OBJECTIVES: Primary * Determine the event-free and relapse-free survival of children with initially unresectable congenital, infantile, or childhood fibrosarcoma treated with neoadjuvant chemotherapy comprising vincristine, dactinomycin, and cyclophosphamide (VAC) before definitive local control. Secondary * Determine the event-free and relapse-free survival of patients initially treated with this regimen followed by observation after local control with positive microscopic margins. * Determine the event-free and relapse-free survival of patients initially treated with this regimen followed by additional chemotherapy comprising etoposide and ifosfamide after local control with gross positive margins. * Determine the event-free and relapse-free survival of patients treated with surgery alone. OUTLINE: This is a pilot, multicenter study. Patients begin treatment according to lesion resectability. Patients with resectable lesions proceed to surgery. * Surgery: Patients undergo resection of disease lesions. Patients with clear or microscopically positive margins undergo observation only. Patients with grossly positive margins undergo re-resection if feasible. Patients with grossly positive margins after re-resection or for whom re-resection is not feasible receive chemotherapy comprising vincristine, dactinomycin, and cyclophosphamide (VAC). Patients with unresectable lesions receive VAC chemotherapy. * VAC chemotherapy: Patients receive vincristine intravenously (IV) on days 1, 8, and 15 and dactinomycin IV and cyclophosphamide IV over 1 hour on day 1. Treatment repeats every 21 days for up to 6 courses in the absence of disease progression or unacceptable toxicity. Patients with disease progression after 2-4 courses of VAC chemotherapy proceed to chemotherapy comprising etoposide and ifosfamide (IE). Patients with stable disease after 4 courses of VAC chemotherapy proceed to IE chemotherapy. Patients with a partial response (PR) and unresectable lesions after 4 courses of VAC chemotherapy receive 2 additional courses of VAC and are then re-evaluated. Patients proceed to surgery if they continue to have a PR or achieve a complete response (CR) and lesions are now resectable. Patients with a CR or PR and resectable lesions after 4 courses of VAC chemotherapy proceed to surgery. Patients with stable disease, progressive disease, or a PR and unresectable lesions after 6 courses of VAC proceed to IE chemotherapy. * IE chemotherapy: Patients receive etoposide IV over 1 hour and ifosfamide IV over 1 hour on days 1-5. Treatment repeats every 21 days for 4 courses in the absence of disease progression or unacceptable toxicity. Patients with a CR or PR and resectable lesions after 2-4 courses of IE chemotherapy proceed to surgery. All patients are followed every 3 months for 6 months, every 6 months for 1 year, and then as clinically indicated. PROJECTED ACCRUAL: A total of 60-70 patients will be accrued for this study within 8 years.
DISEASE CHARACTERISTICS: * Histologically confirmed infantile, congenital, or pediatric fibrosarcoma * Initial biopsy or surgery performed within the past 35 days * No evidence of distant metastases * Available tissue for central review PATIENT CHARACTERISTICS: Age * Under 2 at diagnosis Performance status * Zubrod Score (ECOG) Life expectancy * At least 8 weeks Hematopoietic * Absolute neutrophil count at least 1,000/mm\^3 * Platelet count at least 100,000/mm\^3\* * Hemoglobin at least 10.0 g/dL\* NOTE: \*Transfusions allowed Hepatic * Total bilirubin no greater than 1.5 times upper limit of normal (ULN) (patients over 4 weeks of age) * Patients under 4 weeks of age with an indirect hyperbilirubinemia are eligible, provided the following criteria are met: * At least 2 bilirubin values at separate timepoints show a decrease in measurement * Direct bilirubin is no greater than 20% of the total bilirubin * Direct bilirubin no greater than 1.5 times ULN * Alanine Aminotransferase (ALT) less than 2.5 times ULN Renal * Creatinine clearance or radioisotope glomerular filtration rate at least 70 mL/min PRIOR/CONCURRENT THERAPY: Biologic therapy * No concurrent sargramostim (GM-CSF) Chemotherapy * No prior chemotherapy * No other concurrent anticancer chemotherapy Endocrine therapy * Not specified Radiotherapy * No prior or concurrent radiotherapy except emergent radiotherapy for impending tracheal compression Surgery * See Disease Characteristics
sont désignés dans cette étude