Neoadjuvant Chemoradiation Herapy for Soft Tissue Sarcomas of the Extremities

Abstract

INTRODUCTION AND OBJECTIVENeoadjuvant and adjuvant therapies for soft tissue sarcomas of the extremities are still controversial. The aim of this study was to analyze the results of a protocol of neoadjuvant chemoradiation therapy for extremity sarcomas.METHODSA retrospective analysis was carried out in a consecutive series of 49 adult patients with advanced extremity soft tissue sarcomas that could not be resected with adequate margins during the primary resection. All patients were treated with a protocol of preoperative radiation therapy at a total dose of 30 Gy, concomitant with doxorubicin (60 mg/m2) chemotherapy. The main endpoints assessed were local recurrence-free survival, metastasis-free survival and overall survival. The median follow-up time was 32.1 months.RESULTSThe five-year local recurrence-free survival, metastasis-free survival and overall survival rates were 81.5%, 46.7% and 58.3%, respectively. For high-grade tumors, the five-year metastasis-free and overall survival rates were only 36.3% and 41.2%, respectively. Severe wound complications were observed in 41.8% of the patients who underwent surgery. These complications precluded adjuvant chemotherapy in 73.7% (14/19) of the patients eligible to receive it.CONCLUSIONSIn this study, neoadjuvant chemoradiation therapy was associated with a good local control rate, but the distant relapse-free rate and overall survival rate were still poor. The high rate of wound complications modified the planning of adjuvant treatment in most patients.

(Neo)adjuvant chemotherapy and interdigitated split-course hyperfractionated radiation in high risk soft tissue sarcoma – Results from a large single-institution series

“…31 1992–NA31IFADIC × 4 + IFDIC × 251/1.7 × 2postNA8194 (3.5)77 (3.5)97 (3.5)10Aguiar Jr et al . 35 1995–200449A 20 mg/m 2 × 330/2.5preC5982 (5)47 (5)58 (5)42Greto et al . 21 1998–201132IE × 250/2preC100NA53 (4.9)NANAMahmoud et al .…”

Neoadjuvant Treatment Options in Soft Tissue Sarcomas

“…Neoadjuvant CHT may be a valuable option in patients with a low probability of OS calculated using the prognostic nomogram Sarculator [54,55]. Moreover, neoadjuvant CHT may provide benefit in patients with high-risk or marginally resectable STS [48,56,57]. NCCN suggests considering CHT as an addition to RT or as standalone neoadjuvant treatment in resectable stage II and III STS with predicted adverse functional outcomes, and in primarily unresectable STS [28].…”

“…Guidelines favoring neoadjuvant CHT+RT are not based on high-level evidence [28,31,56,68]. The optimal sequence of treatment is unknown.…”