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

Eric Lu, Kelly S. Perlewitz, James Hayden, Arthur Hung, Yee-Cheen Doung, Lara Davis, Atiya Mansoor, John Vetto, Kevin Billingsley, Andy Kaempf, Byung Park, Christopher Ryan

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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 CloseSPigtSPi 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.

Original languageEnglish (US)
Pages (from-to)920-927
Number of pages8
JournalAnnals of Surgical Oncology
Volume25
Issue number4
DOIs
StatePublished - Apr 1 2018

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Epirubicin
Ifosfamide
Sarcoma
Radiation
Extremities
Survival Rate
Drug Therapy
Therapeutics
Disease-Free Survival
Recurrence
Wounds and Injuries
Population
Neoplasms

ASJC Scopus subject areas

  • Surgery
  • Oncology

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Epirubicin and Ifosfamide with Preoperative Radiation for High-Risk Soft Tissue Sarcomas. / Lu, Eric; Perlewitz, Kelly S.; Hayden, James; Hung, Arthur; Doung, Yee-Cheen; Davis, Lara; Mansoor, Atiya; Vetto, John; Billingsley, Kevin; Kaempf, Andy; Park, Byung; Ryan, Christopher.

In: Annals of Surgical Oncology, Vol. 25, No. 4, 01.04.2018, p. 920-927.

Research output: Contribution to journalArticle

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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 CloseSPigtSPi 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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T1 - Epirubicin and Ifosfamide with Preoperative Radiation for High-Risk Soft Tissue Sarcomas

AU - Lu, Eric

AU - Perlewitz, Kelly S.

AU - Hayden, James

AU - Hung, Arthur

AU - Doung, Yee-Cheen

AU - Davis, Lara

AU - Mansoor, Atiya

AU - Vetto, John

AU - Billingsley, Kevin

AU - Kaempf, Andy

AU - Park, Byung

AU - Ryan, Christopher

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N2 - 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 CloseSPigtSPi 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.

AB - 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 CloseSPigtSPi 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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