(Neo)adjuvant chemotherapy and interdigitated split-course hyperfractionated radiation in high risk soft tissue sarcoma \u2013 Results from a large single-institution series

Riikka Nevala,Tom Böhling,Maija Tarkkanen,Erkki Tukiainen,Carl Blomqvist,Mika Sampo

doi:10.1038/s41598-019-43794-3

Riikka Nevala, Tom Böhling + Show 4 more

Open Access

https://doi.org/10.1038/s41598-019-43794-3

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Abstract

A single-institution series using a (neo)adjuvant chemotherapy and interdigitated hyperfractionated split-course radiation therapy (CRT) treatment protocol for soft tissue sarcoma was reviewed. Our specific aims were to study recurrence rates and long-term toxicity. Between 1998 and 2016, 89 patients with non-metastatic soft tissue sarcoma were treated with surgery combined with six courses of doxorubicin and ifosfamide and hyperfractionated radiation therapy (42–60 Gy/1.5 Gy twice daily). Patients were considered being at high risk if tumour malignancy grade was high and the tumour fulfilled at least two of the following criteria: size >8 cm, presence of necrosis or vascular invasion. The mean age of the patients was 50.7 years. With a median follow-up of 5.4 years for survivors, the local control rate was 81.4%. Six (7%) patients progressed during neoadjuvant CRT. Seven (8%) patients discontinued the treatment due to toxicity. Eighty-six patients were operated and three (3%) of these developed a long-term complication. The estimated metastasis-free survival was 47.6% and overall survival 53.0% at five years. The limb-salvage rate was 93%. The limb-salvage rate, local control and complication rates were good in these patients with high risk soft tissue sarcoma. Metastases-free survival and overall survival rates were less satisfactory, reflecting the aggressive nature of these tumours.

Highlights

Treatment of soft tissue sarcoma (STS) aims to ensure adequate local control (LC) without major disability and to prevent distant metastases
We retrospectively reviewed all STS patients at high risk who received hyperfractionated split-course Radiation therapy (RT) interdigitated betweenadjuvant doxorubicin and ifosfamide with special interest on outcome and treatment-related long-term complications
The patients were highly selected, representing only 7% of the STS patients treated by our group during the same period

Summary

Introduction

Treatment of soft tissue sarcoma (STS) aims to ensure adequate local control (LC) without major disability and to prevent distant metastases. Twenty to 30% of STS patients develop metastases and most of them die from the disease[2]. Many patients with STS at high risk of developing metastatic disease are at risk of local recurrence (LR). These patients have indications for both RT and chemotherapy (CT). Delaying CT may expose the patient to growth of subclinical metastases during RT. Four to six CT cycles may enable local tumour growth of more than 100-fold, if the sarcoma does not respond to CT. We retrospectively reviewed all STS patients at high risk who received hyperfractionated split-course RT interdigitated between (neo)adjuvant doxorubicin and ifosfamide with special interest on outcome and treatment-related long-term complications

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Results

Conclusion