Histologic response of dose-intense chemotherapy with preoperative hypofractionated radiotherapy for patients with high-risk soft tissue sarcomas

Christopher W. Ryan, Anthony G. Montag, Janet R. Hosenpud, Brian Samuels, James B. Hayden, Arthur Y. Hung, Atiya Mansoor, Terrance D. Peabody, Arno J. Mundt, Samir Undevia

Research output: Contribution to journalArticle

37 Scopus citations

Abstract

BACKGROUND. The authors studied a dose-intense regimen of epirubicin and ifosfamide with hypofractionated preoperative radiotherapy for high-risk soft tissue sarcomas. The primary objective was estimation of the rate of ≥95% pathologic necrosis. METHODS. Twenty-five patients with intermediate-grade or high-grade, localized soft tissue sarcomas of the extremity or body wall measuring >5 cm were treated with epirubicin at a dose of 30 mg/m 2/day on Days 1 to 4 and ifosfamide at a dose of 2.5 g/m 2/day on Days 1 to 4 every 21 days for 3 preoperative and 3 postoperative cycles. A total of 28 grays of radiation was administered over 8 fractions during Cycle 2 of preoperative therapy (epirubicin was omitted). RESULTS. Sixteen patients (64%) completed all chemotherapy cycles and the average delivered dose intensity relative to intended therapy was 69%. Twenty-one patients (84%) experienced grade 4 toxicity (using the National Cancer Institute Common Terminology Criteria for Adverse Events [version 2.0]), which was predominantly hematologic. Notable toxicities included neutropenic fever (40%), ifosfamide-induced encephalopathy (24%), and grade 3/4 anemia (64%). Postoperative wound complications requiring a surgical procedure occurred in 20% of patients. The rate of ≥95% pathologic necrosis was 40% (95% confidence interval [95% CI], 21-59%). Estimates of 2-year overall and disease-free survival were 84% (95% CI, 66-100%) and 62% (95% CI, 37-86%), respectively. CONCLUSIONS. A high rate of ≥95% pathologic necrosis was noted with this aggressive chemoradiotherapy regimen. The occurrence of significant acute toxicities limited the delivery of the intended dose intensity.

Original languageEnglish (US)
Pages (from-to)2432-2439
Number of pages8
JournalCancer
Volume112
Issue number11
DOIs
StatePublished - Jun 1 2008

Keywords

  • Chemoradiation
  • Chemotherapy
  • Clinical trial
  • Sarcoma

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

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