Abstract
Background and purpose
As treatment results for high-risk soft tissue sarcoma are still disappointing, treatment intensification is warranted. We performed a retrospective analysis of multimodal preoperative treatment to evaluate the additional effect of concurrent chemotherapy and/or locoregional hyperthermia in comparison to radiotherapy alone.
Patients and methods
Between 1999 and 2011, 28 patients were treated with neoadjuvant radiotherapy to a median 45 Gy for high-risk soft tissue sarcoma. All tumors were deep-seated and grade 2 or 3, 86% (n = 24) larger than 5 cm. Multimodal treatment (n = 12) consisted of ifosfamide (n = 7), locoregional hyperthermia (n = 3), or both modalities (n = 2) concurrent to radiotherapy.
Results
Prognostic factors (grade, size, histology, location) were balanced in the groups with and without concurrent multimodal treatment. There was a significant improvement of disease-specific survival (100% vs. 70% at 3 years, p = 0.03) with multimodal treatment. Distant metastases-free survival was influenced, but was not statistically significant. Local control and disease-free survival did not differ in the two groups.
Conclusion
Our data suggest that multimodal treatment with ifosfamide and/or locoregional hyperthermia in combination with neoadjuvant radiotherapy might improve outcome in high-risk soft tissue sarcomas.
Zusammenfassung
Hintergrund
Angesichts der limitierten Prognose von Hochrisiko-Weichteilsarkomen ergibt sich die Notwendigkeit einer Therapieintensivierung. Die simultane Gabe von Ifosfamid und/oder lokoregionaler Hyperthermie simultan zur neoadjuvanten Bestrahlung wird im Vergleich zu alleiniger Bestrahlung retrospektiv evaluiert.
Material und Methode
Im Zeitraum von 1999 bis 2011 wurden 28 Patienten neoadjuvant bestrahlt und nachfolgend operiert. Die mediane Dosis betrug 45 Gy. Alle Tumore waren subfaszial lokalisiert, 86% (n = 24) waren größer als 5 cm. Im multimodalen Konzept (n = 12) erhielten 7 Patienten eine simultane Chemotherapie mit Ifosfamid, 3 Patienten eine lokoregionale Hyperthermie und 2 Patienten wurden mit beiden Modalitäten parallel zur Strahlentherapie behandelt.
Ergebnisse
Prognostische Faktoren waren gleich verteilt. Es zeigte sich eine signifikante Verbesserung des krankheitsspezifischen Überlebens (100% vs. 70% nach 3 Jahren; p = 0,03) für die multimodale Therapie. Das metastasenfreie Überleben wurde durch die multimodale Therapie beeinflusst, jedoch ohne statistische Signifikanz. Ein Einfluss auf lokale Kontrolle und krankheitsfreies Überleben zeigte sich nicht.
Schlussfolgerung
Die Daten dieser Serie deuten auf einen möglichen Überlebensvorteil durch Ifosfamid und/oder lokoregionale Hyperthermie hin.
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Acknowledgment
The authors are grateful for the assistance of Gabriele Jany in the data management.
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On behalf of all authors, the corresponding author states that there are no conflicts of interest.
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Eckert, F., Gani, C., Kluba, T. et al. Effect of concurrent chemotherapy and hyperthermia on outcome of preoperative radiotherapy of high-risk soft tissue sarcomas. Strahlenther Onkol 189, 482–485 (2013). https://doi.org/10.1007/s00066-013-0312-7
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DOI: https://doi.org/10.1007/s00066-013-0312-7