First report of outcomes with neoadjuvant chemoradiotherapy (NCR) using weekly intravenous (IV) cisplatin with radiation (NCWR) for treatment of stage II and III extremity soft tissue sarcoma (STS).

Abstract

10075 Background: NCR prior to resection of STS is used routinely at our institution. Outcomes with NCR are compared to neoadjuvant radiation (NR) or surgery alone (SA). In addition, the initial experience with NCWR as a preoperative regimen is described. Methods: A retrospective chart review was performed. 101 patients (pts) were identified with stage II and III extremity STS treated at Mayo Clinic Arizona between 1998 and 2008. Treatments included SA (34 pts), NCR (31 pts), and NR (36 pts). A variety of chemotherapy regimens were used initially; 15 pts in the NCR group received NCWR. Cisplatin doses were 20-40 mg/m2 IV weekly. Time to failure analyses were calculated from date of first contact. Kaplan-Meier, chi-square, and logistic regression analyses were used. The median overall follow- up time was 24.2 months (mos). Results: Pts treated with NCR and NR were significantly more likely to have tumors > 5 cm compared to pts treated with SA (84% vs. 45%; p<0.001). Nevertheless, rates of margin-negative resection, local-regional relapse free survival, distant metastases free survival and overall survival (OS) were not different among the groups. The rate of limb amputation was significantly decreased for pts treated with NCR compared to SA (10% vs. 38%; p=0.009). For pts with tumors > 5 cm, a trend to improved OS was observed with NCR compared to SA (40.2 mos vs. 29.2 mos; p=0.08). NCR produced higher rates of wound complications compared to SA (53% vs. 9%; p<0.0001) but was not significantly different from NR (43%, p=0.4). Tumor size > 5 cm also was a significant independent risk factor for wound complications (OR 12.37; p=0.035). Acute toxicities such as wet desquamation were not significantly different between NCR and NR. All NCWR-treated pts undergoing surgery had margin-negative resections and no local-regional relapses, and 14/15 pts had limb preservation. Conclusions: NCR is a useful strategy for extremity STS and does not increase complications compared to NR. NCWR is well-tolerated, straightforward to deliver, and has excellent local control results in the initial patient cohort. The NCWR regimen warrants further study. No significant financial relationships to disclose.