Analysis of a neoadjuvant regimen with a fixed dose of doxorubicin followed by a 10-day course of 27 Gy radiation in the treatment of soft tissue sarcoma (STS) of the extremity/trunk.

Abstract

10037 Background: Local tumor control and preservation of limb function are major goals of treatment of STS. With current standard of combining limb-sparing surgery and 5-6 weeks of neoadjuvant or adjuvant 50-65 Gy radiation, reducing local recurrence has been a challenge with rates of 15-30%. Eilber et al. (Cancer Treatment Symposia 1985; 3:49-57) used a fixed daily dose of doxorubicin for three days with radiation of 35Gy. This yielded a 5% local recurrence, while wound complication rate was 35 %. We reduced the radiation dose to lower the wound complications rate. We report a cohort of patients treated in this manner at our institution. Methods: After a baseline echocardiogram, patients received a radiosensitizing dose of intravenous doxorubicin (30mg/day) for 3 consecutive days, then radiation with 2.7 Gy in 10 fractions, followed by limb sparing surgery. After IRB approval, we retrospectively analyzed records of 191 patients during the treatment period from 1991 to 2010. Data extracted included local tumor recurrences and wound complications defined as non-healed wound at 1 month, number of limb salvage surgeries and involvement of surgical margins. Results: Of the 191 patients, median age was 53 (range, 13-89). Stages at presentation included I, II, III and IV, with 2%, 33%, 61%, 4% respectively. The median follow up was 5 years. Of the 24 types of sarcomas treated, pleomorphic sarcoma was the most common at 21%. The local recurrence rate was 5% (95% CI, 2.7-8.6%) and local wound complications were 21% (95% CI, 15-28%). Most (172 or 90%) of patients were able to undergo limb salvage surgery while 19 (10%) required amputation. Of the 172 patients that had limb salvage, 97% (95% CI, 93-98%) had wide surgical margins, three had < 2 cm margins and two had involved margins. Conclusions: To our knowledge, this is the largest study showing that this short two week course of chemoradiation is effective in achieving high rate of local control, acceptable wound complication rate, wide surgical margins and limb salvage in the treatment of STS. Randomized trials are warranted to confirm results.