Phase II studies using ifosfamide both alone and combined with vindesine and 
cisplatin have shown the effectiveness of this drug in patients with Ewing's 
sarcoma (ES) who had relapsed during VAC (vincristine, actinomycin, 
cyclosphosphamide)/VAd (vincristine, Adriamycin) therapy. In November 1984, 
these results led the SFOP to adopt a protocol consisting of (1) initial 
chemotherapy with three cycles of IVA (ifosfamide, 3 g/m2 on days 1 and 2; 
actinomycin D, 750 mg/m2 on days 1-3; vincristine, 1.5 mg/m2 on day 1) 
alternating every 3 weeks with IVAd (vincristine on day 22; ifosfamide on days 
21-23; Adriamycin, 60 mg/m2 on day 22); (2) radical surgery if possible; (3) 
local radiotherapy (RT); and (4) maintenance chemotherapy with alternating IVA 
and VAd (vincristine, Adriamycin) for up to 9 months. In May 1987, 87 patients 
with previously untreated ES entered the study; 61 had localized ES. To date, 54 
patients with localized disease and 22 with metastatic disease have finished 
initial chemotherapy; 40 patients with localized disease have been evaluated. In 
all, 28 patients (70%) were in complete remission (17 patients) or had a tumor 
regression of greater than 50% 11 patients) and were considered to be good 
responders; 12 patients were considered to be poor responders. After local 
radiotherapy in all but 7 patients and surgical resection in 29, 52 of 54 were 
considered to be in clinical remission. A total of 13 patients with metastatic 
disease were good responders at the completion of the initial chemotherapy. 
These results confirm the efficacy of primary chemotherapy using ifosfamide for 
the treatment of ES.