Abstract
Purpose
Radical definitive surgery is the only curative treatment approach in resectable soft tissue sarcoma. Despite complete resection, patients with grade 2 and 3 soft tissue sarcoma are at high risk of local or distant recurrence. Local and systemic adjuvant treatment includes radiotherapy and chemotherapy, but the optimal scheduling is not known.
Methods
In this phase II clinical trial, we combined surgery with adjuvant chemotherapy and radiotherapy in a novel trimodality treatment sequence. Two to 6 weeks after surgery, patients received 2 cycles of chemotherapy containing doxorubicin and ifosfamide, then 50.4 Gy of percutaneous radiotherapy followed by additional 2 cycles of chemotherapy.
Results
Chemotherapy and radiotherapy-related toxicity was generally mild, without treatment delays in the majority of patients. After a median follow-up of 57 months, 81.5% of patients are alive in complete remission.
Conclusions
The sandwich chemoradiation protocol proved to be feasible with manageable toxicity. The patient outcome compared favorably with other adjuvant trials in preventing relapse, particularly distant relapse which is predictive of poor outcome. This multidisciplinary approach warrants further investigation in a larger randomized trial.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Jemal A, Siegel R, Xu J, Ward E (2010) Cancer statistics, 2010. CA Cancer J Clin 60(5):277–300. doi:10.3322/caac.20073
Lawrence W Jr, Donegan WL, Natarajan N, Mettlin C, Beart R, Winchester D (1987) Adult soft tissue sarcomas. A pattern of care survey of the American College of Surgeons. Ann Surg 205(4):349–359
Wittekind CH, Meyer HJ, Bootz F (2003) TNM, 4th edn. Springer-Verlag Inc, New York
Sarcoma meta-analysis collaboration (1997) Adjuvant chemotherapy for localised resectable soft-tissue sarcoma of adults: meta-analysis of individual data. Lancet 350(9092):1647–1654
Pervaiz N, Colterjohn N, Farrokhyar F, Tozer R, Figueredo A, Ghert M (2008) A systematic meta-analysis of randomized controlled trials of adjuvant chemotherapy for localized resectable soft-tissue sarcoma. Cancer 113(3):573–581. doi:10.1002/cncr.23592
Coindre JM, Trojani M, Contesso G, David M, Rouesse J, Bui NB, Bodaert A, De Mascarel I, De Mascarel A, Goussot JF (1986) Reproducibility of a histopathologic grading system for adult soft tissue sarcoma. Cancer 58(2):306–309
Antman KH (1997) Adjuvant therapy of sarcomas of soft tissue. Semin Oncol 24(5):556–560
Cormier JN, Huang X, Xing Y, Thall PF, Wang X, Benjamin RS, Pollock RE, Antonescu CR, Maki RG, Brennan MF, Pisters PW (2004) Cohort analysis of patients with localized, high-risk, extremity soft tissue sarcoma treated at two cancer centers: chemotherapy-associated outcomes. J Clin Oncol 22(22):4567–4574. doi:10.1200/JCO.2004.02.057
Frustaci S, Gherlinzoni F, De Paoli A, Bonetti M, Azzarelli A, Comandone A, Olmi P, Buonadonna A, Pignatti G, Barbieri E, Apice G, Zmerly H, Serraino D, Picci P (2001) Adjuvant chemotherapy for adult soft tissue sarcomas of the extremities and girdles: results of the Italian randomized cooperative trial. J Clin Oncol 19(5):1238–1247
Petrioli R, Coratti A, Correale P, D’Aniello C, Grimaldi L, Tanzini G, Civitelli S, Marsili S, Messinese S, Marzocca G, Pirtoli L, Francini G (2002) Adjuvant epirubicin with or without Ifosfamide for adult soft-tissue sarcoma. Am J Clin Oncol 25(5):468–473
Frustaci S, De Paoli A, Bidoli E, La Mura N, Berretta M, Buonadonna A, Boz G, Gherlinzoni F (2003) Ifosfamide in the adjuvant therapy of soft tissue sarcomas. Oncology 65(Suppl 2):80–84. doi:10.1159/000073366
Woll PJ, van Glabbeke M, Hohenberger P et al (2007) Adjuvant chemotherapy with doxorubicin and ifosfamide in resected soft tissue sarcoma (STS): interim analysis of a randomised phase III trial (abstract). J Clin Oncol 25:547s
Le Cesne A, Van Glabbeke M, Woll PJ (2008) The end of adjuvant chemotherapy era with doxorubicin-based regimen in resected high-grade soft tissue sarcoma: pooled analysis of the two STBSG-EORTC phase III clinical trials (abstract). J Clin Oncol 26:559s
Casali PG, Blay JY (2010) Soft tissue sarcomas: ESMO clinical practice guidelines for diagnosis, treatment and follow-up. Ann Oncol 21(Suppl 5):v198–v203. doi:10.1093/annonc/mdq209
Author information
Authors and Affiliations
Corresponding authors
Additional information
The authors Wolfgang E. Berdel and Michael Thomas contributed equally and share senior authorship.
Rights and permissions
About this article
Cite this article
Brandts, C.H., Schulz, C., Willich, N. et al. Adjuvant therapy for resectable high-risk soft tissue sarcoma: feasibility and efficacy of a sandwich chemoradiotherapy strategy. Cancer Chemother Pharmacol 69, 613–620 (2012). https://doi.org/10.1007/s00280-011-1731-8
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00280-011-1731-8