Risk-Based Therapy for XXXX .

@entity1 @entity632 @entity137 @entity39 @entity5 @entity900 @entity786 @entity3601 @entity421 @entity1499 @entity204 @entity1349
BACKGROUND: The outcome of @entity421 has remained constant over the past 30 years. Histological response to preoperative chemotherapy is the best predictor of outcome. Strategies to alter treatment based on histological response have not resulted in increased survival. PROCEDURE: @entity1 with @entity421 received preoperative chemotherapy with @entity900 , @entity632 , and @entity1499 . @entity1 whose @entity5 had a good histological response (>= 90% @entity39 ) continued with the same treatment postoperatively. @entity1 with poor histological response (<90% @entity39 ) received three courses of @entity3601 100 mg/m(2) on day -4, @entity786 2,000 mg/m(2) on days -3, and -2 followed by stem cell infusion. RESULTS: Fifty-two @entity1 were enrolled. Median age was 14 years, and 56% of @entity1 were male. The femur was the most common site. Forty @entity1 underwent limb salvage surgery and amputation was performed in six @entity1 . Forty-eight percent of @entity5 showed good histological response. Forty @entity1 were evaluable for outcome; 18 @entity1 with poor histologic response received high-dose chemotherapy. The 5-year event-free survival (EFS) and @entity1349 ( @entity1349 ) for @entity1 treated on the high-dose chemotherapy arm were 28% (95% confidence interval [CI], 10-49) and 48% (95% CI, 23-69), respectively. The 5-year EFS and @entity1349 for @entity1 treated on the standard chemotherapy arm were 62% (95% CI, 36-80) and 74% (95% CI, 44-90), respectively. All @entity1 who received high-dose chemotherapy developed grade 3 or higher hematological @entity137 . There were no treatment-related @entity204 . CONCLUSIONS: Postoperative alkylator intensification with high-dose @entity786 and @entity3601 in @entity1 with @entity421 with poor histological response failed to improve survival.
