
microscopic margins do not receive adjuvant radiotherapy.
NOTE: ***Patients who receive adjuvant radiotherapy in week 16 receive doxorubicin
hydrochloride in week 25 instead of week 19.
GROUP 3 (high risk [metastatic, resected, incompletely resected, or unresected disease]):
Patients with low-grade, all-sites resected tumor with either negative or positive
microscopic margins are assigned to receive treatment as in group 1 regimen A. Patients with
high-grade, grossly resected primary tumor, and metastatic disease are assigned to receive
treatment as in group 2 regimen C. Patients with unresected, high-grade metastatic tumor
are assigned to receive treatment as in group 2 regimen D.
In all groups, treatment continues in the absence of disease progression. After completing
study treatment, patients are followed periodically for at least 5 years.
Interventional
Allocation: Non-Randomized, Endpoint Classification: Efficacy Study, Intervention Model: Parallel Assignment, Masking: Open Label, Primary Purpose: Treatment
Long-term survival for low-risk patients
A monitoring boundary located in some sense halfway between the O'Brien-Fleming and Pocock group sequential boundaries to monitor against the expected experience will be used. A procedure adapted from Woolson will be used.
Up to 5 years
No
Sheri Spunt
Principal Investigator
Children's Oncology Group
United States: Institutional Review Board
ARST0332
NCT00346164
February 2007
Name | Location |
---|---|
Baylor College of Medicine | Houston, Texas 77030 |
Johns Hopkins University | Baltimore, Maryland 21205 |
Cleveland Clinic Foundation | Cleveland, Ohio 44195 |
Roswell Park Cancer Institute | Buffalo, New York 14263 |
Mayo Clinic | Rochester, Minnesota 55905 |
Children's Hospital of Philadelphia | Philadelphia, Pennsylvania 19104 |
University of Iowa Hospitals and Clinics | Iowa City, Iowa 52242 |
University of Mississippi Medical Center | Jackson, Mississippi 39216-4505 |
Washington University School of Medicine | Saint Louis, Missouri 63110 |
Tripler Army Medical Center | Honolulu, Hawaii 96859-5000 |
Hurley Medical Center | Flint, Michigan 48503 |
Rhode Island Hospital | Providence, Rhode Island 02903 |
Medical City Dallas Hospital | Dallas, Texas 75230 |
University of Texas Health Science Center at San Antonio | San Antonio, Texas 78284-7811 |
Midwest Children's Cancer Center | Milwaukee, Wisconsin 53226 |
Sinai Hospital of Baltimore | Baltimore, Maryland 21225 |
Geisinger Medical Center | Danville, Pennsylvania 17822-0001 |
Vanderbilt-Ingram Cancer Center | Nashville, Tennessee 37232-6838 |
Loyola University Medical Center | Maywood, Illinois 60153 |
Massachusetts General Hospital Cancer Center | Boston, Massachusetts 02114 |
Marshfield Clinic | Marshfield, Wisconsin 54449 |
Loma Linda University Medical Center | Loma Linda, California 92354 |
Baptist Hospital of Miami | Miami, Florida 33176-2197 |
Newark Beth Israel Medical Center | Newark, New Jersey 07112 |
New York Medical College | Valhalla, New York 10595 |
Dana-Farber Cancer Institute | Boston, Massachusetts 02115 |
Cedars-Sinai Medical Center | Los Angeles, California 90048 |
University of Arkansas for Medical Sciences | Little Rock, Arkansas 72205 |
Brooke Army Medical Center | Fort Sam Houston, Texas 78234-6200 |
Madigan Army Medical Center | Tacoma, Washington 98431-5048 |
Eastern Maine Medical Center | Bangor, Maine 04401 |
University of Nebraska Medical Center | Omaha, Nebraska 68198-3330 |
Hackensack University Medical Center | Hackensack, New Jersey 07601 |
Children's Hospital Los Angeles | Los Angeles, California 90027-0700 |
Children's National Medical Center | Washington, District of Columbia 20010-2970 |
Miami Children's Hospital | Miami, Florida 33155-4069 |
All Children's Hospital | St. Petersburg, Florida 33701 |
Advocate Hope Children's Hospital | Oak Lawn, Illinois 60453 |
Saint Jude Midwest Affiliate | Peoria, Illinois 61637 |
Maine Children's Cancer Program | Scarborough, Maine 04074-9308 |
Carolinas Medical Center | Charlotte, North Carolina 28232-2861 |
University of Oklahoma Health Sciences Center | Oklahoma City, Oklahoma 73104 |
Legacy Emanuel Hospital and Health Center | Portland, Oregon 97227 |
St. Jude Children's Research Hospital | Memphis, Tennessee 38105-2794 |
Driscoll Children's Hospital | Corpus Christi, Texas 78466 |
Scott and White Memorial Hospital | Temple, Texas 76508 |
Inova Fairfax Hospital | Falls Church, Virginia 22042-3300 |
Southern California Permanente Medical Group | Downey, California 90242 |
Children's Hospital Central California | Madera, California 93638-8762 |
Kosair Children's Hospital | Louisville, Kentucky 40202-3830 |
Brooklyn Hospital Center | Brooklyn, New York 11201 |
Children's Hospital Medical Center of Akron | Akron, Ohio 44308 |
Covenant Children's Hospital | Lubbock, Texas 79410 |
University of Wisconsin Hospital and Clinics | Madison, Wisconsin 53792-0001 |
Overlook Hospital | Summit, New Jersey 07902-0220 |
Mount Sinai Medical Center | New York, New York 10029 |
Cincinnati Children's Hospital Medical Center | Cincinnati, Ohio 45229-3039 |
Methodist Children's Hospital of South Texas | San Antonio, Texas 78229-3993 |
Primary Children's Medical Center | Salt Lake City, Utah 84113-1100 |
Montefiore Medical Center | Bronx, New York 10467-2490 |
Saint Peter's University Hospital | New Brunswick, New Jersey 08901-1780 |
Rady Children's Hospital - San Diego | San Diego, California 92123-4282 |
Children's Hospitals and Clinics of Minnesota - Minneapolis | Minneapolis, Minnesota 55404 |
University of New Mexico Cancer Center | Albuquerque, New Mexico 87131-5636 |
Nationwide Children's Hospital | Columbus, Ohio 43205-2696 |
Children's Hospital of Pittsburgh of UPMC | Pittsburgh, Pennsylvania 15213 |
Dell Children's Medical Center of Central Texas | Austin, Texas 78723 |
Children's Hospital and Research Center at Oakland | Oakland, California 94609-1809 |
Mary Bridge Children's Hospital and Health Center | Tacoma, Washington 98415-0299 |
City of Hope Medical Center | Duarte, California 91010 |
Lehigh Valley Hospital - Muhlenberg | Bethlehem, Pennsylvania 18017 |
Presbyterian Hospital | Charlotte, North Carolina 28233-3549 |
Lee Memorial Health System | Fort Myers, Florida 33902 |
University of Virginia | Charlottesville, Virginia 22908 |
University of Alabama at Birmingham | Birmingham, Alabama 35294-3300 |
Connecticut Children's Medical Center | Hartford, Connecticut 06106 |
University of North Carolina | Chapel Hill, North Carolina 27599 |
Duke University Medical Center | Durham, North Carolina 27710 |
University of Florida | Gainesville, Florida 32610-0277 |
University of Rochester | Rochester, New York 14642 |
Nemours Children's Clinic - Pensacola | Pensacola, Florida 32504 |
Helen DeVos Children's Hospital at Spectrum Health | Grand Rapids, Michigan 49503 |
Yale University | New Haven, Connecticut 06520 |
Wayne State University | Detroit, Michigan 48202 |
Mercy Children's Hospital | Toledo, Ohio 43608 |
Legacy Emanuel Children's Hospital | Portland, Oregon 97227 |
University of Arizona Health Sciences Center | Tucson, Arizona 85724 |
University of Massachusetts Medical School | Worcester, Massachusetts 01605 |
Dartmouth Hitchcock Medical Center | Lebanon, New Hampshire 03756 |
University Of Vermont | Burlington,, Vermont 05403 |
Albany Medical Center | Albany, New York 12208 |
University of Texas Southwestern Medical Center | Dallas, Texas |
University of Kentucky | Lexington, Kentucky 40536-0098 |
Oregon Health and Science University | Portland, Oregon 97201 |
Tulane University Health Sciences Center | New Orleans, Louisiana 70112 |
Virginia Commonwealth University | Richmond, Virginia |
David Geffen School of Medicine at UCLA | Los Angeles, California 90095 |
Florida Hospital | Orlando, Florida 32803 |
Memorial Health University Medical Center | Savannah, Georgia 31404 |
University of Chicago Comprehensive Cancer Center | Chicago, Illinois 60637-1470 |
M D Anderson Cancer Center | Houston, Texas 77030 |
Seattle Children's Hospital | Seattle, Washington 98105 |
Wake Forest University Health Sciences | Winston-Salem, North Carolina 27157 |
Childrens Memorial Hospital | Chicago, Illinois 60614 |
Kaiser Permanente-Oakland | Oakland, California 94611 |
M D Anderson Cancer Center- Orlando | Orlando, Florida 32806 |
University of Hawaii | Honolulu, Hawaii 96813 |
Saint Luke's Mountain States Tumor Institute | Boise, Idaho 83712 |
Saint Vincent Hospital and Health Services | Indianapolis, Indiana 46260 |
Saint John Hospital and Medical Center | Detroit, Michigan 48236 |
Michigan State University - Breslin Cancer Center | East Lansing, Michigan 48824-1313 |
Kalamazoo Center for Medical Studies | Kalamazoo, Michigan 49008 |
Saint John's Mercy Medical Center | Saint Louis, Missouri 63141 |
Nevada Cancer Research Foundation CCOP | Las Vegas, Nevada 89106 |
New York University Langone Medical Center | New York, New York 10016 |
Columbia University Medical Center | New York, New York 10032 |
State University of New York Upstate Medical University | Syracuse, New York 13210 |
Mission Hospitals Inc | Asheville, North Carolina 28801 |
Saint Vincent Hospital | Green Bay, Wisconsin 54301 |
University of Maryland Greenebaum Cancer Center | Baltimore, Maryland 21201 |
University of Illinois | Chicago, Illinois 60612 |
Stony Brook University Medical Center | Stony Brook, New York 11794 |
Cook Children's Medical Center | Fort Worth, Texas 76104 |
Memorial Healthcare System - Joe DiMaggio Children's Hospital | Hollywood, Florida 33021 |
West Virginia University Charleston | Charleston, West Virginia 25304 |
The Children's Medical Center of Dayton | Dayton, Ohio 45404 |
Advocate Lutheran General Hospital | Park Ridge, Illinois 60068 |
University of Miami Miller School of Medicine-Sylvester Cancer Center | Miami, Florida 33136 |
University of Minnesota Medical Center-Fairview | Minneapolis, Minnesota 55455 |
Children's Oncology Group | Arcadia, California 91006-3776 |
C S Mott Children's Hospital | Ann Arbor, Michigan 48109 |
Southern Illinois University | Springfield, Illinois 62702 |
University Of Missouri-Columbia | Columbia, Missouri 65212 |
Walter Reed National Military Medical Center | Bethesda, Maryland 20889 |
Riley Hospital for Children | Indianapolis, Indiana 46202 |
UMDNJ - Robert Wood Johnson University Hospital | New Brunswick, New Jersey 08903 |
Phoenix Childrens Hospital | Phoenix, Arizona 85016 |
Miller Children's Hospital | Long Beach, California 90806 |
Childrens Hospital of Orange County | Orange, California 92868-3874 |
Alfred I duPont Hospital for Children | Wilmington, Delaware 19803 |
Nemours Children's Clinic - Jacksonville | Jacksonville, Florida 32207-8426 |
Nemours Childrens Clinic - Orlando | Orlando, Florida 32806 |
Saint Joseph Children's Hospital of Tampa | Tampa, Florida 33607 |
Children's Healthcare of Atlanta - Egleston | Atlanta, Georgia 30322 |
The Childrens Mercy Hospital | Kansas City, Missouri 64108 |
Rainbow Babies and Childrens Hospital | Cleveland, Ohio 44106 |
Penn State Hershey Children's Hospital | Hershey, Pennsylvania 17033 |
Palmetto Health Richland | Columbia, South Carolina 29203 |
East Tennessee Childrens Hospital | Knoxville, Tennessee 37916 |
Saint Mary's Hospital | West Palm Beach, Florida 33407 |
Saint Joseph's Regional Medical Center | Paterson, New Jersey 07503 |
Texas Tech University Health Science Center-Amarillo | Amarillo, Texas 79106 |
Childrens Hospital-King's Daughters | Norfolk, Virginia 23507 |
Sanford Medical Center-Fargo | Fargo, North Dakota 58122 |
Children's Hospital Colorado | Aurora, Colorado 80045 |
Lucile Packard Children's Hospital Stanford University | Palo Alto, California 94304 |
University of California San Francisco Medical Center-Parnassus | San Francisco, California 94143 |
Rocky Mountain Hospital for Children-Presbyterian Saint Luke's Medical Center | Denver, Colorado 80218 |
The Toledo Hospital/Toledo Children's Hospital | Toledo, Ohio 43606 |
Greenville Cancer Treatment Center | Greenville, South Carolina 29605 |
Sanford USD Medical Center - Sioux Falls | Sioux Falls, South Dakota 57117-5134 |
T C Thompson Children's Hospital | Chattanooga, Tennessee 37403 |
Providence Sacred Heart Medical Center and Children's Hospital | Spokane, Washington 99204 |
Broward Health Medical Center | Fort Lauderdale, Florida 33316 |
The Steven and Alexandra Cohen Children's Medical Center of New York | New Hyde Park, New York 11040 |