RATIONALE: Drugs used in chemotherapy use different ways to stop tumor cells from dividing
so they stop growing or die. Combining more than one drug or combining chemotherapy with
radiation therapy may kill more tumor cells.
PURPOSE: Phase II trial to study the effectiveness of combination chemotherapy followed by
radiation therapy in treating patients with peripheral neuroectodermal tumors, Ewing's
sarcoma, Wilms' tumor, or bone cancer.
OBJECTIVES: I. Determine the response rate and event-free survival of patients with
peripheral primitive neuroectodermal tumors or Ewing's sarcoma treated with
cyclophosphamide, doxorubicin, vincristine, etoposide, and ifosfamide, followed by surgery
(if feasible) and radiotherapy. II. Determine the response to a uniform treatment regimen in
order to clarify whether these disease categories each have a different prognosis.
OUTLINE: Patients are stratified according to disease category (primitive neuroectodermal
tumor vs Ewing's sarcoma). Patients receive treatment on regimen A as outlined below during
courses 1-3 and 6 and regimen B as outlined below during courses 4, 5, and 7 in the absence
of disease progression or unacceptable toxicity. Each course lasts 3-4 weeks. Patients
without metastatic disease after completion of course 3 undergo complete tumor resection, if
feasible. Patients achieving complete response with or without microscopic residual disease
after completion of course 7 undergo radiotherapy twice daily, 5 days a week, for 3 weeks.
Patients with gross residual disease after completion of course 7 undergo radiotherapy twice
daily, 5 days a week, for 3.6 weeks. Regimens A and B are defined below: Regimen A: Patients
receive cyclophosphamide IV over 6 hours on days 1 and 2, doxorubicin IV continuously and
vincristine IV continuously on days 1-3, and vincristine IV on day 9. Regimen B: Patients
receive etoposide IV over 1 hour, followed immediately by ifosfamide IV over 1 hour on days
1-5. Patients are followed monthly for 18 months and then every 6 months for 18 months.
PROJECTED ACCRUAL: A maximum of 50 patients (25 per stratum) will be accrued for this study
within 5 years.
DISEASE CHARACTERISTICS: Diagnosis of peripheral primitive neuroectodermal tumor,
including peripheral neuroepithelioma or Askin tumor OR Diagnosis of localized or
metastatic Ewing's sarcoma, including the following: Unresectable or metastatic small cell
osteosarcoma Unresectable or metastatic other nonrhabdomyosarcomatous soft-tissue sarcomas
Unresectable or metastatic other non-osteosarcomatous bone sarcomas Desmoplastic small
round-cell tumor Metastatic or non-metastatic Wilms' tumor Immunocytochemistry, electron
microscopy, and/or chromosomal analysis may be required to rule out other small round cell
PATIENT CHARACTERISTICS: Age: Any age Performance status: Not specified Life expectancy:
Not specified Hematopoietic: Not specified Hepatic: Not specified Renal: Not specified
PRIOR CONCURRENT THERAPY: Not specified