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

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/m2/day on Days 1 to 4 and ifosfamide at a dose of 2.5 g/m2/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. Cancer 2008. ©2008 American Cancer Society.

Size-Based Clinical Response Evaluation is Insufficient to Assess Clinical Response of Sarcomas Treated with Isolated Limb Perfusion with TNF-α and Melphalan

“…In the studies that have conducted a radiological-pathological comparison and have used RECIST criteria, the predictive value of size reduction for histopathological responders was poor. [16][17][18] Similar to our results, others observed that cystic degeneration as part of posttherapeutic tumor changes are often associated with tumor size increases in pathological responders after RT. 19,20 A study by Stahl et al 21 of the hyperthermia (?…”

Hypofractionated adjuvant radiation therapy of soft-tissue sarcoma achieves excellent results in elderly patients

“…Ryan et al [14] achieved a high rate of pathological tumour necrosis (95%) following 28 Gy administered in eight fractions. We found these regimens to be intriguing and worthy of further study.…”

Evaluation of Soft Tissue Sarcoma Response to Preoperative Chemoradiotherapy Using Dynamic Contrast-Enhanced Magnetic Resonance Imaging

“…In total, 12 patients were treated with our institutional-standard chemoradiotherapy regimen consisting of ifosfamide and epirubicin (IE) combined with preoperative hypofractionated radiation (20). Each 21-day chemotherapy cycle included intravenous (I.V.)…”