scholarly journals Preoperative accelerated radiotherapy combined with chemotherapy in a defined cohort of patients with high risk soft tissue sarcoma: a Scandinavian Sarcoma Group study

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Kirsten Sundby Hall ◽  
Øyvind S. Bruland ◽  
Bodil Bjerkehagen ◽  
Elisabet Lidbrink ◽  
Nina Jebsen ◽  
...  

Abstract Background We recently reported outcomes from a Scandinavian Sarcoma Group adjuvant study (SSG XX group A) conducted on localized and operable high risk soft tissue sarcoma (STS) of the extremities and trunk wall. SSG XX, group B, comprised of patients in a defined cohort with locally advanced STS considered at high risk for intralesional surgery. These patients received preoperative accelerated radiotherapy, together with neoadjuvant and adjuvant chemotherapy. Herein we report the results of this group B. Methods Twenty patients with high-grade, locally advanced and deep STS located in lower extremities (n = 12), upper extremities (5) or trunk wall (3) were included. The median age was 59 years and 14 patients were males. The treatment regimen consisted of 6 cycles of doxorubicin (60 mg/m2) and ifosfamide (6 g/m2), with three cycles given neoadjuvantly, and preoperative radiotherapy (1, 8 Gyx2/daily to 36 Gy) between cycles 2 and 3. After a repeated MRI surgery was then conducted, and the remaining 3 chemotherapy cycles were given postoperatively at 3 weeks intervals. Survival data, local control, toxicity of chemotherapy and postoperative complications are presented. Results Median follow-up time for metastasis-free survival (MFS) was 2.8 years (range 0.3–10.4). The 5-year MFS was 49.5% (95% confidence interval [CI] 31.7–77.4). The median follow-up time was 5.4 years (range 0.3–10.4) for overall survival (OS). The 5-year OS was 64.0% (95% CI 45.8–89.4). The median tumour size was 13 cm, with undifferentiated pleomorphic sarcoma (n = 10) and synovial sarcoma (n = 6) diagnosed most frequently. All patients completed surgery. Resection margins were R0 in 19 patients and R1 in 1 patient. No patients had evidence of disease progression preoperatively. Three patients experienced a local recurrence, in 2 after lung metastases had already been diagnosed. Eleven patients (55%) had postoperative wound problems (temporary in 8 and persistent in 3). Conclusions Preoperative chemotherapy and radiotherapy were associated with temporary wound-healing problems. Survival outcomes, local control and toxicities were deemed satisfactory when considering the locally advanced sarcoma disease status at primary diagnosis. Trial registration This study was registered at ClinicalTrials.gov Identifier NCT00790244 and with European Union Drug Regulating Authorities Clinical Trials No. EUDRACT 2007-001152-39

Sarcoma ◽  
2020 ◽  
Vol 2020 ◽  
pp. 1-10 ◽  
Author(s):  
Veit Bücklein ◽  
Christina Limmroth ◽  
Eric Kampmann ◽  
Gesa Schuebbe ◽  
Rolf Issels ◽  
...  

Patients with localized relapse of soft-tissue sarcoma (STS) after anthracycline-based chemotherapy have a dismal prognosis, particularly when surgery is not possible. To facilitate resection and improve long-term tumor control, we applied an intensified perioperative treatment consisting of ICE (ifosfamide 6 g/m2, carboplatin 400 mg/m2, and etoposide 600 mg/m2) in combination with regional hyperthermia (RHT) to maximize local control. Here, we retrospectively evaluate the safety and efficacy of this strategy. Patients aged ≥18 years with locally advanced high-risk STS, either with or without metastasis, treated with ICE + RHT after the failure of first-line anthracycline-based chemotherapy were included in this analysis. Radiographic response, toxicity, progression-free survival (PFS), and overall survival (OS) were assessed. Between 1996 and 2018, 213 sarcoma patients received ICE at our centre. Of these, 110 patients met the selection criteria (progressive disease, suitable high-grade STS histology, anthracycline pretreatment, RHT treatment) for this analysis. Fifty-four patients had locally advanced disease without metastases (LA-STS), and 56 patients had additional metastatic disease (M-STS). Disease control was achieved in 59% of LA-STS patients and in 47% of M-STS patients. For LA-STS, 21% of the patients achieved radiographic response, facilitating resection in 4 patients (7%), compared with 11% of the M-STS patients, facilitating resection in 5 patients (9%). PFS was significantly longer in LA-STS than in M-STS (10 vs. 4 months, p<0.0001). Median OS was 26 months in LA-STS and 12 months in M-STS. Disease control was the only independent prognostic factor for improved OS in multivariate analysis. Toxicity was high with neutropenic fever occurring in 25% of the patients and three therapy-related deaths (3%). ICE + RHT demonstrated activity in high-risk STS and facilitated resection in selected patients after anthracycline failure. Disease control was associated with improved OS. Based on the observed toxicities, the dose should be reduced to 75%.


2008 ◽  
Vol 26 (20) ◽  
pp. 3440-3444 ◽  
Author(s):  
Kaled M. Alektiar ◽  
Murray F. Brennan ◽  
John H. Healey ◽  
Samuel Singer

Purpose One of the concerns about intensity-modulated radiation therapy (IMRT) is that its tight dose distribution, an advantage in reducing RT morbidity to surrounding normal structures, might compromise tumor coverage. The purpose of this study is to determine if such concern is warranted in soft-tissue sarcoma (STS) of the extremity. Methods Between 02/02 and 05/05, 41 adult patients with primary STS of the extremity were treated with limb-sparing surgery and adjuvant IMRT. The margins were positive/within 1 mm in 21. Tumor size was more than 10 cm in 68% of patients and grade was high in 83%. Preoperative IMRT was given to 7 patients (50 Gy) and postoperative IMRT (median dose, 63 Gy) was given to 34 patients. Complete gross resection including periosteal stripping/bone resection was required in 11, and neurolysis/nerve resection in 24. Results With a median follow-up time of 35 months, two (4.8%) of 41 patients developed local recurrence. The 5-year actuarial local control rate was 94% (95% CI, 86% to 100%). The local control rate was also 94% for patients with negative or positive/close margin. Other prognostic factors such as age, size, and grade did not impact local control either. The 5-year distant control rate was 61% (95% CI, 45% to 76%) and the overall survival rate was 64% (95% CI, 45% to 84%). Conclusion IMRT in STS of the extremity provides excellent local control in a group of patients with high risk features. This suggests that the precision with which IMRT dose is distributed has a beneficiary effect in sparing normal tissue and improving local control.


2014 ◽  
Vol 4 (4) ◽  
Author(s):  
Jacqueline Oxenberg ◽  
Harish K. Malhotra ◽  
Kristopher Attwood ◽  
John M. Kane III ◽  
Kilian Salerno

2020 ◽  
Vol 45 (6) ◽  
pp. 629-635 ◽  
Author(s):  
Mehran Dadras ◽  
Hans-Ulrich Steinau ◽  
Ole Goertz ◽  
Marcus Lehnhardt ◽  
Björn Behr ◽  
...  

Our retrospective study analysed the long-term results of a conservative limb-preserving surgical strategy in 51 patients with soft-tissue sarcoma of the hand from a single institution. We assessed survival and prognostic factors, including the surgical margins. No transradial amputations were performed. Microscopically free resection margins were obtained in 45 of the patients. The remaining six patients had microscopically incomplete resection. Forty-four surviving patients had a median follow-up of 6.5 years (range 12–307), and one patient had no follow-up beyond 3 months following surgery. Among those patients, 29 had more than 5 years of follow-up. Five-year local-recurrence-free survival was 65%, metastasis-free survival was 84%, and disease-specific survival was 91%. Tumour size was predictive of all outcome parameters, but positive resection margins adversely affected local recurrence only. Survival was similar to the survival after a more radical surgical approach reported in the literature. Level of evidence: IV


2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 9573-9573
Author(s):  
Y. B. Kim ◽  
K. H. Shin ◽  
G. E. Kim ◽  
S. B. Han ◽  
J. K. Roh ◽  
...  

9573 Background: Adjuvant radiotherapy (RT) has been shown to improve local control (LC) in patients with extremity and truncal soft tissue sarcoma (STS). The purpose of this study was to analyze how much RT promoted LC in patients with marginally excised STS compared with patients with widely excised STS. Methods: Two hundred and thirty-two patients with STS (173 extremity cases and 59 trunk cases) who had received conserving surgery were divided into 3 groups according to marginal status and the addition of RT; (1) wide excision alone (n = 56, Group A), (2) wide excision plus RT (n = 64, Group B) and (3) marginal excision plus RT (n = 112, Group C). LC, overall survival, and morbidity rates were retrospectively compared among 3 groups. Results: There were no differences in age, gender, pathologic type, and tumor site among three groups, but Group A had the higher incidence of small-sized tumor and low grade tumor than other groups. Thirty-eight patients experienced local failures (LF) after completion of treatment. Group C had similar incidence of LF compared with Group B (Group A; 4%, Group B; 21%, and Group C; 19%). Overall 5-year and 10-year LC rates were 80% and 70%, and there were no significant differences between Group B and Group C in 10-year LC rate (Group A; 84%, Group B; 65%, and Group C; 68%). Tumor grade and tumor site were found to be significant predictors of LF. Group C had lower 10-year overall actuarial survival rate compared with Group B (Group A; 85%, Group B; 78%, and Group C; 69%). This was associated with significantly different incidence of distant failure (Group A; 11%, Group B; 16%, and Group C; 29%, p=0.008). Seven patients suffered from wound dehiscence, and 1 patient from bone necrosis. The incidence of Grade 3–4 late complication was higher in Group B than Group A and Group C (Group A; 0%, Group B; 9.3%, and Group C; 1.7%, p=0.03). Conclusions: Our data indicate that RT seems to promote LC in patients with positive or close margin up to that of patients with wide margin in extremity and truncal STS. We suggest that conserving surgery and RT for patients with marginal STS should be the alternative choice rather than aggressive surgery for better LC without deteriorating limb-function or causing serious complication. No significant financial relationships to disclose.


2018 ◽  
Vol 104 (5) ◽  
pp. 322-329 ◽  
Author(s):  
Daniela Greto ◽  
Mauro Loi ◽  
Calogero Saieva ◽  
Cristina Muntoni ◽  
Camilla Delli Paoli ◽  
...  

Introduction: This retrospective study analyzes the safety and feasibility of concurrent chemoradiotherapy (CRT) in adjuvant treatment of soft tissue sarcoma (STS). Methods: A total of 158 patients with STS were retrospectively analyzed. Anthracycline-based computed tomography was performed in high-risk patients. Acute radiotherapy toxicity and chemotherapy-related toxicity were assessed according to the Common Terminology Criteria for Adverse Events 4.0; late radiotherapy toxicity was recorded according to Radiation Therapy Oncology Group/European Organization for Research and Treatment of Cancer criteria. Results: Fifty-four (34.2%) patients received CRT. Mean follow up was 5.4 years (range .2–21.1 years). Local DFS–recurrence-free survival, distant DFS–relapse-free survival, and overall survival were 79.1%, 76.4%, and 64.6%, respectively, at last follow-up. Leukopenia occurred in 11.4% of patients. Skin acute toxicity developed in 60.1% of patients and determined interruption of radiotherapy treatment in 19 (12%) patients. Nineteen patients (12%) experienced moderate fibrosis (grade 2). Mild and moderate joint stiffness was recorded in 16 (10.1%) patients. Size ≥5 cm was the only predictor of local recurrence at multivariate analysis (hazard ratio [HR] 9.65, 95% confidence interval [CI] 1.28–72.83, p = .028). Age and stage resulted as independent distant relapse predictors (HR 4.77, 95% CI 1.81–12.58, p = .002 and HR 4.83, CI 1.41–16.57, p = .012, respectively). At Cox regression univariate analysis, Karnofsky Performance Status, size, and stage were significant survival predictors (HR 2.23, 95% CI 1.02–4.87, p = .045; HR 2.88, 95% CI 1.10–7.52, p = .031; HR 2.59, 95% CI 1.11–6.04, p = .028). Conclusions: Concurrent CRT is a well-tolerated treatment option with no additional toxicity compared to exclusive radiotherapy or sequential CRT.


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