Skip to main content
SpringerLink
Log in

Intensified adjuvant IFADIC chemotherapy in combination with radiotherapy versus radiotherapy alone for soft tissue sarcoma: long-term follow-up of a prospective randomized feasibility trial

Intensivierte adjuvante IFADIC Chemotherapie in Kombination mit Radiotherapie versus Radiotherapie alleine für Weichteilsarkome: Langzeit-Verlaufskontrolle einer prospektiven randomisierten Machbarkeitsstudie

  • Original article
  • Published:
Wiener klinische Wochenschrift Aims and scope Submit manuscript

Zusammenfassung

Adjuvante Chemotherapie für Patienten mit Weichteilsarkom Grad 2 und 3 muss nach wie vor als experimentell erachtet werden. Neunundfünfzig Patienten wurden primär weit oder knapp im gesunden exzidiert und wurden anschließend in den Radiotherapiearm oder in den Therapiearm mit Radiotherapie und Chemotherapie randomisiert eingeschlossen. Die Chemotherapie, bestehend aus sechs Zyklen Ifosfamid, DTIC und Doxorubicin, wurde alle 14 Tage verabreicht. Zusätzlich erfolgte eine unterstützende Therapie mit G-CSF an den Tagen 5–13. Achtundzwanzig Patienten erhielten Radiotherapie (Kontrollgruppe) und 31 Patienten wurden mit zusätzlicher Chemotherapie behandelt. Nach einer medianen Observationszeit von 97 Monaten (Range: 13–158 Monate), wurden 58 Patienten verlaufskontrolliert. Es wurden Langzeit rezidivfreies Überleben (RFS), lokalrezidivfreies Überleben (TLF), fernmetastasenfreies Überleben (TDF) und Gesamtüberleben (OS) evaluiert. Fünfzehn Patienten (56 %) in der Kontrollgruppe vs. 19 Patienten (61 %) in der Chemotherapiegruppe waren rezidivfrei. Innerhalb der Kontrollgruppe erlitten 12 Patienten (44 %) ein Tumorrezidiv vs. 12 Patienten (39 %) in der Chemotherapiegruppe. Es zeigte sich kein signifikanter Unterschied für RFS (P = 0,87), TLF (P = 0,58), TDF (P = 0,60) und OS (P = 0,99) zwischen den zwei Gruppen. Adjuvante Chemotherapie ergab keinen signifikanten Benefit betreffend RFS, TLF, TDF, und OS für Patienten mit Weichteilsarkom.

Summary

Adjuvant chemotherapy for grade 2 and 3 soft tissue sarcoma (STS) patients still has to be considered experimental. Fifty-nine patients underwent primary surgery by wide or marginal excision and were subsequently randomized to receive radiotherapy alone or in combination with six courses of chemotherapy consisting of ifosfamide, DTIC, and doxorubicin administered in 14-day intervals supported by G-CSF on days 5–13. Twenty-eight patients received radiotherapy (control group) and 31 patients were treated with additional chemotherapy. After a median observation period of 97 months (range: 13–158 months), 58 patients were followed up to assess long-term relapse-free survival (RFS), time to local failure (TLF), time to distant failure (TDF), and overall survival (OS). Fifteen patients (56%) in the control group vs. 19 patients (61%) in the chemotherapy group were free of disease. Within the control group, tumor relapses occurred in 12 patients (44%) vs. 12 patients (39%) in the chemotherapy group. RFS (P = 0.87), TLF (P = 0.58), TDF (P = 0.60) as well as OS (P = 0.99) did not differ significantly between the two groups. Adjuvant chemotherapy was not translated into a significant benefit concerning RFS, TLF, TDF, and OS for STS patients.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

References

  • Kasper B, Gil T, Awada A. Treatment of patients with advanced soft tissue sarcoma: disappointment or challenge? Curr Opin Oncol 2007;19:336–40

    Article  CAS  PubMed  Google Scholar 

  • Singer S, Demetri GD, Baldini EH, Fletcher CD. Management of soft-tissue sarcomas: an overview and update. Lancet Oncol 2000;1:75–85

    Article  CAS  PubMed  Google Scholar 

  • O'Sullivan B, Davis AM, Turcotte R, Bell R, Catton C, Chabot P, et al. Preoperative versus postoperative radiotherapy in soft-tissue sarcoma of the limbs: a randomized trial. Lancet 2002;359:2235–41

    Article  PubMed  Google Scholar 

  • Yang JC, Chang AE, Baker AR, Sindelar WF, Danforth DN, Topalian SL, et al. Randomized prospective study of the benefit of adjuvant radiation therapy in the treatment of soft tissue sarcomas of the extremity. J Clin Oncol 1998;16:197–203

    CAS  PubMed  Google Scholar 

  • Suit HD, Mankin HJ, Wood WC, Proppe KH. Preoperative, intraoperative, and postoperative radiation in the treatment of primary soft tissue sarcoma. Cancer 1985;55:2659–67

    Article  CAS  PubMed  Google Scholar 

  • Pisters PW, Harrison LB, Leung DH, Woodruff JM, Casper ES, Brennan EF. Long-term results of a prospective randomized trial of brachytherapy in soft tissue sarcoma. J Clin Oncol 1996;14:859–68

    CAS  PubMed  Google Scholar 

  • Rydholm A, Gustafson P, Rooser B, Willen H, Akerman M, Herrlin K, et al. Limb-sparing surgery without radiation therapy based on anatomic location of soft tissue sarcoma. J Clin Oncol 1991;9:1757–65

    CAS  PubMed  Google Scholar 

  • Stinson SF, DeLaney TF, Greenberg J, Yang JC, Lampert MH, Hicks JE, et al. Acute and long term effects on limb function of combined modality limb sparing therapy for extremity soft tissue sarcoma. Int J Radiat Oncol Biol Phys 1991;21:1493–9

    Article  CAS  PubMed  Google Scholar 

  • Spiro IJ, Gebhardt MC, Jennings LC, Mankin HJ, Harmon DC, Suit HD. Prognostic factors for local control of sarcomas of the soft tissues managed by radiation and surgery. Semin Oncol 1997;24:540–6

    CAS  PubMed  Google Scholar 

  • Brodowicz T, Schwameis E, Widder J, Amann G, Wilschke C, Dominkus M, et al. Intensified adjuvant IFADIC chemotherapy for adult soft tissue sarcoma: a prospective randomized feasibility trial. Sarcoma 2000;4:151–60

    CAS  PubMed  Google Scholar 

  • Enzinger FM, Weiss SW. Soft tissue tumors, 3rd ed. St. Louis: Mosby-Year Book Inc.; 1995

    Google Scholar 

  • Fletcher CDM. Diagnostic histopathology of tumors, Vol. I and II, 1st ed. Hong Kong: Churchill Livingstone; 1995

    Google Scholar 

  • Grobmyer SR, Maki RG, Demetri GD, Mazumdar M, Riedel E, Brennan MF, et al. Neo-adjuvant chemotherapy for primary high-grade extremity soft tissue sarcoma. Ann Oncol 2004;15:1667–72

    Article  CAS  PubMed  Google Scholar 

  • Frustaci S, Gherlinzoni F, De Paoli A, Bonetti M, Azzarelli A, Comandone A, et al. Adjuvant chemotherapy for adult soft tissue sarcomas of the extremities and girdles: results of the Italian Randomized Cooperative Trial. J Clin Oncol 2001;9:1238–47

    Google Scholar 

  • Schönfeld DA, Rosenbaum C, Horton J, Wolter JM, Falkson G, DeConti RC. A comparison of adriamycin versus vincristin and adriamycin, and cyclophosphamid versus vincristin and adriamycin D, and cyclophosphamid for advanced sarcomas. Cancer 1982;50:2757–62

    Article  Google Scholar 

  • Gherlinzoni F, Pignatti G, Fontana M, Giunti A. Soft tissue sarcomas: the experience at the Istituto Ortopedico Rizzoli. Chir Organi Mov 1990;75:150–4

    CAS  PubMed  Google Scholar 

  • Ravaud A, Bui NB, Coindre JM. Adjuvant chemotherapy with cyvadic in high risk soft tissue sarcoma: a randomized prospective trial. In: Salmon SE, editor. Adjuvant therapy of cancer VI. Philadelphia, PA: WB Saunders; 1990. pp. 556–66

    Google Scholar 

  • Sarcoma Meta-analysis Collaboration. Adjuvant chemotherapy for localised resectable soft-tissue sarcoma of adults. Meta-analysis of individual data. Lancet 1997;350:1647–54

    Article  Google Scholar 

  • Bramwell VHC. Adjuvant chemotherapy for adult soft tissue sarcoma: is there a standard of care? J Clin Oncol 2001;19:1235–7

    CAS  PubMed  Google Scholar 

  • Petrioli R, Coratti A, Correale P, D'Aniello C, Grimaldi L, Tanzini G, et al. Adjuvant epirubicin with or without ifosfamide for adult soft-tissue sarcoma. Am J Clin Oncol 2002;25:468–73

    Article  PubMed  Google Scholar 

  • Frustaci S, De Paoli A, Bidoli E, La Mura N, Berretta M, Buonadonna A, et al. Ifosfamide in the adjuvant therapy of soft tissue sarcoma. Oncology 2003;65:80–4

    Article  CAS  PubMed  Google Scholar 

  • Woll PJ, van Glabbeke M, Hohenberger P. Adjuvant chemotherapy with doxorubicin and ifosfamide in resected soft tissue sarcoma: interim analysis of a randomised phase III trial. J Clin Oncol 2007; 25[Suppl; abstr 10008]:18s

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Clinical Division of Oncology, Department of Internal Medicine I, Medical University Vienna, Vienna, Austria

    Negar Fakhrai, Claudia Ebm, Wolfgang J. Kostler, Christoph C. Zielinski & Thomas Brodowicz

  2. Department of Radiology, Medical University Vienna, Vienna, Austria

    Negar Fakhrai & Marion Jantsch

  3. Department of Orthopaedic Surgery, Medical University Vienna, Vienna, Austria

    Farshid Abdolvahab & Martin Dominkus

  4. Department of Radiotherapy and Radiobiology, Medical University Vienna, Vienna, Austria

    Boris Pokrajac & Daniela Kauer-Dorner

  5. Chair for Medical Experimental Oncology and Ludwig Boltzmann Institute for Clinical Experimental Oncology, Vienna, Austria

    Christoph C. Zielinski

Authors
  1. Negar Fakhrai
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Claudia Ebm
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Wolfgang J. Kostler
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Marion Jantsch
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Farshid Abdolvahab
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Martin Dominkus
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Boris Pokrajac
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Daniela Kauer-Dorner
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Christoph C. Zielinski
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Thomas Brodowicz
    View author publications

    You can also search for this author in PubMed Google Scholar

Consortia

for the Austrian Cooperative Soft Tissue Sarcoma Study Group

Corresponding author

Correspondence to Negar Fakhrai.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Fakhrai, N., Ebm, C., Kostler, W. et al. Intensified adjuvant IFADIC chemotherapy in combination with radiotherapy versus radiotherapy alone for soft tissue sarcoma: long-term follow-up of a prospective randomized feasibility trial. Wien Klin Wochenschr 122, 614–619 (2010). https://doi.org/10.1007/s00508-010-1472-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00508-010-1472-4

Keywords

Search

Navigation