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Gaspar N, Hawkins DS, Dirksen U, Lewis IJ, Ferrari S, Le Deley MC, Kovar H, Grimer R, Whelan J, Claude L, Delattre O, Paulussen M, Picci P, Sundby Hall K, van den Berg H, Ladenstein R, Michon J, Hjorth L, Judson I, Luksch R, Bernstein ML, Marec-Bérard P, Brennan B, Craft AW, Womer RB, Juergens H, Oberlin O. Ewing Sarcoma: Current Management and Future Approaches Through Collaboration. J Clin Oncol 2015; 33:3036-46. [PMID: 26304893 DOI: 10.1200/jco.2014.59.5256] [Citation(s) in RCA: 418] [Impact Index Per Article: 46.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Ewing sarcoma (ES) is an aggressive sarcoma of bone and soft tissue occurring at any age with a peak incidence in adolescents and young adults. The treatment of ES relies on a multidisciplinary approach, coupling risk-adapted intensive neoadjuvant and adjuvant chemotherapies with surgery and/or radiotherapy for control of the primary site and possible metastatic disease. The optimization of ES multimodality therapeutic strategies has resulted from the efforts of several national and international groups in Europe and North America and from cooperation between pediatric and medical oncologists. Successive first-line trials addressed the efficacy of various cyclic combinations of drugs incorporating doxorubicin, vincristine, cyclophosphamide, ifosfamide, etoposide, and dactinomycin and identified prognostic factors now used to tailor therapies. The role of high-dose chemotherapy is still debated. Current 5-year overall survival for patients with localized disease is 65% to 75%. Patients with metastases have a 5-year overall survival < 30%, except for those with isolated pulmonary metastasis (approximately 50%). Patients with recurrence have a dismal prognosis. The many insights into the biology of the EWS-FLI1 protein in the initiation and progression of ES remain to be translated into novel therapeutic strategies. Current options and future approaches will be discussed.
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Affiliation(s)
- Nathalie Gaspar
- Nathalie Gaspar, Marie-Cecile Le Deley, and Odile Oberlin, Institut Gustave Roussy, Villejuif; Nathalie Gaspar, Marie-Cecile Le Deley, Line Claude, Olivier Delattre, Jean Michon, Perrine Marec-Bérard, and Odile Oberlin, Société Française de Lutte Contre les Cancers et les Leucémies de l'Enfant et de l'Adolescent; Marie-Cecile Le Deley, Paris-Sud University, Le Kremlin-Bicêtre; Line Claude and Perrine Marec-Bérard, Centre Léon-Bérard, Lyon; Olivier Delattre and Jean Michon, Institut Curie, Paris, France; Douglas S. Hawkins, Seattle Children's Hospital, Seattle, WA; Douglas S. Hawkins, Mark L. Bernstein, and Richard B. Womer, Children's Oncology Group; Uta Dirksen and Heribert Juergens, University Hospital Münster, Münster; Uta Dirksen, Michael Paulussen, and Heribert Juergens, Gesellschaft für Pädiatrische Onkologie und Hämatologie; Michael Paulussen, Children's and Adolescents' Hospital, Witten/Herdecke University, Datteln, Germany; Ian J. Lewis, Alder Hey Children's National Health Service (NHS) Foundation Trust, Liverpool; Ian J. Lewis, Robert Grimer, Bernadette Brennan, and Alan W. Craft, Children's Cancer and Leukaemia Group; Robert Grimer, Royal Orthopaedic Hospital, Birmingham; Jeremy Whelan, University College London Hospital NHS Foundation Trust; Ian Judson, Royal Marsden Hospital, London; Bernadette Brennan, Royal Manchester Children's Hospital, Manchester; Alan W. Craft, Royal Victoria Infirmary, Newcastle, United Kingdom; Stefano Ferrari and Piero Picci, Rizzoli Institute, Bologna; Stefano Ferrari, Piero Picci, Roberto Luksch, Italian Sarcoma Group; Roberto Luksch, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Istituto Nazionale dei Tumori, Milan, Italy; Heinrich Kovar and Ruth Ladenstein, Children's Cancer Institute, St Anna Kinderkrebsforschung, Wien; Heinrich Kovar and Ruth Ladenstein, Arbeitsgemeinschaft Ambulant Tätiger Pädiatrischer Onkologen und Hämatologen, Vienna, Austria; Jeremy Whelan and Ian Judson, European O
| | - Douglas S Hawkins
- Nathalie Gaspar, Marie-Cecile Le Deley, and Odile Oberlin, Institut Gustave Roussy, Villejuif; Nathalie Gaspar, Marie-Cecile Le Deley, Line Claude, Olivier Delattre, Jean Michon, Perrine Marec-Bérard, and Odile Oberlin, Société Française de Lutte Contre les Cancers et les Leucémies de l'Enfant et de l'Adolescent; Marie-Cecile Le Deley, Paris-Sud University, Le Kremlin-Bicêtre; Line Claude and Perrine Marec-Bérard, Centre Léon-Bérard, Lyon; Olivier Delattre and Jean Michon, Institut Curie, Paris, France; Douglas S. Hawkins, Seattle Children's Hospital, Seattle, WA; Douglas S. Hawkins, Mark L. Bernstein, and Richard B. Womer, Children's Oncology Group; Uta Dirksen and Heribert Juergens, University Hospital Münster, Münster; Uta Dirksen, Michael Paulussen, and Heribert Juergens, Gesellschaft für Pädiatrische Onkologie und Hämatologie; Michael Paulussen, Children's and Adolescents' Hospital, Witten/Herdecke University, Datteln, Germany; Ian J. Lewis, Alder Hey Children's National Health Service (NHS) Foundation Trust, Liverpool; Ian J. Lewis, Robert Grimer, Bernadette Brennan, and Alan W. Craft, Children's Cancer and Leukaemia Group; Robert Grimer, Royal Orthopaedic Hospital, Birmingham; Jeremy Whelan, University College London Hospital NHS Foundation Trust; Ian Judson, Royal Marsden Hospital, London; Bernadette Brennan, Royal Manchester Children's Hospital, Manchester; Alan W. Craft, Royal Victoria Infirmary, Newcastle, United Kingdom; Stefano Ferrari and Piero Picci, Rizzoli Institute, Bologna; Stefano Ferrari, Piero Picci, Roberto Luksch, Italian Sarcoma Group; Roberto Luksch, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Istituto Nazionale dei Tumori, Milan, Italy; Heinrich Kovar and Ruth Ladenstein, Children's Cancer Institute, St Anna Kinderkrebsforschung, Wien; Heinrich Kovar and Ruth Ladenstein, Arbeitsgemeinschaft Ambulant Tätiger Pädiatrischer Onkologen und Hämatologen, Vienna, Austria; Jeremy Whelan and Ian Judson, European O
| | - Uta Dirksen
- Nathalie Gaspar, Marie-Cecile Le Deley, and Odile Oberlin, Institut Gustave Roussy, Villejuif; Nathalie Gaspar, Marie-Cecile Le Deley, Line Claude, Olivier Delattre, Jean Michon, Perrine Marec-Bérard, and Odile Oberlin, Société Française de Lutte Contre les Cancers et les Leucémies de l'Enfant et de l'Adolescent; Marie-Cecile Le Deley, Paris-Sud University, Le Kremlin-Bicêtre; Line Claude and Perrine Marec-Bérard, Centre Léon-Bérard, Lyon; Olivier Delattre and Jean Michon, Institut Curie, Paris, France; Douglas S. Hawkins, Seattle Children's Hospital, Seattle, WA; Douglas S. Hawkins, Mark L. Bernstein, and Richard B. Womer, Children's Oncology Group; Uta Dirksen and Heribert Juergens, University Hospital Münster, Münster; Uta Dirksen, Michael Paulussen, and Heribert Juergens, Gesellschaft für Pädiatrische Onkologie und Hämatologie; Michael Paulussen, Children's and Adolescents' Hospital, Witten/Herdecke University, Datteln, Germany; Ian J. Lewis, Alder Hey Children's National Health Service (NHS) Foundation Trust, Liverpool; Ian J. Lewis, Robert Grimer, Bernadette Brennan, and Alan W. Craft, Children's Cancer and Leukaemia Group; Robert Grimer, Royal Orthopaedic Hospital, Birmingham; Jeremy Whelan, University College London Hospital NHS Foundation Trust; Ian Judson, Royal Marsden Hospital, London; Bernadette Brennan, Royal Manchester Children's Hospital, Manchester; Alan W. Craft, Royal Victoria Infirmary, Newcastle, United Kingdom; Stefano Ferrari and Piero Picci, Rizzoli Institute, Bologna; Stefano Ferrari, Piero Picci, Roberto Luksch, Italian Sarcoma Group; Roberto Luksch, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Istituto Nazionale dei Tumori, Milan, Italy; Heinrich Kovar and Ruth Ladenstein, Children's Cancer Institute, St Anna Kinderkrebsforschung, Wien; Heinrich Kovar and Ruth Ladenstein, Arbeitsgemeinschaft Ambulant Tätiger Pädiatrischer Onkologen und Hämatologen, Vienna, Austria; Jeremy Whelan and Ian Judson, European O
| | - Ian J Lewis
- Nathalie Gaspar, Marie-Cecile Le Deley, and Odile Oberlin, Institut Gustave Roussy, Villejuif; Nathalie Gaspar, Marie-Cecile Le Deley, Line Claude, Olivier Delattre, Jean Michon, Perrine Marec-Bérard, and Odile Oberlin, Société Française de Lutte Contre les Cancers et les Leucémies de l'Enfant et de l'Adolescent; Marie-Cecile Le Deley, Paris-Sud University, Le Kremlin-Bicêtre; Line Claude and Perrine Marec-Bérard, Centre Léon-Bérard, Lyon; Olivier Delattre and Jean Michon, Institut Curie, Paris, France; Douglas S. Hawkins, Seattle Children's Hospital, Seattle, WA; Douglas S. Hawkins, Mark L. Bernstein, and Richard B. Womer, Children's Oncology Group; Uta Dirksen and Heribert Juergens, University Hospital Münster, Münster; Uta Dirksen, Michael Paulussen, and Heribert Juergens, Gesellschaft für Pädiatrische Onkologie und Hämatologie; Michael Paulussen, Children's and Adolescents' Hospital, Witten/Herdecke University, Datteln, Germany; Ian J. Lewis, Alder Hey Children's National Health Service (NHS) Foundation Trust, Liverpool; Ian J. Lewis, Robert Grimer, Bernadette Brennan, and Alan W. Craft, Children's Cancer and Leukaemia Group; Robert Grimer, Royal Orthopaedic Hospital, Birmingham; Jeremy Whelan, University College London Hospital NHS Foundation Trust; Ian Judson, Royal Marsden Hospital, London; Bernadette Brennan, Royal Manchester Children's Hospital, Manchester; Alan W. Craft, Royal Victoria Infirmary, Newcastle, United Kingdom; Stefano Ferrari and Piero Picci, Rizzoli Institute, Bologna; Stefano Ferrari, Piero Picci, Roberto Luksch, Italian Sarcoma Group; Roberto Luksch, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Istituto Nazionale dei Tumori, Milan, Italy; Heinrich Kovar and Ruth Ladenstein, Children's Cancer Institute, St Anna Kinderkrebsforschung, Wien; Heinrich Kovar and Ruth Ladenstein, Arbeitsgemeinschaft Ambulant Tätiger Pädiatrischer Onkologen und Hämatologen, Vienna, Austria; Jeremy Whelan and Ian Judson, European O
| | - Stefano Ferrari
- Nathalie Gaspar, Marie-Cecile Le Deley, and Odile Oberlin, Institut Gustave Roussy, Villejuif; Nathalie Gaspar, Marie-Cecile Le Deley, Line Claude, Olivier Delattre, Jean Michon, Perrine Marec-Bérard, and Odile Oberlin, Société Française de Lutte Contre les Cancers et les Leucémies de l'Enfant et de l'Adolescent; Marie-Cecile Le Deley, Paris-Sud University, Le Kremlin-Bicêtre; Line Claude and Perrine Marec-Bérard, Centre Léon-Bérard, Lyon; Olivier Delattre and Jean Michon, Institut Curie, Paris, France; Douglas S. Hawkins, Seattle Children's Hospital, Seattle, WA; Douglas S. Hawkins, Mark L. Bernstein, and Richard B. Womer, Children's Oncology Group; Uta Dirksen and Heribert Juergens, University Hospital Münster, Münster; Uta Dirksen, Michael Paulussen, and Heribert Juergens, Gesellschaft für Pädiatrische Onkologie und Hämatologie; Michael Paulussen, Children's and Adolescents' Hospital, Witten/Herdecke University, Datteln, Germany; Ian J. Lewis, Alder Hey Children's National Health Service (NHS) Foundation Trust, Liverpool; Ian J. Lewis, Robert Grimer, Bernadette Brennan, and Alan W. Craft, Children's Cancer and Leukaemia Group; Robert Grimer, Royal Orthopaedic Hospital, Birmingham; Jeremy Whelan, University College London Hospital NHS Foundation Trust; Ian Judson, Royal Marsden Hospital, London; Bernadette Brennan, Royal Manchester Children's Hospital, Manchester; Alan W. Craft, Royal Victoria Infirmary, Newcastle, United Kingdom; Stefano Ferrari and Piero Picci, Rizzoli Institute, Bologna; Stefano Ferrari, Piero Picci, Roberto Luksch, Italian Sarcoma Group; Roberto Luksch, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Istituto Nazionale dei Tumori, Milan, Italy; Heinrich Kovar and Ruth Ladenstein, Children's Cancer Institute, St Anna Kinderkrebsforschung, Wien; Heinrich Kovar and Ruth Ladenstein, Arbeitsgemeinschaft Ambulant Tätiger Pädiatrischer Onkologen und Hämatologen, Vienna, Austria; Jeremy Whelan and Ian Judson, European O
| | - Marie-Cecile Le Deley
- Nathalie Gaspar, Marie-Cecile Le Deley, and Odile Oberlin, Institut Gustave Roussy, Villejuif; Nathalie Gaspar, Marie-Cecile Le Deley, Line Claude, Olivier Delattre, Jean Michon, Perrine Marec-Bérard, and Odile Oberlin, Société Française de Lutte Contre les Cancers et les Leucémies de l'Enfant et de l'Adolescent; Marie-Cecile Le Deley, Paris-Sud University, Le Kremlin-Bicêtre; Line Claude and Perrine Marec-Bérard, Centre Léon-Bérard, Lyon; Olivier Delattre and Jean Michon, Institut Curie, Paris, France; Douglas S. Hawkins, Seattle Children's Hospital, Seattle, WA; Douglas S. Hawkins, Mark L. Bernstein, and Richard B. Womer, Children's Oncology Group; Uta Dirksen and Heribert Juergens, University Hospital Münster, Münster; Uta Dirksen, Michael Paulussen, and Heribert Juergens, Gesellschaft für Pädiatrische Onkologie und Hämatologie; Michael Paulussen, Children's and Adolescents' Hospital, Witten/Herdecke University, Datteln, Germany; Ian J. Lewis, Alder Hey Children's National Health Service (NHS) Foundation Trust, Liverpool; Ian J. Lewis, Robert Grimer, Bernadette Brennan, and Alan W. Craft, Children's Cancer and Leukaemia Group; Robert Grimer, Royal Orthopaedic Hospital, Birmingham; Jeremy Whelan, University College London Hospital NHS Foundation Trust; Ian Judson, Royal Marsden Hospital, London; Bernadette Brennan, Royal Manchester Children's Hospital, Manchester; Alan W. Craft, Royal Victoria Infirmary, Newcastle, United Kingdom; Stefano Ferrari and Piero Picci, Rizzoli Institute, Bologna; Stefano Ferrari, Piero Picci, Roberto Luksch, Italian Sarcoma Group; Roberto Luksch, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Istituto Nazionale dei Tumori, Milan, Italy; Heinrich Kovar and Ruth Ladenstein, Children's Cancer Institute, St Anna Kinderkrebsforschung, Wien; Heinrich Kovar and Ruth Ladenstein, Arbeitsgemeinschaft Ambulant Tätiger Pädiatrischer Onkologen und Hämatologen, Vienna, Austria; Jeremy Whelan and Ian Judson, European O
| | - Heinrich Kovar
- Nathalie Gaspar, Marie-Cecile Le Deley, and Odile Oberlin, Institut Gustave Roussy, Villejuif; Nathalie Gaspar, Marie-Cecile Le Deley, Line Claude, Olivier Delattre, Jean Michon, Perrine Marec-Bérard, and Odile Oberlin, Société Française de Lutte Contre les Cancers et les Leucémies de l'Enfant et de l'Adolescent; Marie-Cecile Le Deley, Paris-Sud University, Le Kremlin-Bicêtre; Line Claude and Perrine Marec-Bérard, Centre Léon-Bérard, Lyon; Olivier Delattre and Jean Michon, Institut Curie, Paris, France; Douglas S. Hawkins, Seattle Children's Hospital, Seattle, WA; Douglas S. Hawkins, Mark L. Bernstein, and Richard B. Womer, Children's Oncology Group; Uta Dirksen and Heribert Juergens, University Hospital Münster, Münster; Uta Dirksen, Michael Paulussen, and Heribert Juergens, Gesellschaft für Pädiatrische Onkologie und Hämatologie; Michael Paulussen, Children's and Adolescents' Hospital, Witten/Herdecke University, Datteln, Germany; Ian J. Lewis, Alder Hey Children's National Health Service (NHS) Foundation Trust, Liverpool; Ian J. Lewis, Robert Grimer, Bernadette Brennan, and Alan W. Craft, Children's Cancer and Leukaemia Group; Robert Grimer, Royal Orthopaedic Hospital, Birmingham; Jeremy Whelan, University College London Hospital NHS Foundation Trust; Ian Judson, Royal Marsden Hospital, London; Bernadette Brennan, Royal Manchester Children's Hospital, Manchester; Alan W. Craft, Royal Victoria Infirmary, Newcastle, United Kingdom; Stefano Ferrari and Piero Picci, Rizzoli Institute, Bologna; Stefano Ferrari, Piero Picci, Roberto Luksch, Italian Sarcoma Group; Roberto Luksch, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Istituto Nazionale dei Tumori, Milan, Italy; Heinrich Kovar and Ruth Ladenstein, Children's Cancer Institute, St Anna Kinderkrebsforschung, Wien; Heinrich Kovar and Ruth Ladenstein, Arbeitsgemeinschaft Ambulant Tätiger Pädiatrischer Onkologen und Hämatologen, Vienna, Austria; Jeremy Whelan and Ian Judson, European O
| | - Robert Grimer
- Nathalie Gaspar, Marie-Cecile Le Deley, and Odile Oberlin, Institut Gustave Roussy, Villejuif; Nathalie Gaspar, Marie-Cecile Le Deley, Line Claude, Olivier Delattre, Jean Michon, Perrine Marec-Bérard, and Odile Oberlin, Société Française de Lutte Contre les Cancers et les Leucémies de l'Enfant et de l'Adolescent; Marie-Cecile Le Deley, Paris-Sud University, Le Kremlin-Bicêtre; Line Claude and Perrine Marec-Bérard, Centre Léon-Bérard, Lyon; Olivier Delattre and Jean Michon, Institut Curie, Paris, France; Douglas S. Hawkins, Seattle Children's Hospital, Seattle, WA; Douglas S. Hawkins, Mark L. Bernstein, and Richard B. Womer, Children's Oncology Group; Uta Dirksen and Heribert Juergens, University Hospital Münster, Münster; Uta Dirksen, Michael Paulussen, and Heribert Juergens, Gesellschaft für Pädiatrische Onkologie und Hämatologie; Michael Paulussen, Children's and Adolescents' Hospital, Witten/Herdecke University, Datteln, Germany; Ian J. Lewis, Alder Hey Children's National Health Service (NHS) Foundation Trust, Liverpool; Ian J. Lewis, Robert Grimer, Bernadette Brennan, and Alan W. Craft, Children's Cancer and Leukaemia Group; Robert Grimer, Royal Orthopaedic Hospital, Birmingham; Jeremy Whelan, University College London Hospital NHS Foundation Trust; Ian Judson, Royal Marsden Hospital, London; Bernadette Brennan, Royal Manchester Children's Hospital, Manchester; Alan W. Craft, Royal Victoria Infirmary, Newcastle, United Kingdom; Stefano Ferrari and Piero Picci, Rizzoli Institute, Bologna; Stefano Ferrari, Piero Picci, Roberto Luksch, Italian Sarcoma Group; Roberto Luksch, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Istituto Nazionale dei Tumori, Milan, Italy; Heinrich Kovar and Ruth Ladenstein, Children's Cancer Institute, St Anna Kinderkrebsforschung, Wien; Heinrich Kovar and Ruth Ladenstein, Arbeitsgemeinschaft Ambulant Tätiger Pädiatrischer Onkologen und Hämatologen, Vienna, Austria; Jeremy Whelan and Ian Judson, European O
| | - Jeremy Whelan
- Nathalie Gaspar, Marie-Cecile Le Deley, and Odile Oberlin, Institut Gustave Roussy, Villejuif; Nathalie Gaspar, Marie-Cecile Le Deley, Line Claude, Olivier Delattre, Jean Michon, Perrine Marec-Bérard, and Odile Oberlin, Société Française de Lutte Contre les Cancers et les Leucémies de l'Enfant et de l'Adolescent; Marie-Cecile Le Deley, Paris-Sud University, Le Kremlin-Bicêtre; Line Claude and Perrine Marec-Bérard, Centre Léon-Bérard, Lyon; Olivier Delattre and Jean Michon, Institut Curie, Paris, France; Douglas S. Hawkins, Seattle Children's Hospital, Seattle, WA; Douglas S. Hawkins, Mark L. Bernstein, and Richard B. Womer, Children's Oncology Group; Uta Dirksen and Heribert Juergens, University Hospital Münster, Münster; Uta Dirksen, Michael Paulussen, and Heribert Juergens, Gesellschaft für Pädiatrische Onkologie und Hämatologie; Michael Paulussen, Children's and Adolescents' Hospital, Witten/Herdecke University, Datteln, Germany; Ian J. Lewis, Alder Hey Children's National Health Service (NHS) Foundation Trust, Liverpool; Ian J. Lewis, Robert Grimer, Bernadette Brennan, and Alan W. Craft, Children's Cancer and Leukaemia Group; Robert Grimer, Royal Orthopaedic Hospital, Birmingham; Jeremy Whelan, University College London Hospital NHS Foundation Trust; Ian Judson, Royal Marsden Hospital, London; Bernadette Brennan, Royal Manchester Children's Hospital, Manchester; Alan W. Craft, Royal Victoria Infirmary, Newcastle, United Kingdom; Stefano Ferrari and Piero Picci, Rizzoli Institute, Bologna; Stefano Ferrari, Piero Picci, Roberto Luksch, Italian Sarcoma Group; Roberto Luksch, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Istituto Nazionale dei Tumori, Milan, Italy; Heinrich Kovar and Ruth Ladenstein, Children's Cancer Institute, St Anna Kinderkrebsforschung, Wien; Heinrich Kovar and Ruth Ladenstein, Arbeitsgemeinschaft Ambulant Tätiger Pädiatrischer Onkologen und Hämatologen, Vienna, Austria; Jeremy Whelan and Ian Judson, European O
| | - Line Claude
- Nathalie Gaspar, Marie-Cecile Le Deley, and Odile Oberlin, Institut Gustave Roussy, Villejuif; Nathalie Gaspar, Marie-Cecile Le Deley, Line Claude, Olivier Delattre, Jean Michon, Perrine Marec-Bérard, and Odile Oberlin, Société Française de Lutte Contre les Cancers et les Leucémies de l'Enfant et de l'Adolescent; Marie-Cecile Le Deley, Paris-Sud University, Le Kremlin-Bicêtre; Line Claude and Perrine Marec-Bérard, Centre Léon-Bérard, Lyon; Olivier Delattre and Jean Michon, Institut Curie, Paris, France; Douglas S. Hawkins, Seattle Children's Hospital, Seattle, WA; Douglas S. Hawkins, Mark L. Bernstein, and Richard B. Womer, Children's Oncology Group; Uta Dirksen and Heribert Juergens, University Hospital Münster, Münster; Uta Dirksen, Michael Paulussen, and Heribert Juergens, Gesellschaft für Pädiatrische Onkologie und Hämatologie; Michael Paulussen, Children's and Adolescents' Hospital, Witten/Herdecke University, Datteln, Germany; Ian J. Lewis, Alder Hey Children's National Health Service (NHS) Foundation Trust, Liverpool; Ian J. Lewis, Robert Grimer, Bernadette Brennan, and Alan W. Craft, Children's Cancer and Leukaemia Group; Robert Grimer, Royal Orthopaedic Hospital, Birmingham; Jeremy Whelan, University College London Hospital NHS Foundation Trust; Ian Judson, Royal Marsden Hospital, London; Bernadette Brennan, Royal Manchester Children's Hospital, Manchester; Alan W. Craft, Royal Victoria Infirmary, Newcastle, United Kingdom; Stefano Ferrari and Piero Picci, Rizzoli Institute, Bologna; Stefano Ferrari, Piero Picci, Roberto Luksch, Italian Sarcoma Group; Roberto Luksch, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Istituto Nazionale dei Tumori, Milan, Italy; Heinrich Kovar and Ruth Ladenstein, Children's Cancer Institute, St Anna Kinderkrebsforschung, Wien; Heinrich Kovar and Ruth Ladenstein, Arbeitsgemeinschaft Ambulant Tätiger Pädiatrischer Onkologen und Hämatologen, Vienna, Austria; Jeremy Whelan and Ian Judson, European O
| | - Olivier Delattre
- Nathalie Gaspar, Marie-Cecile Le Deley, and Odile Oberlin, Institut Gustave Roussy, Villejuif; Nathalie Gaspar, Marie-Cecile Le Deley, Line Claude, Olivier Delattre, Jean Michon, Perrine Marec-Bérard, and Odile Oberlin, Société Française de Lutte Contre les Cancers et les Leucémies de l'Enfant et de l'Adolescent; Marie-Cecile Le Deley, Paris-Sud University, Le Kremlin-Bicêtre; Line Claude and Perrine Marec-Bérard, Centre Léon-Bérard, Lyon; Olivier Delattre and Jean Michon, Institut Curie, Paris, France; Douglas S. Hawkins, Seattle Children's Hospital, Seattle, WA; Douglas S. Hawkins, Mark L. Bernstein, and Richard B. Womer, Children's Oncology Group; Uta Dirksen and Heribert Juergens, University Hospital Münster, Münster; Uta Dirksen, Michael Paulussen, and Heribert Juergens, Gesellschaft für Pädiatrische Onkologie und Hämatologie; Michael Paulussen, Children's and Adolescents' Hospital, Witten/Herdecke University, Datteln, Germany; Ian J. Lewis, Alder Hey Children's National Health Service (NHS) Foundation Trust, Liverpool; Ian J. Lewis, Robert Grimer, Bernadette Brennan, and Alan W. Craft, Children's Cancer and Leukaemia Group; Robert Grimer, Royal Orthopaedic Hospital, Birmingham; Jeremy Whelan, University College London Hospital NHS Foundation Trust; Ian Judson, Royal Marsden Hospital, London; Bernadette Brennan, Royal Manchester Children's Hospital, Manchester; Alan W. Craft, Royal Victoria Infirmary, Newcastle, United Kingdom; Stefano Ferrari and Piero Picci, Rizzoli Institute, Bologna; Stefano Ferrari, Piero Picci, Roberto Luksch, Italian Sarcoma Group; Roberto Luksch, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Istituto Nazionale dei Tumori, Milan, Italy; Heinrich Kovar and Ruth Ladenstein, Children's Cancer Institute, St Anna Kinderkrebsforschung, Wien; Heinrich Kovar and Ruth Ladenstein, Arbeitsgemeinschaft Ambulant Tätiger Pädiatrischer Onkologen und Hämatologen, Vienna, Austria; Jeremy Whelan and Ian Judson, European O
| | - Michael Paulussen
- Nathalie Gaspar, Marie-Cecile Le Deley, and Odile Oberlin, Institut Gustave Roussy, Villejuif; Nathalie Gaspar, Marie-Cecile Le Deley, Line Claude, Olivier Delattre, Jean Michon, Perrine Marec-Bérard, and Odile Oberlin, Société Française de Lutte Contre les Cancers et les Leucémies de l'Enfant et de l'Adolescent; Marie-Cecile Le Deley, Paris-Sud University, Le Kremlin-Bicêtre; Line Claude and Perrine Marec-Bérard, Centre Léon-Bérard, Lyon; Olivier Delattre and Jean Michon, Institut Curie, Paris, France; Douglas S. Hawkins, Seattle Children's Hospital, Seattle, WA; Douglas S. Hawkins, Mark L. Bernstein, and Richard B. Womer, Children's Oncology Group; Uta Dirksen and Heribert Juergens, University Hospital Münster, Münster; Uta Dirksen, Michael Paulussen, and Heribert Juergens, Gesellschaft für Pädiatrische Onkologie und Hämatologie; Michael Paulussen, Children's and Adolescents' Hospital, Witten/Herdecke University, Datteln, Germany; Ian J. Lewis, Alder Hey Children's National Health Service (NHS) Foundation Trust, Liverpool; Ian J. Lewis, Robert Grimer, Bernadette Brennan, and Alan W. Craft, Children's Cancer and Leukaemia Group; Robert Grimer, Royal Orthopaedic Hospital, Birmingham; Jeremy Whelan, University College London Hospital NHS Foundation Trust; Ian Judson, Royal Marsden Hospital, London; Bernadette Brennan, Royal Manchester Children's Hospital, Manchester; Alan W. Craft, Royal Victoria Infirmary, Newcastle, United Kingdom; Stefano Ferrari and Piero Picci, Rizzoli Institute, Bologna; Stefano Ferrari, Piero Picci, Roberto Luksch, Italian Sarcoma Group; Roberto Luksch, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Istituto Nazionale dei Tumori, Milan, Italy; Heinrich Kovar and Ruth Ladenstein, Children's Cancer Institute, St Anna Kinderkrebsforschung, Wien; Heinrich Kovar and Ruth Ladenstein, Arbeitsgemeinschaft Ambulant Tätiger Pädiatrischer Onkologen und Hämatologen, Vienna, Austria; Jeremy Whelan and Ian Judson, European O
| | - Piero Picci
- Nathalie Gaspar, Marie-Cecile Le Deley, and Odile Oberlin, Institut Gustave Roussy, Villejuif; Nathalie Gaspar, Marie-Cecile Le Deley, Line Claude, Olivier Delattre, Jean Michon, Perrine Marec-Bérard, and Odile Oberlin, Société Française de Lutte Contre les Cancers et les Leucémies de l'Enfant et de l'Adolescent; Marie-Cecile Le Deley, Paris-Sud University, Le Kremlin-Bicêtre; Line Claude and Perrine Marec-Bérard, Centre Léon-Bérard, Lyon; Olivier Delattre and Jean Michon, Institut Curie, Paris, France; Douglas S. Hawkins, Seattle Children's Hospital, Seattle, WA; Douglas S. Hawkins, Mark L. Bernstein, and Richard B. Womer, Children's Oncology Group; Uta Dirksen and Heribert Juergens, University Hospital Münster, Münster; Uta Dirksen, Michael Paulussen, and Heribert Juergens, Gesellschaft für Pädiatrische Onkologie und Hämatologie; Michael Paulussen, Children's and Adolescents' Hospital, Witten/Herdecke University, Datteln, Germany; Ian J. Lewis, Alder Hey Children's National Health Service (NHS) Foundation Trust, Liverpool; Ian J. Lewis, Robert Grimer, Bernadette Brennan, and Alan W. Craft, Children's Cancer and Leukaemia Group; Robert Grimer, Royal Orthopaedic Hospital, Birmingham; Jeremy Whelan, University College London Hospital NHS Foundation Trust; Ian Judson, Royal Marsden Hospital, London; Bernadette Brennan, Royal Manchester Children's Hospital, Manchester; Alan W. Craft, Royal Victoria Infirmary, Newcastle, United Kingdom; Stefano Ferrari and Piero Picci, Rizzoli Institute, Bologna; Stefano Ferrari, Piero Picci, Roberto Luksch, Italian Sarcoma Group; Roberto Luksch, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Istituto Nazionale dei Tumori, Milan, Italy; Heinrich Kovar and Ruth Ladenstein, Children's Cancer Institute, St Anna Kinderkrebsforschung, Wien; Heinrich Kovar and Ruth Ladenstein, Arbeitsgemeinschaft Ambulant Tätiger Pädiatrischer Onkologen und Hämatologen, Vienna, Austria; Jeremy Whelan and Ian Judson, European O
| | - Kirsten Sundby Hall
- Nathalie Gaspar, Marie-Cecile Le Deley, and Odile Oberlin, Institut Gustave Roussy, Villejuif; Nathalie Gaspar, Marie-Cecile Le Deley, Line Claude, Olivier Delattre, Jean Michon, Perrine Marec-Bérard, and Odile Oberlin, Société Française de Lutte Contre les Cancers et les Leucémies de l'Enfant et de l'Adolescent; Marie-Cecile Le Deley, Paris-Sud University, Le Kremlin-Bicêtre; Line Claude and Perrine Marec-Bérard, Centre Léon-Bérard, Lyon; Olivier Delattre and Jean Michon, Institut Curie, Paris, France; Douglas S. Hawkins, Seattle Children's Hospital, Seattle, WA; Douglas S. Hawkins, Mark L. Bernstein, and Richard B. Womer, Children's Oncology Group; Uta Dirksen and Heribert Juergens, University Hospital Münster, Münster; Uta Dirksen, Michael Paulussen, and Heribert Juergens, Gesellschaft für Pädiatrische Onkologie und Hämatologie; Michael Paulussen, Children's and Adolescents' Hospital, Witten/Herdecke University, Datteln, Germany; Ian J. Lewis, Alder Hey Children's National Health Service (NHS) Foundation Trust, Liverpool; Ian J. Lewis, Robert Grimer, Bernadette Brennan, and Alan W. Craft, Children's Cancer and Leukaemia Group; Robert Grimer, Royal Orthopaedic Hospital, Birmingham; Jeremy Whelan, University College London Hospital NHS Foundation Trust; Ian Judson, Royal Marsden Hospital, London; Bernadette Brennan, Royal Manchester Children's Hospital, Manchester; Alan W. Craft, Royal Victoria Infirmary, Newcastle, United Kingdom; Stefano Ferrari and Piero Picci, Rizzoli Institute, Bologna; Stefano Ferrari, Piero Picci, Roberto Luksch, Italian Sarcoma Group; Roberto Luksch, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Istituto Nazionale dei Tumori, Milan, Italy; Heinrich Kovar and Ruth Ladenstein, Children's Cancer Institute, St Anna Kinderkrebsforschung, Wien; Heinrich Kovar and Ruth Ladenstein, Arbeitsgemeinschaft Ambulant Tätiger Pädiatrischer Onkologen und Hämatologen, Vienna, Austria; Jeremy Whelan and Ian Judson, European O
| | - Hendrik van den Berg
- Nathalie Gaspar, Marie-Cecile Le Deley, and Odile Oberlin, Institut Gustave Roussy, Villejuif; Nathalie Gaspar, Marie-Cecile Le Deley, Line Claude, Olivier Delattre, Jean Michon, Perrine Marec-Bérard, and Odile Oberlin, Société Française de Lutte Contre les Cancers et les Leucémies de l'Enfant et de l'Adolescent; Marie-Cecile Le Deley, Paris-Sud University, Le Kremlin-Bicêtre; Line Claude and Perrine Marec-Bérard, Centre Léon-Bérard, Lyon; Olivier Delattre and Jean Michon, Institut Curie, Paris, France; Douglas S. Hawkins, Seattle Children's Hospital, Seattle, WA; Douglas S. Hawkins, Mark L. Bernstein, and Richard B. Womer, Children's Oncology Group; Uta Dirksen and Heribert Juergens, University Hospital Münster, Münster; Uta Dirksen, Michael Paulussen, and Heribert Juergens, Gesellschaft für Pädiatrische Onkologie und Hämatologie; Michael Paulussen, Children's and Adolescents' Hospital, Witten/Herdecke University, Datteln, Germany; Ian J. Lewis, Alder Hey Children's National Health Service (NHS) Foundation Trust, Liverpool; Ian J. Lewis, Robert Grimer, Bernadette Brennan, and Alan W. Craft, Children's Cancer and Leukaemia Group; Robert Grimer, Royal Orthopaedic Hospital, Birmingham; Jeremy Whelan, University College London Hospital NHS Foundation Trust; Ian Judson, Royal Marsden Hospital, London; Bernadette Brennan, Royal Manchester Children's Hospital, Manchester; Alan W. Craft, Royal Victoria Infirmary, Newcastle, United Kingdom; Stefano Ferrari and Piero Picci, Rizzoli Institute, Bologna; Stefano Ferrari, Piero Picci, Roberto Luksch, Italian Sarcoma Group; Roberto Luksch, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Istituto Nazionale dei Tumori, Milan, Italy; Heinrich Kovar and Ruth Ladenstein, Children's Cancer Institute, St Anna Kinderkrebsforschung, Wien; Heinrich Kovar and Ruth Ladenstein, Arbeitsgemeinschaft Ambulant Tätiger Pädiatrischer Onkologen und Hämatologen, Vienna, Austria; Jeremy Whelan and Ian Judson, European O
| | - Ruth Ladenstein
- Nathalie Gaspar, Marie-Cecile Le Deley, and Odile Oberlin, Institut Gustave Roussy, Villejuif; Nathalie Gaspar, Marie-Cecile Le Deley, Line Claude, Olivier Delattre, Jean Michon, Perrine Marec-Bérard, and Odile Oberlin, Société Française de Lutte Contre les Cancers et les Leucémies de l'Enfant et de l'Adolescent; Marie-Cecile Le Deley, Paris-Sud University, Le Kremlin-Bicêtre; Line Claude and Perrine Marec-Bérard, Centre Léon-Bérard, Lyon; Olivier Delattre and Jean Michon, Institut Curie, Paris, France; Douglas S. Hawkins, Seattle Children's Hospital, Seattle, WA; Douglas S. Hawkins, Mark L. Bernstein, and Richard B. Womer, Children's Oncology Group; Uta Dirksen and Heribert Juergens, University Hospital Münster, Münster; Uta Dirksen, Michael Paulussen, and Heribert Juergens, Gesellschaft für Pädiatrische Onkologie und Hämatologie; Michael Paulussen, Children's and Adolescents' Hospital, Witten/Herdecke University, Datteln, Germany; Ian J. Lewis, Alder Hey Children's National Health Service (NHS) Foundation Trust, Liverpool; Ian J. Lewis, Robert Grimer, Bernadette Brennan, and Alan W. Craft, Children's Cancer and Leukaemia Group; Robert Grimer, Royal Orthopaedic Hospital, Birmingham; Jeremy Whelan, University College London Hospital NHS Foundation Trust; Ian Judson, Royal Marsden Hospital, London; Bernadette Brennan, Royal Manchester Children's Hospital, Manchester; Alan W. Craft, Royal Victoria Infirmary, Newcastle, United Kingdom; Stefano Ferrari and Piero Picci, Rizzoli Institute, Bologna; Stefano Ferrari, Piero Picci, Roberto Luksch, Italian Sarcoma Group; Roberto Luksch, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Istituto Nazionale dei Tumori, Milan, Italy; Heinrich Kovar and Ruth Ladenstein, Children's Cancer Institute, St Anna Kinderkrebsforschung, Wien; Heinrich Kovar and Ruth Ladenstein, Arbeitsgemeinschaft Ambulant Tätiger Pädiatrischer Onkologen und Hämatologen, Vienna, Austria; Jeremy Whelan and Ian Judson, European O
| | - Jean Michon
- Nathalie Gaspar, Marie-Cecile Le Deley, and Odile Oberlin, Institut Gustave Roussy, Villejuif; Nathalie Gaspar, Marie-Cecile Le Deley, Line Claude, Olivier Delattre, Jean Michon, Perrine Marec-Bérard, and Odile Oberlin, Société Française de Lutte Contre les Cancers et les Leucémies de l'Enfant et de l'Adolescent; Marie-Cecile Le Deley, Paris-Sud University, Le Kremlin-Bicêtre; Line Claude and Perrine Marec-Bérard, Centre Léon-Bérard, Lyon; Olivier Delattre and Jean Michon, Institut Curie, Paris, France; Douglas S. Hawkins, Seattle Children's Hospital, Seattle, WA; Douglas S. Hawkins, Mark L. Bernstein, and Richard B. Womer, Children's Oncology Group; Uta Dirksen and Heribert Juergens, University Hospital Münster, Münster; Uta Dirksen, Michael Paulussen, and Heribert Juergens, Gesellschaft für Pädiatrische Onkologie und Hämatologie; Michael Paulussen, Children's and Adolescents' Hospital, Witten/Herdecke University, Datteln, Germany; Ian J. Lewis, Alder Hey Children's National Health Service (NHS) Foundation Trust, Liverpool; Ian J. Lewis, Robert Grimer, Bernadette Brennan, and Alan W. Craft, Children's Cancer and Leukaemia Group; Robert Grimer, Royal Orthopaedic Hospital, Birmingham; Jeremy Whelan, University College London Hospital NHS Foundation Trust; Ian Judson, Royal Marsden Hospital, London; Bernadette Brennan, Royal Manchester Children's Hospital, Manchester; Alan W. Craft, Royal Victoria Infirmary, Newcastle, United Kingdom; Stefano Ferrari and Piero Picci, Rizzoli Institute, Bologna; Stefano Ferrari, Piero Picci, Roberto Luksch, Italian Sarcoma Group; Roberto Luksch, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Istituto Nazionale dei Tumori, Milan, Italy; Heinrich Kovar and Ruth Ladenstein, Children's Cancer Institute, St Anna Kinderkrebsforschung, Wien; Heinrich Kovar and Ruth Ladenstein, Arbeitsgemeinschaft Ambulant Tätiger Pädiatrischer Onkologen und Hämatologen, Vienna, Austria; Jeremy Whelan and Ian Judson, European O
| | - Lars Hjorth
- Nathalie Gaspar, Marie-Cecile Le Deley, and Odile Oberlin, Institut Gustave Roussy, Villejuif; Nathalie Gaspar, Marie-Cecile Le Deley, Line Claude, Olivier Delattre, Jean Michon, Perrine Marec-Bérard, and Odile Oberlin, Société Française de Lutte Contre les Cancers et les Leucémies de l'Enfant et de l'Adolescent; Marie-Cecile Le Deley, Paris-Sud University, Le Kremlin-Bicêtre; Line Claude and Perrine Marec-Bérard, Centre Léon-Bérard, Lyon; Olivier Delattre and Jean Michon, Institut Curie, Paris, France; Douglas S. Hawkins, Seattle Children's Hospital, Seattle, WA; Douglas S. Hawkins, Mark L. Bernstein, and Richard B. Womer, Children's Oncology Group; Uta Dirksen and Heribert Juergens, University Hospital Münster, Münster; Uta Dirksen, Michael Paulussen, and Heribert Juergens, Gesellschaft für Pädiatrische Onkologie und Hämatologie; Michael Paulussen, Children's and Adolescents' Hospital, Witten/Herdecke University, Datteln, Germany; Ian J. Lewis, Alder Hey Children's National Health Service (NHS) Foundation Trust, Liverpool; Ian J. Lewis, Robert Grimer, Bernadette Brennan, and Alan W. Craft, Children's Cancer and Leukaemia Group; Robert Grimer, Royal Orthopaedic Hospital, Birmingham; Jeremy Whelan, University College London Hospital NHS Foundation Trust; Ian Judson, Royal Marsden Hospital, London; Bernadette Brennan, Royal Manchester Children's Hospital, Manchester; Alan W. Craft, Royal Victoria Infirmary, Newcastle, United Kingdom; Stefano Ferrari and Piero Picci, Rizzoli Institute, Bologna; Stefano Ferrari, Piero Picci, Roberto Luksch, Italian Sarcoma Group; Roberto Luksch, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Istituto Nazionale dei Tumori, Milan, Italy; Heinrich Kovar and Ruth Ladenstein, Children's Cancer Institute, St Anna Kinderkrebsforschung, Wien; Heinrich Kovar and Ruth Ladenstein, Arbeitsgemeinschaft Ambulant Tätiger Pädiatrischer Onkologen und Hämatologen, Vienna, Austria; Jeremy Whelan and Ian Judson, European O
| | - Ian Judson
- Nathalie Gaspar, Marie-Cecile Le Deley, and Odile Oberlin, Institut Gustave Roussy, Villejuif; Nathalie Gaspar, Marie-Cecile Le Deley, Line Claude, Olivier Delattre, Jean Michon, Perrine Marec-Bérard, and Odile Oberlin, Société Française de Lutte Contre les Cancers et les Leucémies de l'Enfant et de l'Adolescent; Marie-Cecile Le Deley, Paris-Sud University, Le Kremlin-Bicêtre; Line Claude and Perrine Marec-Bérard, Centre Léon-Bérard, Lyon; Olivier Delattre and Jean Michon, Institut Curie, Paris, France; Douglas S. Hawkins, Seattle Children's Hospital, Seattle, WA; Douglas S. Hawkins, Mark L. Bernstein, and Richard B. Womer, Children's Oncology Group; Uta Dirksen and Heribert Juergens, University Hospital Münster, Münster; Uta Dirksen, Michael Paulussen, and Heribert Juergens, Gesellschaft für Pädiatrische Onkologie und Hämatologie; Michael Paulussen, Children's and Adolescents' Hospital, Witten/Herdecke University, Datteln, Germany; Ian J. Lewis, Alder Hey Children's National Health Service (NHS) Foundation Trust, Liverpool; Ian J. Lewis, Robert Grimer, Bernadette Brennan, and Alan W. Craft, Children's Cancer and Leukaemia Group; Robert Grimer, Royal Orthopaedic Hospital, Birmingham; Jeremy Whelan, University College London Hospital NHS Foundation Trust; Ian Judson, Royal Marsden Hospital, London; Bernadette Brennan, Royal Manchester Children's Hospital, Manchester; Alan W. Craft, Royal Victoria Infirmary, Newcastle, United Kingdom; Stefano Ferrari and Piero Picci, Rizzoli Institute, Bologna; Stefano Ferrari, Piero Picci, Roberto Luksch, Italian Sarcoma Group; Roberto Luksch, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Istituto Nazionale dei Tumori, Milan, Italy; Heinrich Kovar and Ruth Ladenstein, Children's Cancer Institute, St Anna Kinderkrebsforschung, Wien; Heinrich Kovar and Ruth Ladenstein, Arbeitsgemeinschaft Ambulant Tätiger Pädiatrischer Onkologen und Hämatologen, Vienna, Austria; Jeremy Whelan and Ian Judson, European O
| | - Roberto Luksch
- Nathalie Gaspar, Marie-Cecile Le Deley, and Odile Oberlin, Institut Gustave Roussy, Villejuif; Nathalie Gaspar, Marie-Cecile Le Deley, Line Claude, Olivier Delattre, Jean Michon, Perrine Marec-Bérard, and Odile Oberlin, Société Française de Lutte Contre les Cancers et les Leucémies de l'Enfant et de l'Adolescent; Marie-Cecile Le Deley, Paris-Sud University, Le Kremlin-Bicêtre; Line Claude and Perrine Marec-Bérard, Centre Léon-Bérard, Lyon; Olivier Delattre and Jean Michon, Institut Curie, Paris, France; Douglas S. Hawkins, Seattle Children's Hospital, Seattle, WA; Douglas S. Hawkins, Mark L. Bernstein, and Richard B. Womer, Children's Oncology Group; Uta Dirksen and Heribert Juergens, University Hospital Münster, Münster; Uta Dirksen, Michael Paulussen, and Heribert Juergens, Gesellschaft für Pädiatrische Onkologie und Hämatologie; Michael Paulussen, Children's and Adolescents' Hospital, Witten/Herdecke University, Datteln, Germany; Ian J. Lewis, Alder Hey Children's National Health Service (NHS) Foundation Trust, Liverpool; Ian J. Lewis, Robert Grimer, Bernadette Brennan, and Alan W. Craft, Children's Cancer and Leukaemia Group; Robert Grimer, Royal Orthopaedic Hospital, Birmingham; Jeremy Whelan, University College London Hospital NHS Foundation Trust; Ian Judson, Royal Marsden Hospital, London; Bernadette Brennan, Royal Manchester Children's Hospital, Manchester; Alan W. Craft, Royal Victoria Infirmary, Newcastle, United Kingdom; Stefano Ferrari and Piero Picci, Rizzoli Institute, Bologna; Stefano Ferrari, Piero Picci, Roberto Luksch, Italian Sarcoma Group; Roberto Luksch, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Istituto Nazionale dei Tumori, Milan, Italy; Heinrich Kovar and Ruth Ladenstein, Children's Cancer Institute, St Anna Kinderkrebsforschung, Wien; Heinrich Kovar and Ruth Ladenstein, Arbeitsgemeinschaft Ambulant Tätiger Pädiatrischer Onkologen und Hämatologen, Vienna, Austria; Jeremy Whelan and Ian Judson, European O
| | - Mark L Bernstein
- Nathalie Gaspar, Marie-Cecile Le Deley, and Odile Oberlin, Institut Gustave Roussy, Villejuif; Nathalie Gaspar, Marie-Cecile Le Deley, Line Claude, Olivier Delattre, Jean Michon, Perrine Marec-Bérard, and Odile Oberlin, Société Française de Lutte Contre les Cancers et les Leucémies de l'Enfant et de l'Adolescent; Marie-Cecile Le Deley, Paris-Sud University, Le Kremlin-Bicêtre; Line Claude and Perrine Marec-Bérard, Centre Léon-Bérard, Lyon; Olivier Delattre and Jean Michon, Institut Curie, Paris, France; Douglas S. Hawkins, Seattle Children's Hospital, Seattle, WA; Douglas S. Hawkins, Mark L. Bernstein, and Richard B. Womer, Children's Oncology Group; Uta Dirksen and Heribert Juergens, University Hospital Münster, Münster; Uta Dirksen, Michael Paulussen, and Heribert Juergens, Gesellschaft für Pädiatrische Onkologie und Hämatologie; Michael Paulussen, Children's and Adolescents' Hospital, Witten/Herdecke University, Datteln, Germany; Ian J. Lewis, Alder Hey Children's National Health Service (NHS) Foundation Trust, Liverpool; Ian J. Lewis, Robert Grimer, Bernadette Brennan, and Alan W. Craft, Children's Cancer and Leukaemia Group; Robert Grimer, Royal Orthopaedic Hospital, Birmingham; Jeremy Whelan, University College London Hospital NHS Foundation Trust; Ian Judson, Royal Marsden Hospital, London; Bernadette Brennan, Royal Manchester Children's Hospital, Manchester; Alan W. Craft, Royal Victoria Infirmary, Newcastle, United Kingdom; Stefano Ferrari and Piero Picci, Rizzoli Institute, Bologna; Stefano Ferrari, Piero Picci, Roberto Luksch, Italian Sarcoma Group; Roberto Luksch, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Istituto Nazionale dei Tumori, Milan, Italy; Heinrich Kovar and Ruth Ladenstein, Children's Cancer Institute, St Anna Kinderkrebsforschung, Wien; Heinrich Kovar and Ruth Ladenstein, Arbeitsgemeinschaft Ambulant Tätiger Pädiatrischer Onkologen und Hämatologen, Vienna, Austria; Jeremy Whelan and Ian Judson, European O
| | - Perrine Marec-Bérard
- Nathalie Gaspar, Marie-Cecile Le Deley, and Odile Oberlin, Institut Gustave Roussy, Villejuif; Nathalie Gaspar, Marie-Cecile Le Deley, Line Claude, Olivier Delattre, Jean Michon, Perrine Marec-Bérard, and Odile Oberlin, Société Française de Lutte Contre les Cancers et les Leucémies de l'Enfant et de l'Adolescent; Marie-Cecile Le Deley, Paris-Sud University, Le Kremlin-Bicêtre; Line Claude and Perrine Marec-Bérard, Centre Léon-Bérard, Lyon; Olivier Delattre and Jean Michon, Institut Curie, Paris, France; Douglas S. Hawkins, Seattle Children's Hospital, Seattle, WA; Douglas S. Hawkins, Mark L. Bernstein, and Richard B. Womer, Children's Oncology Group; Uta Dirksen and Heribert Juergens, University Hospital Münster, Münster; Uta Dirksen, Michael Paulussen, and Heribert Juergens, Gesellschaft für Pädiatrische Onkologie und Hämatologie; Michael Paulussen, Children's and Adolescents' Hospital, Witten/Herdecke University, Datteln, Germany; Ian J. Lewis, Alder Hey Children's National Health Service (NHS) Foundation Trust, Liverpool; Ian J. Lewis, Robert Grimer, Bernadette Brennan, and Alan W. Craft, Children's Cancer and Leukaemia Group; Robert Grimer, Royal Orthopaedic Hospital, Birmingham; Jeremy Whelan, University College London Hospital NHS Foundation Trust; Ian Judson, Royal Marsden Hospital, London; Bernadette Brennan, Royal Manchester Children's Hospital, Manchester; Alan W. Craft, Royal Victoria Infirmary, Newcastle, United Kingdom; Stefano Ferrari and Piero Picci, Rizzoli Institute, Bologna; Stefano Ferrari, Piero Picci, Roberto Luksch, Italian Sarcoma Group; Roberto Luksch, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Istituto Nazionale dei Tumori, Milan, Italy; Heinrich Kovar and Ruth Ladenstein, Children's Cancer Institute, St Anna Kinderkrebsforschung, Wien; Heinrich Kovar and Ruth Ladenstein, Arbeitsgemeinschaft Ambulant Tätiger Pädiatrischer Onkologen und Hämatologen, Vienna, Austria; Jeremy Whelan and Ian Judson, European O
| | - Bernadette Brennan
- Nathalie Gaspar, Marie-Cecile Le Deley, and Odile Oberlin, Institut Gustave Roussy, Villejuif; Nathalie Gaspar, Marie-Cecile Le Deley, Line Claude, Olivier Delattre, Jean Michon, Perrine Marec-Bérard, and Odile Oberlin, Société Française de Lutte Contre les Cancers et les Leucémies de l'Enfant et de l'Adolescent; Marie-Cecile Le Deley, Paris-Sud University, Le Kremlin-Bicêtre; Line Claude and Perrine Marec-Bérard, Centre Léon-Bérard, Lyon; Olivier Delattre and Jean Michon, Institut Curie, Paris, France; Douglas S. Hawkins, Seattle Children's Hospital, Seattle, WA; Douglas S. Hawkins, Mark L. Bernstein, and Richard B. Womer, Children's Oncology Group; Uta Dirksen and Heribert Juergens, University Hospital Münster, Münster; Uta Dirksen, Michael Paulussen, and Heribert Juergens, Gesellschaft für Pädiatrische Onkologie und Hämatologie; Michael Paulussen, Children's and Adolescents' Hospital, Witten/Herdecke University, Datteln, Germany; Ian J. Lewis, Alder Hey Children's National Health Service (NHS) Foundation Trust, Liverpool; Ian J. Lewis, Robert Grimer, Bernadette Brennan, and Alan W. Craft, Children's Cancer and Leukaemia Group; Robert Grimer, Royal Orthopaedic Hospital, Birmingham; Jeremy Whelan, University College London Hospital NHS Foundation Trust; Ian Judson, Royal Marsden Hospital, London; Bernadette Brennan, Royal Manchester Children's Hospital, Manchester; Alan W. Craft, Royal Victoria Infirmary, Newcastle, United Kingdom; Stefano Ferrari and Piero Picci, Rizzoli Institute, Bologna; Stefano Ferrari, Piero Picci, Roberto Luksch, Italian Sarcoma Group; Roberto Luksch, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Istituto Nazionale dei Tumori, Milan, Italy; Heinrich Kovar and Ruth Ladenstein, Children's Cancer Institute, St Anna Kinderkrebsforschung, Wien; Heinrich Kovar and Ruth Ladenstein, Arbeitsgemeinschaft Ambulant Tätiger Pädiatrischer Onkologen und Hämatologen, Vienna, Austria; Jeremy Whelan and Ian Judson, European O
| | - Alan W Craft
- Nathalie Gaspar, Marie-Cecile Le Deley, and Odile Oberlin, Institut Gustave Roussy, Villejuif; Nathalie Gaspar, Marie-Cecile Le Deley, Line Claude, Olivier Delattre, Jean Michon, Perrine Marec-Bérard, and Odile Oberlin, Société Française de Lutte Contre les Cancers et les Leucémies de l'Enfant et de l'Adolescent; Marie-Cecile Le Deley, Paris-Sud University, Le Kremlin-Bicêtre; Line Claude and Perrine Marec-Bérard, Centre Léon-Bérard, Lyon; Olivier Delattre and Jean Michon, Institut Curie, Paris, France; Douglas S. Hawkins, Seattle Children's Hospital, Seattle, WA; Douglas S. Hawkins, Mark L. Bernstein, and Richard B. Womer, Children's Oncology Group; Uta Dirksen and Heribert Juergens, University Hospital Münster, Münster; Uta Dirksen, Michael Paulussen, and Heribert Juergens, Gesellschaft für Pädiatrische Onkologie und Hämatologie; Michael Paulussen, Children's and Adolescents' Hospital, Witten/Herdecke University, Datteln, Germany; Ian J. Lewis, Alder Hey Children's National Health Service (NHS) Foundation Trust, Liverpool; Ian J. Lewis, Robert Grimer, Bernadette Brennan, and Alan W. Craft, Children's Cancer and Leukaemia Group; Robert Grimer, Royal Orthopaedic Hospital, Birmingham; Jeremy Whelan, University College London Hospital NHS Foundation Trust; Ian Judson, Royal Marsden Hospital, London; Bernadette Brennan, Royal Manchester Children's Hospital, Manchester; Alan W. Craft, Royal Victoria Infirmary, Newcastle, United Kingdom; Stefano Ferrari and Piero Picci, Rizzoli Institute, Bologna; Stefano Ferrari, Piero Picci, Roberto Luksch, Italian Sarcoma Group; Roberto Luksch, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Istituto Nazionale dei Tumori, Milan, Italy; Heinrich Kovar and Ruth Ladenstein, Children's Cancer Institute, St Anna Kinderkrebsforschung, Wien; Heinrich Kovar and Ruth Ladenstein, Arbeitsgemeinschaft Ambulant Tätiger Pädiatrischer Onkologen und Hämatologen, Vienna, Austria; Jeremy Whelan and Ian Judson, European O
| | - Richard B Womer
- Nathalie Gaspar, Marie-Cecile Le Deley, and Odile Oberlin, Institut Gustave Roussy, Villejuif; Nathalie Gaspar, Marie-Cecile Le Deley, Line Claude, Olivier Delattre, Jean Michon, Perrine Marec-Bérard, and Odile Oberlin, Société Française de Lutte Contre les Cancers et les Leucémies de l'Enfant et de l'Adolescent; Marie-Cecile Le Deley, Paris-Sud University, Le Kremlin-Bicêtre; Line Claude and Perrine Marec-Bérard, Centre Léon-Bérard, Lyon; Olivier Delattre and Jean Michon, Institut Curie, Paris, France; Douglas S. Hawkins, Seattle Children's Hospital, Seattle, WA; Douglas S. Hawkins, Mark L. Bernstein, and Richard B. Womer, Children's Oncology Group; Uta Dirksen and Heribert Juergens, University Hospital Münster, Münster; Uta Dirksen, Michael Paulussen, and Heribert Juergens, Gesellschaft für Pädiatrische Onkologie und Hämatologie; Michael Paulussen, Children's and Adolescents' Hospital, Witten/Herdecke University, Datteln, Germany; Ian J. Lewis, Alder Hey Children's National Health Service (NHS) Foundation Trust, Liverpool; Ian J. Lewis, Robert Grimer, Bernadette Brennan, and Alan W. Craft, Children's Cancer and Leukaemia Group; Robert Grimer, Royal Orthopaedic Hospital, Birmingham; Jeremy Whelan, University College London Hospital NHS Foundation Trust; Ian Judson, Royal Marsden Hospital, London; Bernadette Brennan, Royal Manchester Children's Hospital, Manchester; Alan W. Craft, Royal Victoria Infirmary, Newcastle, United Kingdom; Stefano Ferrari and Piero Picci, Rizzoli Institute, Bologna; Stefano Ferrari, Piero Picci, Roberto Luksch, Italian Sarcoma Group; Roberto Luksch, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Istituto Nazionale dei Tumori, Milan, Italy; Heinrich Kovar and Ruth Ladenstein, Children's Cancer Institute, St Anna Kinderkrebsforschung, Wien; Heinrich Kovar and Ruth Ladenstein, Arbeitsgemeinschaft Ambulant Tätiger Pädiatrischer Onkologen und Hämatologen, Vienna, Austria; Jeremy Whelan and Ian Judson, European O
| | - Heribert Juergens
- Nathalie Gaspar, Marie-Cecile Le Deley, and Odile Oberlin, Institut Gustave Roussy, Villejuif; Nathalie Gaspar, Marie-Cecile Le Deley, Line Claude, Olivier Delattre, Jean Michon, Perrine Marec-Bérard, and Odile Oberlin, Société Française de Lutte Contre les Cancers et les Leucémies de l'Enfant et de l'Adolescent; Marie-Cecile Le Deley, Paris-Sud University, Le Kremlin-Bicêtre; Line Claude and Perrine Marec-Bérard, Centre Léon-Bérard, Lyon; Olivier Delattre and Jean Michon, Institut Curie, Paris, France; Douglas S. Hawkins, Seattle Children's Hospital, Seattle, WA; Douglas S. Hawkins, Mark L. Bernstein, and Richard B. Womer, Children's Oncology Group; Uta Dirksen and Heribert Juergens, University Hospital Münster, Münster; Uta Dirksen, Michael Paulussen, and Heribert Juergens, Gesellschaft für Pädiatrische Onkologie und Hämatologie; Michael Paulussen, Children's and Adolescents' Hospital, Witten/Herdecke University, Datteln, Germany; Ian J. Lewis, Alder Hey Children's National Health Service (NHS) Foundation Trust, Liverpool; Ian J. Lewis, Robert Grimer, Bernadette Brennan, and Alan W. Craft, Children's Cancer and Leukaemia Group; Robert Grimer, Royal Orthopaedic Hospital, Birmingham; Jeremy Whelan, University College London Hospital NHS Foundation Trust; Ian Judson, Royal Marsden Hospital, London; Bernadette Brennan, Royal Manchester Children's Hospital, Manchester; Alan W. Craft, Royal Victoria Infirmary, Newcastle, United Kingdom; Stefano Ferrari and Piero Picci, Rizzoli Institute, Bologna; Stefano Ferrari, Piero Picci, Roberto Luksch, Italian Sarcoma Group; Roberto Luksch, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Istituto Nazionale dei Tumori, Milan, Italy; Heinrich Kovar and Ruth Ladenstein, Children's Cancer Institute, St Anna Kinderkrebsforschung, Wien; Heinrich Kovar and Ruth Ladenstein, Arbeitsgemeinschaft Ambulant Tätiger Pädiatrischer Onkologen und Hämatologen, Vienna, Austria; Jeremy Whelan and Ian Judson, European O
| | - Odile Oberlin
- Nathalie Gaspar, Marie-Cecile Le Deley, and Odile Oberlin, Institut Gustave Roussy, Villejuif; Nathalie Gaspar, Marie-Cecile Le Deley, Line Claude, Olivier Delattre, Jean Michon, Perrine Marec-Bérard, and Odile Oberlin, Société Française de Lutte Contre les Cancers et les Leucémies de l'Enfant et de l'Adolescent; Marie-Cecile Le Deley, Paris-Sud University, Le Kremlin-Bicêtre; Line Claude and Perrine Marec-Bérard, Centre Léon-Bérard, Lyon; Olivier Delattre and Jean Michon, Institut Curie, Paris, France; Douglas S. Hawkins, Seattle Children's Hospital, Seattle, WA; Douglas S. Hawkins, Mark L. Bernstein, and Richard B. Womer, Children's Oncology Group; Uta Dirksen and Heribert Juergens, University Hospital Münster, Münster; Uta Dirksen, Michael Paulussen, and Heribert Juergens, Gesellschaft für Pädiatrische Onkologie und Hämatologie; Michael Paulussen, Children's and Adolescents' Hospital, Witten/Herdecke University, Datteln, Germany; Ian J. Lewis, Alder Hey Children's National Health Service (NHS) Foundation Trust, Liverpool; Ian J. Lewis, Robert Grimer, Bernadette Brennan, and Alan W. Craft, Children's Cancer and Leukaemia Group; Robert Grimer, Royal Orthopaedic Hospital, Birmingham; Jeremy Whelan, University College London Hospital NHS Foundation Trust; Ian Judson, Royal Marsden Hospital, London; Bernadette Brennan, Royal Manchester Children's Hospital, Manchester; Alan W. Craft, Royal Victoria Infirmary, Newcastle, United Kingdom; Stefano Ferrari and Piero Picci, Rizzoli Institute, Bologna; Stefano Ferrari, Piero Picci, Roberto Luksch, Italian Sarcoma Group; Roberto Luksch, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Istituto Nazionale dei Tumori, Milan, Italy; Heinrich Kovar and Ruth Ladenstein, Children's Cancer Institute, St Anna Kinderkrebsforschung, Wien; Heinrich Kovar and Ruth Ladenstein, Arbeitsgemeinschaft Ambulant Tätiger Pädiatrischer Onkologen und Hämatologen, Vienna, Austria; Jeremy Whelan and Ian Judson, European O
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Le Deley MC, Paulussen M, Lewis I, Brennan B, Ranft A, Whelan J, Le Teuff G, Michon J, Ladenstein R, Marec-Bérard P, van den Berg H, Hjorth L, Wheatley K, Judson I, Juergens H, Craft A, Oberlin O, Dirksen U. Cyclophosphamide compared with ifosfamide in consolidation treatment of standard-risk Ewing sarcoma: results of the randomized noninferiority Euro-EWING99-R1 trial. J Clin Oncol 2014; 32:2440-8. [PMID: 24982464 DOI: 10.1200/jco.2013.54.4833] [Citation(s) in RCA: 108] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
PURPOSE Relative efficacy and toxicity of cyclophosphamide compared with ifosfamide are debatable. The Euro-EWING99-R1 trial asked whether cyclophosphamide may replace ifosfamide in combination with vincristine and dactinomycin (vincristine, dactinomycin, and cyclophosphamide [VAC] v vincristine, dactinomycin, and ifosfamide [VAI]) after an intensive induction chemotherapy containing vincristine, ifosfamide, doxorubicin, and etoposide (VIDE) in standard-risk localized disease (NCT00020566). METHODS Standard-risk Ewing sarcomas were localized tumors with either a good histologic response to chemotherapy (< 10% cells) or small tumors (< 200 mL) resected at diagnosis or receiving radiotherapy alone as local treatment. Patients entered the trial after six VIDE+1 VAI courses. Allocated treatment was either 7 VAC courses with 1.5 g/m(2) of cyclophosphamide or seven VAI-courses with 6 g/m(2) ifosfamide. The limit of noninferiority was set at -8.5% for the 3-year event-free survival rate (EFS), equivalent to 1.43 in terms of the hazard ratio of event (HR(event)). RESULTS This large international trial recruited 856 patients between February 2000 and March 2010 (n = 431 receiving VAC and n = 425 receiving VAI). With a median follow-up of 5.9 years, the 3-year EFSs were 75.4% and 78.2%, respectively, the 3-year EFS difference was -2.8% (91.4% CI, -7.8 to 2.2%), the HR(event) was 1.12 (91.4% CI, 0.89 to 1.41), and the HR(death) was 1.09 (91.4% CI, 0.84 to 1.42; intention-to-treat). The HR(event) was 1.22 (91.4% CI, 0.96 to 1.54) on the per-protocol population. Major treatment modifications were significantly less frequent in the VAC arm (< 1%) than in the VAI arm (7%), mainly resulting from toxicity. Patients experienced more frequent thrombocytopenia in the VAC arm (45% v 35%) but fewer grade 2 to 4 acute tubular toxicities (16% v 31%). CONCLUSION Cyclophosphamide may be able to replace ifosfamide in consolidation treatment of standard-risk Ewing sarcoma. However, some uncertainty surrounding the noninferiority of VAC compared with VAI remains at this stage. The ongoing comparative evaluation of long-term renal and gonadal toxicity is crucial to decisions regarding future patients.
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Affiliation(s)
- Marie-Cécile Le Deley
- Odile Oberlin, Gustave Roussy Institute, Villejuif; Marie-Cécile Le Deley, Université Paris-Sud, Le Kremlin-Bicêtre; Jean Michon, Institut Curie, Paris; Perrine Marec-Bérard, Centre Léon-Bérard, Lyon, France; Michael Paulussen, Vestische Kinder-und Jugendklinik Datteln, Witten/Herdecke University, Datteln; Andreas Ranft, Heribert Juergens, and Uta Dirksen, University Hospital Münster, Münster, Germany; Ian Lewis, Alder Hey Children's National Health Service Foundation Trust, Liverpool; Bernadette Brennan, Royal Manchester Children's Hospital, Manchester; Jeremy Whelan, University College London Hospital National Health Service Foundation Trust; Ian Judson, The Royal Marsden Hospital, London; Keith Wheatley, University of Birmingham, Birmingham; Alan Craft, Royal Victoria Infirmary, Newcastle, United Kingdom; Ruth Ladenstein, St Anna Children's Cancer Research Institute, Vienna, Austria; Henk van den Berg, Emma Children Hospital AMC, Amsterdam, the Netherlands; and Lars Hjorth, Skåne University Hospital, Lund University, Lund, Sweden.
| | - Michael Paulussen
- Odile Oberlin, Gustave Roussy Institute, Villejuif; Marie-Cécile Le Deley, Université Paris-Sud, Le Kremlin-Bicêtre; Jean Michon, Institut Curie, Paris; Perrine Marec-Bérard, Centre Léon-Bérard, Lyon, France; Michael Paulussen, Vestische Kinder-und Jugendklinik Datteln, Witten/Herdecke University, Datteln; Andreas Ranft, Heribert Juergens, and Uta Dirksen, University Hospital Münster, Münster, Germany; Ian Lewis, Alder Hey Children's National Health Service Foundation Trust, Liverpool; Bernadette Brennan, Royal Manchester Children's Hospital, Manchester; Jeremy Whelan, University College London Hospital National Health Service Foundation Trust; Ian Judson, The Royal Marsden Hospital, London; Keith Wheatley, University of Birmingham, Birmingham; Alan Craft, Royal Victoria Infirmary, Newcastle, United Kingdom; Ruth Ladenstein, St Anna Children's Cancer Research Institute, Vienna, Austria; Henk van den Berg, Emma Children Hospital AMC, Amsterdam, the Netherlands; and Lars Hjorth, Skåne University Hospital, Lund University, Lund, Sweden
| | - Ian Lewis
- Odile Oberlin, Gustave Roussy Institute, Villejuif; Marie-Cécile Le Deley, Université Paris-Sud, Le Kremlin-Bicêtre; Jean Michon, Institut Curie, Paris; Perrine Marec-Bérard, Centre Léon-Bérard, Lyon, France; Michael Paulussen, Vestische Kinder-und Jugendklinik Datteln, Witten/Herdecke University, Datteln; Andreas Ranft, Heribert Juergens, and Uta Dirksen, University Hospital Münster, Münster, Germany; Ian Lewis, Alder Hey Children's National Health Service Foundation Trust, Liverpool; Bernadette Brennan, Royal Manchester Children's Hospital, Manchester; Jeremy Whelan, University College London Hospital National Health Service Foundation Trust; Ian Judson, The Royal Marsden Hospital, London; Keith Wheatley, University of Birmingham, Birmingham; Alan Craft, Royal Victoria Infirmary, Newcastle, United Kingdom; Ruth Ladenstein, St Anna Children's Cancer Research Institute, Vienna, Austria; Henk van den Berg, Emma Children Hospital AMC, Amsterdam, the Netherlands; and Lars Hjorth, Skåne University Hospital, Lund University, Lund, Sweden
| | - Bernadette Brennan
- Odile Oberlin, Gustave Roussy Institute, Villejuif; Marie-Cécile Le Deley, Université Paris-Sud, Le Kremlin-Bicêtre; Jean Michon, Institut Curie, Paris; Perrine Marec-Bérard, Centre Léon-Bérard, Lyon, France; Michael Paulussen, Vestische Kinder-und Jugendklinik Datteln, Witten/Herdecke University, Datteln; Andreas Ranft, Heribert Juergens, and Uta Dirksen, University Hospital Münster, Münster, Germany; Ian Lewis, Alder Hey Children's National Health Service Foundation Trust, Liverpool; Bernadette Brennan, Royal Manchester Children's Hospital, Manchester; Jeremy Whelan, University College London Hospital National Health Service Foundation Trust; Ian Judson, The Royal Marsden Hospital, London; Keith Wheatley, University of Birmingham, Birmingham; Alan Craft, Royal Victoria Infirmary, Newcastle, United Kingdom; Ruth Ladenstein, St Anna Children's Cancer Research Institute, Vienna, Austria; Henk van den Berg, Emma Children Hospital AMC, Amsterdam, the Netherlands; and Lars Hjorth, Skåne University Hospital, Lund University, Lund, Sweden
| | - Andreas Ranft
- Odile Oberlin, Gustave Roussy Institute, Villejuif; Marie-Cécile Le Deley, Université Paris-Sud, Le Kremlin-Bicêtre; Jean Michon, Institut Curie, Paris; Perrine Marec-Bérard, Centre Léon-Bérard, Lyon, France; Michael Paulussen, Vestische Kinder-und Jugendklinik Datteln, Witten/Herdecke University, Datteln; Andreas Ranft, Heribert Juergens, and Uta Dirksen, University Hospital Münster, Münster, Germany; Ian Lewis, Alder Hey Children's National Health Service Foundation Trust, Liverpool; Bernadette Brennan, Royal Manchester Children's Hospital, Manchester; Jeremy Whelan, University College London Hospital National Health Service Foundation Trust; Ian Judson, The Royal Marsden Hospital, London; Keith Wheatley, University of Birmingham, Birmingham; Alan Craft, Royal Victoria Infirmary, Newcastle, United Kingdom; Ruth Ladenstein, St Anna Children's Cancer Research Institute, Vienna, Austria; Henk van den Berg, Emma Children Hospital AMC, Amsterdam, the Netherlands; and Lars Hjorth, Skåne University Hospital, Lund University, Lund, Sweden
| | - Jeremy Whelan
- Odile Oberlin, Gustave Roussy Institute, Villejuif; Marie-Cécile Le Deley, Université Paris-Sud, Le Kremlin-Bicêtre; Jean Michon, Institut Curie, Paris; Perrine Marec-Bérard, Centre Léon-Bérard, Lyon, France; Michael Paulussen, Vestische Kinder-und Jugendklinik Datteln, Witten/Herdecke University, Datteln; Andreas Ranft, Heribert Juergens, and Uta Dirksen, University Hospital Münster, Münster, Germany; Ian Lewis, Alder Hey Children's National Health Service Foundation Trust, Liverpool; Bernadette Brennan, Royal Manchester Children's Hospital, Manchester; Jeremy Whelan, University College London Hospital National Health Service Foundation Trust; Ian Judson, The Royal Marsden Hospital, London; Keith Wheatley, University of Birmingham, Birmingham; Alan Craft, Royal Victoria Infirmary, Newcastle, United Kingdom; Ruth Ladenstein, St Anna Children's Cancer Research Institute, Vienna, Austria; Henk van den Berg, Emma Children Hospital AMC, Amsterdam, the Netherlands; and Lars Hjorth, Skåne University Hospital, Lund University, Lund, Sweden
| | - Gwénaël Le Teuff
- Odile Oberlin, Gustave Roussy Institute, Villejuif; Marie-Cécile Le Deley, Université Paris-Sud, Le Kremlin-Bicêtre; Jean Michon, Institut Curie, Paris; Perrine Marec-Bérard, Centre Léon-Bérard, Lyon, France; Michael Paulussen, Vestische Kinder-und Jugendklinik Datteln, Witten/Herdecke University, Datteln; Andreas Ranft, Heribert Juergens, and Uta Dirksen, University Hospital Münster, Münster, Germany; Ian Lewis, Alder Hey Children's National Health Service Foundation Trust, Liverpool; Bernadette Brennan, Royal Manchester Children's Hospital, Manchester; Jeremy Whelan, University College London Hospital National Health Service Foundation Trust; Ian Judson, The Royal Marsden Hospital, London; Keith Wheatley, University of Birmingham, Birmingham; Alan Craft, Royal Victoria Infirmary, Newcastle, United Kingdom; Ruth Ladenstein, St Anna Children's Cancer Research Institute, Vienna, Austria; Henk van den Berg, Emma Children Hospital AMC, Amsterdam, the Netherlands; and Lars Hjorth, Skåne University Hospital, Lund University, Lund, Sweden
| | - Jean Michon
- Odile Oberlin, Gustave Roussy Institute, Villejuif; Marie-Cécile Le Deley, Université Paris-Sud, Le Kremlin-Bicêtre; Jean Michon, Institut Curie, Paris; Perrine Marec-Bérard, Centre Léon-Bérard, Lyon, France; Michael Paulussen, Vestische Kinder-und Jugendklinik Datteln, Witten/Herdecke University, Datteln; Andreas Ranft, Heribert Juergens, and Uta Dirksen, University Hospital Münster, Münster, Germany; Ian Lewis, Alder Hey Children's National Health Service Foundation Trust, Liverpool; Bernadette Brennan, Royal Manchester Children's Hospital, Manchester; Jeremy Whelan, University College London Hospital National Health Service Foundation Trust; Ian Judson, The Royal Marsden Hospital, London; Keith Wheatley, University of Birmingham, Birmingham; Alan Craft, Royal Victoria Infirmary, Newcastle, United Kingdom; Ruth Ladenstein, St Anna Children's Cancer Research Institute, Vienna, Austria; Henk van den Berg, Emma Children Hospital AMC, Amsterdam, the Netherlands; and Lars Hjorth, Skåne University Hospital, Lund University, Lund, Sweden
| | - Ruth Ladenstein
- Odile Oberlin, Gustave Roussy Institute, Villejuif; Marie-Cécile Le Deley, Université Paris-Sud, Le Kremlin-Bicêtre; Jean Michon, Institut Curie, Paris; Perrine Marec-Bérard, Centre Léon-Bérard, Lyon, France; Michael Paulussen, Vestische Kinder-und Jugendklinik Datteln, Witten/Herdecke University, Datteln; Andreas Ranft, Heribert Juergens, and Uta Dirksen, University Hospital Münster, Münster, Germany; Ian Lewis, Alder Hey Children's National Health Service Foundation Trust, Liverpool; Bernadette Brennan, Royal Manchester Children's Hospital, Manchester; Jeremy Whelan, University College London Hospital National Health Service Foundation Trust; Ian Judson, The Royal Marsden Hospital, London; Keith Wheatley, University of Birmingham, Birmingham; Alan Craft, Royal Victoria Infirmary, Newcastle, United Kingdom; Ruth Ladenstein, St Anna Children's Cancer Research Institute, Vienna, Austria; Henk van den Berg, Emma Children Hospital AMC, Amsterdam, the Netherlands; and Lars Hjorth, Skåne University Hospital, Lund University, Lund, Sweden
| | - Perrine Marec-Bérard
- Odile Oberlin, Gustave Roussy Institute, Villejuif; Marie-Cécile Le Deley, Université Paris-Sud, Le Kremlin-Bicêtre; Jean Michon, Institut Curie, Paris; Perrine Marec-Bérard, Centre Léon-Bérard, Lyon, France; Michael Paulussen, Vestische Kinder-und Jugendklinik Datteln, Witten/Herdecke University, Datteln; Andreas Ranft, Heribert Juergens, and Uta Dirksen, University Hospital Münster, Münster, Germany; Ian Lewis, Alder Hey Children's National Health Service Foundation Trust, Liverpool; Bernadette Brennan, Royal Manchester Children's Hospital, Manchester; Jeremy Whelan, University College London Hospital National Health Service Foundation Trust; Ian Judson, The Royal Marsden Hospital, London; Keith Wheatley, University of Birmingham, Birmingham; Alan Craft, Royal Victoria Infirmary, Newcastle, United Kingdom; Ruth Ladenstein, St Anna Children's Cancer Research Institute, Vienna, Austria; Henk van den Berg, Emma Children Hospital AMC, Amsterdam, the Netherlands; and Lars Hjorth, Skåne University Hospital, Lund University, Lund, Sweden
| | - Henk van den Berg
- Odile Oberlin, Gustave Roussy Institute, Villejuif; Marie-Cécile Le Deley, Université Paris-Sud, Le Kremlin-Bicêtre; Jean Michon, Institut Curie, Paris; Perrine Marec-Bérard, Centre Léon-Bérard, Lyon, France; Michael Paulussen, Vestische Kinder-und Jugendklinik Datteln, Witten/Herdecke University, Datteln; Andreas Ranft, Heribert Juergens, and Uta Dirksen, University Hospital Münster, Münster, Germany; Ian Lewis, Alder Hey Children's National Health Service Foundation Trust, Liverpool; Bernadette Brennan, Royal Manchester Children's Hospital, Manchester; Jeremy Whelan, University College London Hospital National Health Service Foundation Trust; Ian Judson, The Royal Marsden Hospital, London; Keith Wheatley, University of Birmingham, Birmingham; Alan Craft, Royal Victoria Infirmary, Newcastle, United Kingdom; Ruth Ladenstein, St Anna Children's Cancer Research Institute, Vienna, Austria; Henk van den Berg, Emma Children Hospital AMC, Amsterdam, the Netherlands; and Lars Hjorth, Skåne University Hospital, Lund University, Lund, Sweden
| | - Lars Hjorth
- Odile Oberlin, Gustave Roussy Institute, Villejuif; Marie-Cécile Le Deley, Université Paris-Sud, Le Kremlin-Bicêtre; Jean Michon, Institut Curie, Paris; Perrine Marec-Bérard, Centre Léon-Bérard, Lyon, France; Michael Paulussen, Vestische Kinder-und Jugendklinik Datteln, Witten/Herdecke University, Datteln; Andreas Ranft, Heribert Juergens, and Uta Dirksen, University Hospital Münster, Münster, Germany; Ian Lewis, Alder Hey Children's National Health Service Foundation Trust, Liverpool; Bernadette Brennan, Royal Manchester Children's Hospital, Manchester; Jeremy Whelan, University College London Hospital National Health Service Foundation Trust; Ian Judson, The Royal Marsden Hospital, London; Keith Wheatley, University of Birmingham, Birmingham; Alan Craft, Royal Victoria Infirmary, Newcastle, United Kingdom; Ruth Ladenstein, St Anna Children's Cancer Research Institute, Vienna, Austria; Henk van den Berg, Emma Children Hospital AMC, Amsterdam, the Netherlands; and Lars Hjorth, Skåne University Hospital, Lund University, Lund, Sweden
| | - Keith Wheatley
- Odile Oberlin, Gustave Roussy Institute, Villejuif; Marie-Cécile Le Deley, Université Paris-Sud, Le Kremlin-Bicêtre; Jean Michon, Institut Curie, Paris; Perrine Marec-Bérard, Centre Léon-Bérard, Lyon, France; Michael Paulussen, Vestische Kinder-und Jugendklinik Datteln, Witten/Herdecke University, Datteln; Andreas Ranft, Heribert Juergens, and Uta Dirksen, University Hospital Münster, Münster, Germany; Ian Lewis, Alder Hey Children's National Health Service Foundation Trust, Liverpool; Bernadette Brennan, Royal Manchester Children's Hospital, Manchester; Jeremy Whelan, University College London Hospital National Health Service Foundation Trust; Ian Judson, The Royal Marsden Hospital, London; Keith Wheatley, University of Birmingham, Birmingham; Alan Craft, Royal Victoria Infirmary, Newcastle, United Kingdom; Ruth Ladenstein, St Anna Children's Cancer Research Institute, Vienna, Austria; Henk van den Berg, Emma Children Hospital AMC, Amsterdam, the Netherlands; and Lars Hjorth, Skåne University Hospital, Lund University, Lund, Sweden
| | - Ian Judson
- Odile Oberlin, Gustave Roussy Institute, Villejuif; Marie-Cécile Le Deley, Université Paris-Sud, Le Kremlin-Bicêtre; Jean Michon, Institut Curie, Paris; Perrine Marec-Bérard, Centre Léon-Bérard, Lyon, France; Michael Paulussen, Vestische Kinder-und Jugendklinik Datteln, Witten/Herdecke University, Datteln; Andreas Ranft, Heribert Juergens, and Uta Dirksen, University Hospital Münster, Münster, Germany; Ian Lewis, Alder Hey Children's National Health Service Foundation Trust, Liverpool; Bernadette Brennan, Royal Manchester Children's Hospital, Manchester; Jeremy Whelan, University College London Hospital National Health Service Foundation Trust; Ian Judson, The Royal Marsden Hospital, London; Keith Wheatley, University of Birmingham, Birmingham; Alan Craft, Royal Victoria Infirmary, Newcastle, United Kingdom; Ruth Ladenstein, St Anna Children's Cancer Research Institute, Vienna, Austria; Henk van den Berg, Emma Children Hospital AMC, Amsterdam, the Netherlands; and Lars Hjorth, Skåne University Hospital, Lund University, Lund, Sweden
| | - Heribert Juergens
- Odile Oberlin, Gustave Roussy Institute, Villejuif; Marie-Cécile Le Deley, Université Paris-Sud, Le Kremlin-Bicêtre; Jean Michon, Institut Curie, Paris; Perrine Marec-Bérard, Centre Léon-Bérard, Lyon, France; Michael Paulussen, Vestische Kinder-und Jugendklinik Datteln, Witten/Herdecke University, Datteln; Andreas Ranft, Heribert Juergens, and Uta Dirksen, University Hospital Münster, Münster, Germany; Ian Lewis, Alder Hey Children's National Health Service Foundation Trust, Liverpool; Bernadette Brennan, Royal Manchester Children's Hospital, Manchester; Jeremy Whelan, University College London Hospital National Health Service Foundation Trust; Ian Judson, The Royal Marsden Hospital, London; Keith Wheatley, University of Birmingham, Birmingham; Alan Craft, Royal Victoria Infirmary, Newcastle, United Kingdom; Ruth Ladenstein, St Anna Children's Cancer Research Institute, Vienna, Austria; Henk van den Berg, Emma Children Hospital AMC, Amsterdam, the Netherlands; and Lars Hjorth, Skåne University Hospital, Lund University, Lund, Sweden
| | - Alan Craft
- Odile Oberlin, Gustave Roussy Institute, Villejuif; Marie-Cécile Le Deley, Université Paris-Sud, Le Kremlin-Bicêtre; Jean Michon, Institut Curie, Paris; Perrine Marec-Bérard, Centre Léon-Bérard, Lyon, France; Michael Paulussen, Vestische Kinder-und Jugendklinik Datteln, Witten/Herdecke University, Datteln; Andreas Ranft, Heribert Juergens, and Uta Dirksen, University Hospital Münster, Münster, Germany; Ian Lewis, Alder Hey Children's National Health Service Foundation Trust, Liverpool; Bernadette Brennan, Royal Manchester Children's Hospital, Manchester; Jeremy Whelan, University College London Hospital National Health Service Foundation Trust; Ian Judson, The Royal Marsden Hospital, London; Keith Wheatley, University of Birmingham, Birmingham; Alan Craft, Royal Victoria Infirmary, Newcastle, United Kingdom; Ruth Ladenstein, St Anna Children's Cancer Research Institute, Vienna, Austria; Henk van den Berg, Emma Children Hospital AMC, Amsterdam, the Netherlands; and Lars Hjorth, Skåne University Hospital, Lund University, Lund, Sweden
| | - Odile Oberlin
- Odile Oberlin, Gustave Roussy Institute, Villejuif; Marie-Cécile Le Deley, Université Paris-Sud, Le Kremlin-Bicêtre; Jean Michon, Institut Curie, Paris; Perrine Marec-Bérard, Centre Léon-Bérard, Lyon, France; Michael Paulussen, Vestische Kinder-und Jugendklinik Datteln, Witten/Herdecke University, Datteln; Andreas Ranft, Heribert Juergens, and Uta Dirksen, University Hospital Münster, Münster, Germany; Ian Lewis, Alder Hey Children's National Health Service Foundation Trust, Liverpool; Bernadette Brennan, Royal Manchester Children's Hospital, Manchester; Jeremy Whelan, University College London Hospital National Health Service Foundation Trust; Ian Judson, The Royal Marsden Hospital, London; Keith Wheatley, University of Birmingham, Birmingham; Alan Craft, Royal Victoria Infirmary, Newcastle, United Kingdom; Ruth Ladenstein, St Anna Children's Cancer Research Institute, Vienna, Austria; Henk van den Berg, Emma Children Hospital AMC, Amsterdam, the Netherlands; and Lars Hjorth, Skåne University Hospital, Lund University, Lund, Sweden
| | - Uta Dirksen
- Odile Oberlin, Gustave Roussy Institute, Villejuif; Marie-Cécile Le Deley, Université Paris-Sud, Le Kremlin-Bicêtre; Jean Michon, Institut Curie, Paris; Perrine Marec-Bérard, Centre Léon-Bérard, Lyon, France; Michael Paulussen, Vestische Kinder-und Jugendklinik Datteln, Witten/Herdecke University, Datteln; Andreas Ranft, Heribert Juergens, and Uta Dirksen, University Hospital Münster, Münster, Germany; Ian Lewis, Alder Hey Children's National Health Service Foundation Trust, Liverpool; Bernadette Brennan, Royal Manchester Children's Hospital, Manchester; Jeremy Whelan, University College London Hospital National Health Service Foundation Trust; Ian Judson, The Royal Marsden Hospital, London; Keith Wheatley, University of Birmingham, Birmingham; Alan Craft, Royal Victoria Infirmary, Newcastle, United Kingdom; Ruth Ladenstein, St Anna Children's Cancer Research Institute, Vienna, Austria; Henk van den Berg, Emma Children Hospital AMC, Amsterdam, the Netherlands; and Lars Hjorth, Skåne University Hospital, Lund University, Lund, Sweden
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