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Epirubicin and Ifosfamide with Preoperative Radiation for High-Risk Soft Tissue Sarcomas

  • Bone and Soft Tissue Sarcomas
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

The optimal treatment of high-risk soft tissue sarcomas (STS) of the extremities remains controversial. We report follow-up from a phase II study of dose-intense chemotherapy with preoperative hypofractionated radiation in this population supplemented with subsequent data from an extensive institutional experience using this regimen.

Methods

Patients with localized, intermediate- or high-grade STS of the extremity or body wall measuring > 5 cm were treated with epirubicin 30 mg/m2/day and ifosfamide 2.5 g/m2/day on days 1–4 every 21 days for 3 preoperative and 3 postoperative cycles. During cycle 2 of preoperative therapy, epirubicin was omitted, and a total of 28 Gy of radiation (8 fractions) was delivered. Twenty-five patients were treated on the phase II study (2002–2005). Fifty-one additional patients were identified from a retrospective chart review (2005–2014).

Results

The 5-year rates for overall survival, distant disease-free survival, and freedom from local regional failure were 70.4% (95% CI 59.2–83.7%), 55.9% (95% CI 44.5–70.2%), and 87.2% (95% CI 77.9–96.5%) respectively. Thirty-eight percent of tumors (29/76) demonstrated ≥ 90% pathologic response. Wound complications occurred in 32% (24/76) of patients.

Discussion

Treatment with preoperative radiation and pre- and post-operative epirubicin and ifosfamide was associated with favorable clinical outcomes. Survival and recurrence rates were comparable to those reported with other preoperative chemotherapy regimens in high-risk extremity sarcomas. Use of trimodality therapy should be considered for appropriate high-risk STS patients.

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Authors and Affiliations

  1. Department of Medicine, Oregon Health and Science University, Portland, OR, USA

    Eric Lu MD

  2. Providence Cancer Institute, Newberg, OR, USA

    Kelly S. Perlewitz MD

  3. Department of Orthopedics, Oregon Health and Science University, Portland, OR, USA

    James B. Hayden MD, PhD & Yee-Cheen Doung MD

  4. Department of Radiation Medicine, Knight Cancer Institute, Oregon Health and Science University, Portland, OR, USA

    Arthur Y. Hung MD

  5. Division of Hematology and Medical Oncology, Knight Cancer Institute, Oregon Health and Science University, Portland, OR, USA

    Lara E. Davis MD & Christopher W. Ryan MD

  6. Department of Anatomical Pathology, Oregon Health and Science University, Portland, OR, USA

    Atiya Mansoor MD

  7. Department of Surgery, Division of Surgical Oncology, Oregon Health and Science University, Portland, OR, USA

    John T. Vetto MD & Kevin G. Billingsley MD

  8. Biostatistics, Knight Cancer Institute, Oregon Health and Science University, Portland, OR, USA

    Andy Kaempf MS & Byung Park PhD

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Correspondence to Christopher W. Ryan MD.

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Lu, E., Perlewitz, K.S., Hayden, J.B. et al. Epirubicin and Ifosfamide with Preoperative Radiation for High-Risk Soft Tissue Sarcomas. Ann Surg Oncol 25, 920–927 (2018). https://doi.org/10.1245/s10434-018-6346-4

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