A Pilot Phase II Study for Children With Infantile Fibrosarcoma

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.