Neoadjuvant chemoradiation compared to neoadjuvant radiation alone and surgery alone for Stage II and III soft tissue sarcoma of the extremities.

Kelly K Curtis,Leonard L Gunderson,Tom R Fitch,Jonathan B Ashman,Matthew D Callister,Christopher P Beauchamp,Adam J Schwartz,Amylou C Dueck

doi:10.1186/1748-717x-6-91

Kelly K Curtis, Leonard L Gunderson + Show 6 more

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https://doi.org/10.1186/1748-717x-6-91

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Journal: Radiation Oncology	Publication Date: Aug 9, 2011
Citations: 29	License type: cc-by

Affiliation: Mayo Clinic, Winneshiek Medical Center

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BackgroundNeoadjuvant chemoradiation (NCR) prior to resection of extremity soft tissue sarcoma (STS) has been studied, but data are limited. We present outcomes with NCR using a variety of chemotherapy regimens compared to neoadjuvant radiation without chemotherapy (NR) and surgery alone (SA).MethodsWe conducted a retrospective chart review of 112 cases.ResultsTreatments included SA (36 patients), NCR (39 patients), and NR (37 patients). NCR did not improve the rate of margin-negative resections over SA or NR. Loco-regional relapse-free survival, distant metastases-free survival, and overall survival (OS) were not different among the treatment groups. Patients with relapsed disease (OR 11.6; p = 0.01), and tumor size greater than 5 cm (OR 9.4; p = 0.01) were more likely to have a loco-regional recurrence on logistic regression analysis. Significantly increased OS was found among NCR-treated patients with tumors greater than 5 cm compared to SA (3 year OS 69 vs. 40%; p = 0.03). Wound complication rates were higher after NCR compared to SA (50 vs. 11%; p = 0.003) but not compared to NR (p = 0.36). Wet desquamation was the most common adverse event of NCR.ConclusionsNCR and NR are acceptable strategies for patients with STS. NCR is well-tolerated, but not clearly superior to NR.

Highlights

Neoadjuvant chemoradiation (NCR) prior to resection of extremity soft tissue sarcoma (STS) has been studied, but data are limited
Previous phase III randomized trials have shown pre- and post-operative external beam irradiation (EBRT) [14,15,16,17,18,19] and peri-operative brachytherapy [20,21,22] improve LR-RFS compared to surgery alone (SA)
Despite the limitations of the methodology, the results of this study have merit. We conclude that both NCR and neoadjuvant radiation without chemotherapy (NR) result in a low rate of loco-regional relapse, high rates of limb preservation, and acceptable toxicity

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Neoadjuvant chemoradiation (NCR) prior to resection of extremity soft tissue sarcoma (STS) has been studied, but data are limited. Multi-agent chemotherapy regimens given pre-operatively with radiation include MAID (mesna, doxorubicin, ifosfamide and dacarbazine) or IMAP/MAP (ifosfamide, mitomycin, doxorubicin, and cisplatin) [5,6,7]. These strategies have shown promising results, including 5-year overall survival rates up to 70% [8,9,10,11], 5-year local control rates up to 92% [5] and limb preservation rates up to 100% [4]. Toxicities of NCR typically include wound complications, many of which require re-operation, and long bone fracture [12]

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