Treatment of XXXX in adolescents and young adults with intensive combined modality therapy.

@entity1 @entity2828 @entity10476 @entity632 @entity137 @entity75 @entity5 @entity3491 @entity786 @entity530 @entity348 @entity1891 @entity3943
Adolescent and young adult @entity1 with @entity530 continue to have a poor prognosis with standard combination chemotherapy and local irradiation. In addition to a significant risk of local failure, these @entity1 are at high risk for systemic relapse. Twenty-three consecutive @entity1 with @entity2828 , @entity3943 , @entity3491 , or malignant @entity10476 originating in the pelvis were treated with short, intensive combined modality therapy. This approach integrates 5 cycles of VADRIAC chemotherapy ( @entity1891 , @entity632 , @entity786 ) with high dose irradiation to the @entity75 (55-60 Gy) and sites of gross metastatic disease (45-50 Gy). Following achievement of a complete response, intensification therapy consisting of @entity348 ( @entity348 ) (8.0 Gy), high dose VADRIAC chemotherapy, and autologous bone marow transplantation is given. All therapy is completed within 6-7 months. No maintenance chemotherapy is given; no surgery is intended. Of the twenty-three @entity1 with @entity530 treated on this combined modality protocol, 22 achieved a complete remission. Local control was achieved and maintained in all twenty-three @entity1 . With a median follow-up of 21 months since initiation of treatment, there have been nine relapses (all systemic). Seven relapses occurred among the thirteen @entity1 who presented with overt metastatic disease and the other two relapses were among the ten @entity1 with localized disease at presentation. All seven metastatic @entity1 who relapsed have died, whereas both of the relapsed localized @entity1 remain alive. Acute and late @entity137 have been acceptable using this aggressive combined modality approach. Induction chemotherapy had a significant impact on reduction of the typically large (greater than 10 cm diameter) soft tissue mass associated with these @entity530 , thus facilitating achievement of local control by high dose irradiation. Of 18 @entity1 with measureable soft tissue @entity5 , all experienced a partial response (greater than 50% reduction in size) following the initial two cycles of chemotherapy given prior to local irradiation. In conclusion, this short, intensive chemoradiotherapeutic regimen is highly effective in controlling the @entity75 (100% local control) and inducing a complete response in a high proportion (96%) of these high risk pediatric and young adult @entity1 with @entity530 . The role of @entity348 as "systemic" adjuvant therapy to control micrometastatic disease is discussed as still under investigation.
