Abstract
Background
The introduction of a combined-modality approach, which added chemotherapy to local therapy (surgery and radiotherapy), has been controversial. We present our experience of the efficacy of neoadjuvant chemotherapy in patients with high-risk sarcomas and evaluate the benefit of intra-arterial (IA) chemotherapy.
Patients and methods
Forty patients with intermediate to high-grade soft tissue sarcomas (STS) were treated with neoadjuvant chemotherapy from 1994 to 2001 at the Institut Curie. Thirty-seven patients had localized tumours. Neoadjuvant intravenous (IV) chemotherapy consisted of 4–6 cycles of treatment (mainly CYVADIC, MAID). Sixteen patients (40%) received 2 cycles of IA chemotherapy with a combination of adriamycin and cisplatin. Radiotherapy was delivered in an adjuvant setting.
Results
All patients underwent limb-sparing surgical resection after neoadjuvant therapy and pathologic assessment of tumour necrosis was performed on the resected specimens. Two groups of tumours were analysed: 1–95% (28 cases), and 95–100% (10 cases) of pathological necrosis, with a survival benefit in the group with more than 95% necrosis (p = 0.07). IA chemotherapy was superior to IV chemotherapy in terms of the necrosis rate (p = 0.045). With a median follow-up of 51 months, the 2-year overall survival rate was 90% for localized tumours.
Conclusion
Neoadjuvant chemotherapy can be considered to be effective in the treatment of STS. This study demonstrates the benefit of neoadjuvant therapy for patients with a high necrosis rate (very clear tendency) and the contribution of IA chemotherapy to the response rate, but with no survival advantage.
Similar content being viewed by others
References
Rosen G (1982) Preoperative chemotherapy for osteogenic sarcoma: selection of postoperative adjuvant chemotherapy based on the response of the primary tumor to preoperative chemotherapy. Cancer 49:1221–1230
Wunder JS (1998) The histological response to chemotherapy as a predictor of the oncological outcome of operative treatment of Ewing sarcoma. J Bone Joint Surg Am 80:1020–1033
Picci P (1997) Chemotherapy-induced tumor necrosis as a prognostic factor in localized Ewing’s sarcoma of the extremities. J Clin Onco 15:1553–1559
Eilber FC (2001) Treatment-induced pathologic necrosis: a predictor of local recurrence and survival in patients receiving neoadjuvant therapy for high-grade extremity soft tissue sarcomas. J Clin Oncol 19:3203–3209
Rosenberg SA (1982) The treatment of soft-tissue sarcomas of the extremities prospective randomized evaluations of (1) limb-sparing surgery plus radiation therapy compared with amputation and (2) the role of adjuvant chemotherapy. Ann Surg 196:305–314
Rahoty P (1993) Konya A: results of preoperative neoadjuvant chemotherapy and surgery in the management of patients with soft tissue sarcoma. Eur J Surg Oncol 19:641–645
Picci P (1993) Prognostic significance of histopathologic response to chemotherapy in nonmetastatic Ewing’s sarcoma of the extremity. J Clin Oncol 11:1763–1769
Casper ES (1994) Preoperative and postoperative adjuvant combination chemotherapy for adults with high grade soft tissue sarcoma. Cancer 73:1644–1651
Hajdu SI (1988) The role of the pathologist in the management of soft tissue sarcomas. World J Surg 12:326–331
Pisters PW (1999) Chemoradiation treatment strategies for localized sarcoma: conventional and investigational approaches. Semin Surg Oncol 17:66–71
Zagars GK (2003) Preoperative vs. postoperative radiation therapy for soft tissue sarcoma: a retrospective comparative evaluation of disease outcome. Int J Radiat Oncol Biol Phys 56:482–428
Wanebo HJ (1995) Preoperative regional therapy for extremity sarcoma. A tricenter update. Cancer 75:2299–2306
Eilber F, Giuliano A, Huth J, Mirra J (1988) Neoadjuvant chemotherapy, radiation, and limited surgery for high grade soft tissue sarcoma of the extremity. In: Ryan JR, Baker LH (eds) Recent concepts in sarcoma treatment. Kluwer, Dordrecht, p 115
Levine EA (1993) Preoperative multimodality treatment for soft tissue sarcomas. Cancer 71:3685–3689
Coindre J (1996) Prognostic factors in adult patients with locally controlled soft tissue sarcoma: a study of 546 patients from the French Federation of Cancer Centers Sarcoma Group. J Clin Oncol 14:869–877
Pezzi CM (1990) Preoperative chemotherapy for soft-tissue sarcomas of the extremities. Ann Surg 211:476–481
Fleming ID (1997) AJCC cancer staging manual, 5th edn. Lippincott-Raven, Philadelphia, p 131
Patel SR (1999) New chemotherapeutic strategies for soft tissue sarcomas. Semin Surg Oncol 17:47–51
Conflict of interest statement
No funds were received in support of this study.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Guetz, G.D., Alapetite, C., Anract, P. et al. Neoadjuvant chemotherapy for adult soft tissue sarcoma: comparaison of systemic and intra-arterial chemotherapy. Eur J Orthop Surg Traumatol 18, 455–459 (2008). https://doi.org/10.1007/s00590-008-0329-2
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00590-008-0329-2