Phase II Study of Neoadjuvant Chemotherapy and Radiation Therapy in the Management of High-Risk, High-Grade, Soft Tissue Sarcomas of the Extremities and Body Wall: Radiation Therapy Oncology Group Trial 9514

Kraybill, William G.; Harris, J. E.; Spiro, Ira J.; Ettinger, David S.; DeLaney, Thomas F.; Blum, Ronald H.; Lucas, David R.; Harmon, David C.; Letson, G. Douglas; Eisenberg, Burton L.

doi:10.1200/jco.2005.02.5577

Cited by 260 publications

(212 citation statements)

References 25 publications

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“…Postoperative radiotherapy as an adjunct to surgical treatment is required for the patients with large and high grade tumors and with close or positive margins (Lindberg et al, 1981;Wouters et al, 2008;Burt et al, 2013). On the other hand preoperative radiotherapy, chemotherapy, or combined chemoradiotherapy can be applied to these patients in order to allow more conservative surgery with negative margins (Kraybill et al, 2010;Burt et al, 2013). Some authors recommended preoperative radiotherapy when close margins were anticipated in order to improve LC and DFS (Kachroo et al, 2012;Gronchi et al, 2013).…”

Section: Long-term Treatment Results In Soft Tissuementioning

confidence: 99%

Long-Term Treatment Results in Soft Tissue Sarcomas of the Thoracic Wall Treated with Pre-or-Postoperative Radiotherapy - a Single Institution Experience

Öksüz¹,

Özdemir²,

Kaydıhan³

et al. 2014

Asian Pacific Journal of Cancer Prevention

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Objective: To evaluate the long term results among patients with soft tissue sarcoma of the thoracic wall. Materials and Methods: Twenty-six patients who were treated with pre-or postoperative radiotherapy between December 1980-December 2007, with a diagnosis of soft tissue sarcoma of the thoracic wall were retrospectively evaluated. Results: The median age was 44 years (14-85 years) and 15 of them were male. A total of 50% of patients were grade 3. The most common histologic type of tumor was undifferentiated pleomorphic sarcoma (26.9%). Tumor size varied between 2-25 cm (median 6.5 cm). Seventeen of the cases had marginal and 9 had wide local resection. Four cases received preoperative radiotherapy and 22 postoperative radiotherapy. Six of the patients with large and high grade tumors received chemotherapy. Median follow-up time was 82 months (9-309 months). Local recurrence and metastasis was detected in 34.6% and 42.3% of patients, respectively. Fiveyear local control (LC), disease-free survival (DFS), overall survival (OS), and disease-specific survival (DSS) were 62%, 38%, 69%, and 76% respectively. On univariate analysis, the patients with positive surgical margins had a markedly lower 5-year LC rate than patients with negative surgical margin, but the difference was not significant (43% vs 78%, p=0.1). Five-year DFS (66% vs 17%) and DSS (92% vs 60%) rates were significantly worse for the patients who had high grade tumors (p=0.01, p=0.008 respectively). Conclusions: Tumor grade and surgical margin are essential parameters for determining the prognosis of thoracic wall soft tissue sarcoma both in our series and the literature.

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Section: Long-term Treatment Results In Soft Tissuementioning

confidence: 99%

Long-Term Treatment Results in Soft Tissue Sarcomas of the Thoracic Wall Treated with Pre-or-Postoperative Radiotherapy - a Single Institution Experience

Öksüz¹,

Özdemir²,

Kaydıhan³

et al. 2014

Asian Pacific Journal of Cancer Prevention

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“…26,28,35 Such a distinction encompasses, in addition to tumor necrosis, the presence of fibrosis and acellular matrix as elements of nonviable tumor, and cumulatively represents treatment effect. In routine practice, a pathologist would presumably consider the entire area occupied by necrotic cells, acellular matrix, and loose fibrous tissue in estimating the extent of ''necrosis.''…”

Section: Discussionmentioning

confidence: 99%

Histopathologic Features of Prognostic Significance in High-Grade Osteosarcoma

Chui

Kandel²,

Wong³

et al. 2016

Archives of Pathology &Amp; Laboratory Medicine

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Context.-In osteosarcoma treated with neoadjuvant chemotherapy the extent of tumor necrosis on resection is considered an indicator of treatment response, and this has been shown to correlate with survival in most but not all studies.Objective.-To identify additional histologic variables of prognostic significance in high-grade osteosarcoma.Design.-Slides of pretreatment biopsy and primary postneoadjuvant chemotherapy resections from 165 patients with high-grade osteosarcoma were reviewed. Univariate (Kaplan-Meier) and multivariate (Cox regression) analyses were performed to identify clinical and histomorphologic attributes associated with overall survival.Results.-Univariate analyses confirmed the prognostic significance of metastatic status on presentation, primary tumor size, anatomic site, and histologic subtype. Additionally, the identification of lymphovascular invasion, 10% or more residual viable tumor, and 10 or more mitoses per 10 high-powered fields assessed in posttreatment resections were associated with poor survival, retaining significance in multivariate analyses. Based on results from multivariate analysis, we developed a prognostic index incorporating primary tumor size and site, and significant histologic features assessed on resection (ie, lymphovascular invasion status, mitotic rate, and extent of viable tumor). This scoring system segregates patients into 3 risk categories with significant differences in overall survival and retained significance in an independent validation set of 42 cases.Conclusions.-The integration of clinical and microscopic features improves prognostication of patients with osteosarcoma.

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“…More recent efforts have explored the use of interdigitated radiotherapy with doxorubicin-containing chemotherapy regimens such as MAID (mesna, doxorubicin, ifosfamide, and dacarbazine). Favorable outcome with this schedule, though substantially greater short-term toxicities has been reported (Kraybill et al, 2010). We prefer to use doxorubicin, ifosfamide with mesna (AIM) rather than MAID regimen while there are several published data showing good results with high dose adriamycin and ifosfamide with G-CSF (Le Cesne et al, 2000;Pervaiz, 2008).…”

Section: 1775 Preoperative Radiotherapy With or Without Chemotherapymentioning

confidence: 99%

“…It is not easy to distinguish which of the side effects are related to surgery, radiotherapy or chemotherapy. Various rates of major wound complications have been reported since many factors such as; size and anatomic location of the tumor, wound closure, radiotherapy dose and volume, prior surgery, medical status and age of the patient might affect the outcome (Nielsen et al, 1991;Le Cesne et al, 2000;Kunisada et al, 2002;O'Sullivan et al, 2002;Davis et al2005;Mack et al, 2005;Kraybill et al, 2010). O'Sullivan et al reported that, acute wound complications were significantly more common with preoperative treatment compared with postoperative treatment (35 versus 17 %) (O'Sullivan et al, 2002).…”

Section: 1775 Preoperative Radiotherapy With or Without Chemotherapymentioning

confidence: 99%

Neoadjuvant Treatment with Preoperative Radiotherapy for Extremity Soft Tissue Sarcomas: Long-Term Results from a Single Institution in Turkey

Dinçbaş

Öksüz²,

Yetmen³

et al. 2014

Asian Pacific Journal of Cancer Prevention

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Background: To assess the long term clinical outcome of preoperative radiotherapy with or without chemotherapy followed by limb sparing surgery in patients with non-metastatic soft tissue sarcomas (STS) of the extremities. Materials and Methods: Sixty patients with locally advanced STS were retrospectively analyzed. The median tumor diameter was 12 cm. All patients were treated with preoperative radiotherapy delivered with two different fractionation schedules (35Gy/10fr or 46-50Gy/23-25fr). Neoadjuvant chemotherapy was added to 44 patients with large and/or high grade tumors. Surgery was performed 2-6 weeks after radiotherapy. Chemotherapy was completed up to 6 courses after surgery in patients who had good responses. Results: Median follow-up time was 67 months (8-268 months). All of the patients had limb sparing surgery. The 5-year local control (LC), disease free (DFS) and overall survival (OSS) rates for all of the patients were 81%, 48.1% and 68.3% respectively. 5-year LC, DFS and cause specific survival (CSS) were 81.7%, 47%, 69.8%, and 80%, 60%, 60% in the chemoradiotherapy and radiotherapy groups, respectively. On univariate analysis, patients who were treated with hypofractionation experienced significantly superior LC, DFS and CSS rates with similar rates of late toxicity when compared with patients who were treated with conventional fractionation and statistical significance was retained on multivariate analysis. Conclusions: Treatment results are consistent with the literature. As neoadjuvant chemoradiotherapy provides effective LC and CSS with acceptable morbidity, it should be preferred for patients with large and borderline resectable STS.

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Phase II Study of Neoadjuvant Chemotherapy and Radiation Therapy in the Management of High-Risk, High-Grade, Soft Tissue Sarcomas of the Extremities and Body Wall: Radiation Therapy Oncology Group Trial 9514

Abstract: This combined-modality treatment can be delivered successfully in a multi-institutional setting. Efficacy results are consistent with previous single-institution results.

Cited by 260 publications

References 25 publications

Long-Term Treatment Results in Soft Tissue Sarcomas of the Thoracic Wall Treated with Pre-or-Postoperative Radiotherapy - a Single Institution Experience

Long-Term Treatment Results in Soft Tissue Sarcomas of the Thoracic Wall Treated with Pre-or-Postoperative Radiotherapy - a Single Institution Experience

Histopathologic Features of Prognostic Significance in High-Grade Osteosarcoma

Neoadjuvant Treatment with Preoperative Radiotherapy for Extremity Soft Tissue Sarcomas: Long-Term Results from a Single Institution in Turkey

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