Neoadjuvant chemotherapy and radiotherapy for large extremity soft-tissue sarcomas

Thomas F. DeLaney, Ira J. Spiro, Herman D. Suit, Mark C. Gebhardt, Francis J. Hornicek, Henry J. Mankin, Andrew Rosenberg, Daniel I. Rosenthal, Fariba Miryousefi, Marcus Ancukiewicz, David C. Harmon

Research output: Contribution to journalArticle

208 Citations (Scopus)

Abstract

Purpose: Treatment of extremity soft-tissue sarcomas yields excellent local control, but distant failure is common with large, high-grade tumors. A regimen of preoperative chemotherapy consisting of mesna, adriamycin, ifosfamide, and dacarbazine (MAID) interdigitated with radiotherapy followed by resection and postoperative chemotherapy with or without radiotherapy was designed to improve treatment outcome. We report the mature outcome data on 48 treated patients and compare them with the data of an historical matched control patient population. Methods and Materials: Adult patients with high-grade extremity soft-tissue sarcomas ≥8 cm were treated with three cycles of preoperative chemotherapy combined with 44 Gy of radiotherapy followed by surgery. Three cycles of postoperative MAID were planned. For patients with positive surgical margins, 16 Gy was delivered postoperatively. Results: All 48 patients (M0) received the MAID protocol treatment, and their outcome was superior to that of the historical control patients. The 5-year actuarial local control, freedom from distant metastasis, disease-free survival, and overall survival rate was 92% and 86% (p = 0.1155), 75% and 44% (p = 0.0016), 70% and 42% (p = 0.0002), and 87% and 58% (p = 0.0003) for the MAID and control patient groups, respectively. Acute hematologic toxicity in the MAID group included febrile neutropenia in 12 patients (25%). Wound healing complications occurred in 14 (29%) of 48 MAID patients. One MAID patient developed late fatal myelodysplasia. Conclusion: After aggressive chemoradiation and surgery, these patients showed a significant reduction in distant metastases, with a highly significant gain in disease-free and overall survival compared with a historical control group. On the basis of this experience, the Radiation Therapy Oncology Group conducted a multi-institutional trial.

Original languageEnglish
Pages (from-to)1117-1127
Number of pages11
JournalInternational Journal of Radiation Oncology Biology Physics
Volume56
Issue number4
DOIs
StatePublished - Jul 15 2003
Externally publishedYes

Fingerprint

chemotherapy
Sarcoma
Mesna
radiation therapy
Dacarbazine
Radiotherapy
Ifosfamide
Extremities
cancer
Drug Therapy
Doxorubicin
metastasis
surgery
Disease-Free Survival
grade
Neoplasm Metastasis
wound healing
Febrile Neutropenia
Control Groups
cycles

Keywords

  • Adjuvant therapy
  • Soft tissue sarcoma

ASJC Scopus subject areas

  • Oncology
  • Radiology Nuclear Medicine and imaging
  • Radiation

Cite this

DeLaney, T. F., Spiro, I. J., Suit, H. D., Gebhardt, M. C., Hornicek, F. J., Mankin, H. J., ... Harmon, D. C. (2003). Neoadjuvant chemotherapy and radiotherapy for large extremity soft-tissue sarcomas. International Journal of Radiation Oncology Biology Physics, 56(4), 1117-1127. https://doi.org/10.1016/S0360-3016(03)00186-X

Neoadjuvant chemotherapy and radiotherapy for large extremity soft-tissue sarcomas. / DeLaney, Thomas F.; Spiro, Ira J.; Suit, Herman D.; Gebhardt, Mark C.; Hornicek, Francis J.; Mankin, Henry J.; Rosenberg, Andrew; Rosenthal, Daniel I.; Miryousefi, Fariba; Ancukiewicz, Marcus; Harmon, David C.

In: International Journal of Radiation Oncology Biology Physics, Vol. 56, No. 4, 15.07.2003, p. 1117-1127.

Research output: Contribution to journalArticle

DeLaney, TF, Spiro, IJ, Suit, HD, Gebhardt, MC, Hornicek, FJ, Mankin, HJ, Rosenberg, A, Rosenthal, DI, Miryousefi, F, Ancukiewicz, M & Harmon, DC 2003, 'Neoadjuvant chemotherapy and radiotherapy for large extremity soft-tissue sarcomas', International Journal of Radiation Oncology Biology Physics, vol. 56, no. 4, pp. 1117-1127. https://doi.org/10.1016/S0360-3016(03)00186-X
DeLaney, Thomas F. ; Spiro, Ira J. ; Suit, Herman D. ; Gebhardt, Mark C. ; Hornicek, Francis J. ; Mankin, Henry J. ; Rosenberg, Andrew ; Rosenthal, Daniel I. ; Miryousefi, Fariba ; Ancukiewicz, Marcus ; Harmon, David C. / Neoadjuvant chemotherapy and radiotherapy for large extremity soft-tissue sarcomas. In: International Journal of Radiation Oncology Biology Physics. 2003 ; Vol. 56, No. 4. pp. 1117-1127.
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AU - Hornicek, Francis J.

AU - Mankin, Henry J.

AU - Rosenberg, Andrew

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