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. 2010 Mar 15;76(4):1147-53.
doi: 10.1016/j.ijrobp.2009.03.015. Epub 2009 Jul 4.

Primary tumor necrosis predicts distant control in locally advanced soft-tissue sarcomas after preoperative concurrent chemoradiotherapy

Dhara M MacDermed  1 , Luke L Miller, Terrance D Peabody, Michael A Simon, Hue H Luu, Rex C Haydon, Anthony G Montag, Samir D Undevia, Philip P Connell
Affiliations

Primary tumor necrosis predicts distant control in locally advanced soft-tissue sarcomas after preoperative concurrent chemoradiotherapy

Dhara M MacDermed et al. Int J Radiat Oncol Biol Phys. .

Abstract

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 (> or =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 superior 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.

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Conflict of interest statement

Conflict of Interest Statement:

None of the authors have any actual or potential conflicts of interest to report.

Figures

Figure 1
Figure 1
Actuarial survival and freedom from distant metastasis in patients with localized disease at time of diagnosis.
Figure 2
Figure 2
Actuarial survival (A) and freedom from distant metastasis (B) based on treatment-induced necrosis rates.
Figure 2
Figure 2
Actuarial survival (A) and freedom from distant metastasis (B) based on treatment-induced necrosis rates.
See this image and copyright information in PMC

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