Feasibility study of postoperative adjuvant chemotherapy and radiotherapy for soft-tissue sarcoma.
In a nonrandomized trial, postoperative, adjuvant, combined chemotherapy and radiotherapy were given to 17 patients with high-grade soft-tissue sarcomas. All patients had undergone conservative limb-sparing surgery. Soft-tissue sarcomas were localized in the extremities (13 patients), superficial trunk (3), and neck (1). In all, 13 patients received 50 mg/m2 doxorubicin and 5 g/m2 ifosfamide with mesna uroprotection for a total of 6 cycles and 4 patients received CYVADIC (cyclophosphamide/vincristine/doxorubicin/dacarbazine). Chemotherapy was started immediately after wound healing. Irradiation using the shrinking-field technique was commenced 3-7 days following chemotherapy; a total dose of 65 Gy was applied. The major side effects of chemotherapy were nausea and vomiting [17 of 17 patients, 5 experiencing World Health Organization (WHO) grade 3 toxicity and 1, WHO grade 4], leukopenia of <3.0 x 10(9)/l (17 patients), and leukopenia of <1.0 x 10(9)/l (7 patients). The median leukocyte nadir was reached on day 11 (range, days 7-16). The duration of critical leukopenia did not exceed 1 week. Reversible alopecia occurred in all patients. Temporary cardiomyopathy was recorded in 1 patient. Following radiotherapy, 11 episodes of epitheliolysis and 1 case of moderate lymphedema were documented. There was no life-threatening condition. After a follow-up of 58 months, the outcome was as follows: disease-free survival, 9 patients; distant metastases, 7; local recurrence, 1. Excluding 3 patients who entered the study after undergoing surgery for local relapse, the rate of distant metastases was 36%. In summary, the postoperative use of chemotherapy/radiotherapy is feasible, producing relevant but manageable toxicity. This combination results in effective local tumor control with good functional results following limb-sparing surgery. The incidence of distant metastases, however, is high.
Fuchs
R
R
Klinik für Hämatologie/Onkologie, St. Antonius-Hospital, Eschweiler, Federal Republic of Germany.
Schadeck-Gressel
C
C
Makoski
H B
HB
von Andrian-Werburg
H F
HF
Knieriem
H J
HJ
Westerhausen
M
M
D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D017024:Chemotherapy, Adjuvant; D003131:Combined Modality Therapy; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012509:Sarcoma / Q000188:drug therapy* / Q000532:radiotherapy* / Q000601:surgery; D012983:Soft Tissue Neoplasms / Q000188:drug therapy* / Q000532:radiotherapy* / Q000601:surgery; D016019:Survival Analysis