The shorter, 5-day VIT regimen is an active and well-tolerated regimen in refractory ES. This combination deserves further investigation in the upfront management of patients with metastatic disease.

Successful treatment of ES requires optimal systemic and local therapy. We were able to replicate the results of modern multi-modal protocols. Validation of current treatment protocols in countries with more limited cancer treatment resources is required.

The aim of this study was to assess bone mineral density (BMD) and biochemical bone metabolism markers in patients with bone tumors after anti-cancer treatment.The study included 27 patients (median age 15 years) with malignant bone tumors and 27 healthy children. In all subjects, BMD and body composition were measured by dual-energy X-ray absorptiometry. Serum bone markers were determined by immunoenzymatic assays. After completion of treatment, patients with bone tumors had significantly decreased total and lumbar spine BMD. We observed lower calcium and vitamin D levels in patients and comparable values of bone turnover markers (carboxyterminal telopeptide of collagen type I -CTX, bone alkaline phosphatase -BALP and osteocalcin -OC) in both groups of children. However, the level of carboxylated osteocalcin (cOC) was significantly lower (p<0.01) and undercarboxylated OC (ucOC) was higher (p<0.05) in patients than in the controls. Additionally, we observed similar values of anthropometric parameters in the subgroups of patients treated with methotrexate (MTX) or without MTX. In patients treated without MTX we found lower (p<0.05) ratio of cOC/ucOC, lower vitamin D level and higher CTX concentration.Patients with bone tumors after anticancer treatment had decreased bone mineral density and alterations in bone metabolism markers with potential decrease in bone formation.

A large proportion of women receiving multimodal therapy for ES develop premature ovarian insufficiency. Patients and guardians should be informed about the reproductive potential and strategies for preservation of ovarian function should be considered individually. Pediatr Blood Cancer 2015;62:341-345. © 2014 Wiley Periodicals, Inc.

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