Preoperative chemoradiotherapy (modified Eilber protocol) provides maximum local control and minimal morbidity in patients with soft tissue sarcoma.
BACKGROUND
Local recurrence rates of 15% to 30% after treatment of soft tissue sarcoma (STS) are still common but unacceptable. Our hypothesis was that a refined neoadjuvant chemotherapy and radiation protocol (modified Eilber protocol) improves local control rates while minimizing major morbidity.


METHODS
Consecutive patients with STS deep to the fascia of the extremity or trunk during 1984 to 1996 were treated with 3 days of doxorubicin (30 mg/day) and sequential radiation (300 cGy/day for 10 days). Wide excision with limb preservation was performed 4 to 8 weeks after radiation completion. Treatment complications, margins, local recurrence, and survival were prospectively documented.


RESULTS
Of 75 patients, 66% had tumors >5 cm, and 71% were grade 2/3. In eight patients, negative margins were not achieved, and four of these had amputation (95% limb salvage). Three of the remaining four had local recurrence with a 5- and 7-year actuarial local control rate of 50% and 25%, respectively. In contrast, of the 67 patients with negative margins, a local control rate of 97% at 5 years and 94% at 7 years and an overall survival of 63% were achieved. Although margin (P = .001) and stage (P = .035) were correlated, these were not significant on multivariate Cox regression analysis. Risk factors for death included tumor stage (hazard ratio, 1.54; P = .001) and tumor grade (hazard ratio, 1.4; P = .02). Three patients (4%) required reoperation for tissue loss, and eight patients (10.6%) developed minor wound complications.


CONCLUSIONS
This modified Eilber protocol seems to maximize local control and minimize major wound complications for extremity/truncal STS.
Mack
Lloyd A
LA
Division of Surgical Oncology, University of Calgary, Tom Baker Cancer Centre, 1331 29th Street N.W., Calgary, Alberta, Canada T2N 4N2.
Crowe
Phil J
PJ
Yang
Jia Lin
JL
Schachar
Norman S
NS
Morris
Don G
DG
Kurien
Elizabeth C
EC
Temple
Claire L F
CL
Lindsay
Robert L
RL
Magi
Enzio
E
DeHaas
William G
WG
Temple
Walley J
WJ
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000903:Antibiotics, Antineoplastic / Q000008:administration & dosage; D017024:Chemotherapy, Adjuvant; D004317:Doxorubicin / Q000008:administration & dosage; D005260:Female; D018219:Histiocytoma, Benign Fibrous / Q000473:pathology / Q000601:surgery / Q000628:therapy; D006801:Humans; D007890:Leiomyosarcoma / Q000473:pathology / Q000601:surgery / Q000628:therapy; D008080:Liposarcoma / Q000473:pathology / Q000601:surgery / Q000628:therapy; D008875:Middle Aged; D020360:Neoadjuvant Therapy / Q000379:methods*; D009364:Neoplasm Recurrence, Local / Q000517:prevention & control; D011879:Radiotherapy Dosage; D018714:Radiotherapy, Adjuvant; D012189:Retrospective Studies; D012509:Sarcoma / Q000188:drug therapy / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery*
D000903:Antibiotics, Antineoplastic; D004317:Doxorubicin