Abstract
Regional hyperthermia is considered to enhance the antitumor effects of chemotherapy and radiotherapy. In this study, we confirmed the efficacy of concomitant radiotherapy, hyperthermia, and chemotherapy (RHC) for neoadjuvant treatment of malignant soft tissue sarcoma (STS). From 1994 to 2013, we performed RHC in 150 patients. This study was limited to 60 patients using the following exclusion criteria: salvage for recurrence or unplanned excision, trunk location, metastasis at initiation, non‐STS, and no definitive surgery. As a control group, we collected data from 11,031 patients in the Bone and Soft Tissue Tumor Registry in Japan (BSTT). We performed multivariate logistic regression analysis, and propensity scores were created for comparisons between groups. The primary outcome of this study was to compare oncologic outcomes (5‐year local control rate [LC] and overall survival rate [OS]). In the RHC group, two local recurrences (3.3%) occurred, and no patients underwent amputation. Margins of definitive surgery were not identical between groups [wide margins (60.0% vs. 85.3%), marginal margins (28.3% vs. 10.5%), and intralesional margins (7.4% vs. 4.2%), RHC and BSTT groups, respectively, P < 0.001]. After adjustment, the difference in OS was not significant between groups (HR = 1.26, P = 0.532); however, a statistically significant difference in LC was observed (HR = 4.82, P = 0.037). RHC resulted in a high LC at 5 years compared to the BSTT group, and amputation was averted in the RHC group, despite the wider margins in the BSTT group. This indicates that less invasive surgery might be achieved with effective neoadjuvant therapy.
Highlights
Soft tissue sarcoma (STS) is an extremely rare disease, with an annual incidence of three per 100,000 people, accounting for ≤1% of all malignant tumors [1]
Data from the no neoadjuvant therapy subgroup, radiotherapy subgroup, and radiotherapy + chemotherapy subgroup were extracted from the whole BSTT group to determine the Hyperthermia refers to heating tumors, tissues, or systems to temperatures of up to 42°C, either to sensitize tissue to conventional treatments or to induce tumor regression [14]
Hyperthermia is thought to enhance the antitumor activity of agents such as bleomycin [3], CDDP [4], and ADR [5, 6] by inhibiting their excretion and/or augmenting cancer cell sensitivity to these agents. Both in vitro and in vivo studies have shown that hyperthermia has synergistic effects with radiotherapy
Summary
Soft tissue sarcoma (STS) is an extremely rare disease, with an annual incidence of three per 100,000 people, accounting for ≤1% of all malignant tumors [1]. About 60–70% of STS lesions are located in the extremities [2]. The primary goal of therapy for extremity STS is complete tumor resection with a negative margin. Clinicians are sometimes distressed when making the choice between sacrificing neurovascular bundles and/or amputation and preserving function, especially for tumors located near c ritical areas for function or circulation. Regional hyperthermia is considered to enhance the antitumor effects of chemotherapy and radiotherapy by compensating for the weak points of these therapies [3,4,5,6,7,8]. The prospective randomized multicenter EORTC (European Organisation of Research and Treatment of Cancer) 62,691 trial revealed that adding hyperthermia to chemotherapy (etoposide [VP-16] + ifosfamide [IFO] + doxorubicin [ADR]; EIA) provided a benefit to patients with high-risk
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