Abstract
Adjuvant therapy of local soft tissue sarcomas (STS) after wide surgical excision still is a topic under controversial scientific debate. In this single center report we have offered an adjuvant “sandwich” therapy protocol consisting of 4 cycles of doxorubicin (75 mg/m2 i.v. over 1 h on day 1) followed by ifosfamide (5 g/m2 i.v. over 24 h starting on day 1) and local radiotherapy scheduled between chemotherapy cycles 2 and 3 to 104 consecutive patients after wide surgical excision (R0) of histologically proven high-grade STS. After a mean follow-up of 39 months (range 5–194 months) relapse free survival (RFS) at 2 and 5 years was 68.1% (95% CI, 58.5–77.7%) and 61.2% (95% CI, 50.4–71.6%). When analyzing the 82 STS cases of the extremities only 2- and 5-year RFS was 74.0% (95% CI, 64.0–84.0%) and 65.3% (95% CI, 53.7–76.9%). By intent-to-treat analysis, the overall survival (OS) at 2 years was 87.3% (95% CI, 80.5–94.1%) and 75.6% (95% CI, 65.2–86.0%) at 5 years, while OS for STS of the extremities only cohort was 90.5% (95% CI, 83.7–97.3%) and 79.0% (95% CI, 68.4–89.6%), respectively. Tolerability of the treatment was good. This analysis demonstrates the feasibility of adjuvant chemoradiotherapy and reflects the results of the long lasting intensive multidisciplinary team approach at our “high-volume” sarcoma center. The long-term survival in our patients is among the highest reported and the low local and distant recurrence rate in high-risk STS is at least comparable to the published data.
Highlights
With the aim to find an optimal compromise between reducing the risk of distant recurrence and preventing local relapse, we have previously investigated the feasibility, toxicity and efficacy of adjuvant radiation therapy ‘‘sandwiched” in the middle of four chemotherapy cycles of doxorubicin and ifosfamide in patients with soft tissue sarcomas (STS) [11]
According to the original protocol patients with clearly resectable tumors were offered to have wide resection first followed by four cycles of chemotherapy with ifosfamide/ doxorubicin and local radiation performed between cycles 2 and 3
These represented a wide array of histologies, with the majority being undifferentiated pleomorphic sarcoma, myxofibrosarcoma and synovial sarcoma. 87/104 patients had high-risk STS with aggressive G3 tumors and 73/104 patients had a UICC stage III
Summary
Surgical resection is the standard and the only potentially curative therapy for STS [3,4,5]. A large proportion of STS patients eventually develop metastases, those with high-grade histology, large tumors and deep tumor localizations [3, 6,7,8]. Even though resection of oligometastatic disease may cure a minority of patients, the overall prognosis of disseminated STS remains highly unsatisfactory. The heterogeneity and the rarity of STS contribute to a high degree of uncertainty in terms of post-surgery treatment recommendations. There is still no consensus on the clinical value of adjuvant chemotherapy in STS, several controlled trials have been published over the last decades and have been pooled into meta-analyses [5, 9, 10]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
