Treatment Options

First line chemotherapy generally involves:

1. P6 Protocol established by Memorial Sloan-Kettering Cancer Center.


 * The P6 protocol consists of seven courses of chemotherapy.


 * Courses 1, 2, 3, and 6 include 6-hour infusions of cyclophosphamide on days 1 and 2 for a total of 4,200 mg/m2 per course (140 mg/kg per course for patients < 10 years old), plus 72-hour infusions of doxorubicin 75 mg/m2 and vincristine 2.0 mg/m2 beginning on day 1 (HD-CAV).


 * Courses 4, 5, and 7 consist of 1-hour infusions of ifosfamide 1.8 g/m2/d and etoposide (VP-16) 100 mg/m2/d, for 5 days.


 * Granulocyte colony-stimulating factor (G-CSF) and mesna are used.


 * Courses start after neutrophil counts reach 500/microL and platelet counts reach 100,000/uL.

2. Variations of the P6 protocol
 * Surgical resection follows course 3 and radiotherapy follows completion of all chemotherapy. Pubmed Abstract

3. Debulking surgery

4. Radiation

5. Stem cell rescue

6. Cytoreductive surgery and Intraperitoneal Hyperthermic chemoperfusion

7. Radioablation

8. Maintenance drugs