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Title: Primary Tumor Necrosis Predicts Distant Control in Locally Advanced Soft-Tissue Sarcomas After Preoperative Concurrent Chemoradiotherapy

Purpose: Various neoadjuvant approaches have been evaluated for the treatment of locally advanced soft-tissue sarcomas. This retrospective study describes a uniquely modified version of the Eilber regimen developed at the University of Chicago. Methods and Materials: We treated 34 patients (28 Stage III and 6 Stage IV) with locally advanced soft-tissue sarcomas of an extremity between 1995 and 2008. All patients received preoperative therapy including ifosfamide (2.5 g/m2 per day for 5 days) with concurrent radiation (28 Gy in 3.5-Gy daily fractions), sandwiched between various chemotherapy regimens. Postoperatively, 47% received further adjuvant chemotherapy. Results: Most tumors (94%) were Grade 3, and all were T2b, with a median size of 10.3 cm. Wide excision was performed in 29 patients (85%), and 5 required amputation. Of the resected tumor specimens, 50% exhibited high (>=90%) treatment-induced necrosis and 11.8% had a complete pathologic response. Surgical margins were negative in all patients. The 5-year survival rate was 42.3% for all patients and 45.2% for Stage III patients. For limb-preservation patients, the 5-year local control rate was 89.0% and reoperation was required for wound complications in 17.2%. The 5-year freedom-from-distant metastasis rate was 53.4% (Stage IV patients excluded), and freedom from distant metastasis was superiormore » if treatment-induced tumor necrosis was 90% or greater (84.6% vs. 19.9%, p = 0.02). Conclusions: This well-tolerated concurrent chemoradiotherapy approach yields excellent rates of limb preservation and local control. The resulting treatment-induced necrosis rates are predictive of subsequent metastatic risk, and this information may provide an opportunity to guide postoperative systemic therapies.« less
Authors:
 [1] ;  [2] ; ; ; ;  [3] ;  [4] ;  [5] ;  [1]
  1. Department of Radiation and Cellular Oncology, University of Chicago, Chicago, IL (United States)
  2. Pritzker School of Medicine, University of Chicago, Chicago, IL (United States)
  3. Section of Orthopaedic Surgery and Rehabilitation, Department of Surgery, University of Chicago, Chicago, IL (United States)
  4. Department of Pathology, University of Chicago, Chicago, IL (United States)
  5. Section of Hematology/Oncology, Department of Medicine, University of Chicago, Chicago, IL (United States)
Publication Date:
OSTI Identifier:
21372173
Resource Type:
Journal Article
Resource Relation:
Journal Name: International Journal of Radiation Oncology, Biology and Physics; Journal Volume: 76; Journal Issue: 4; Other Information: DOI: 10.1016/j.ijrobp.2009.03.015; PII: S0360-3016(09)00442-8; Copyright (c) 2010 Elsevier Science B.V., Amsterdam, The Netherlands, All rights reserved.
Country of Publication:
United States
Language:
English
Subject:
62 RADIOLOGY AND NUCLEAR MEDICINE; CHEMOTHERAPY; COMBINED THERAPY; METASTASES; NECROSIS; RADIOTHERAPY; SARCOMAS; WOUNDS DISEASES; INJURIES; MEDICINE; NEOPLASMS; NUCLEAR MEDICINE; PATHOLOGICAL CHANGES; RADIOLOGY; THERAPY