title: Preoperative intensity-modulated radiotherapy combined with temozolomide for locally advanced soft-tissue sarcoma.
abstract: OBJECTIVE
  To evaluate the toxicity and efficacy of preoperative intensity-modulated radiotherapy (IMRT) combined with temozolomide to improve local tumor control in soft-tissue sarcoma (STS).
  
  
  METHODS
  A cohort of 15 consecutive patients with nonmetastasized, primary high-grade or locally recurrent Stage III (n = 14) or IIb (n = 1) STS not amenable to surgical resection without significant organ or extremity function loss was prospectively investigated. Median tumor size was 9.8 cm, and most tumors were non-extremity sarcomas. Patients preoperatively received 50 mg/m(2) of temozolomide during IMRT (50.4 Gy). Resection was intended 6 weeks thereafter. Toxicity was assessed by the National Cancer Institute Common Terminology Criteria for Adverse Events version 3.0, and response was assessed by Response Evaluation Criteria in Solid Tumors.
  
  
  RESULTS
  Of 15 patients, 14 completed preoperative treatment. No Grade 4 toxicities occurred. Nausea and vomiting were the most frequent Grade 3 toxicities. The most frequent toxicities of any grade were dermatologic, gastrointestinal, and hematologic. Response was partial response in 5, stable disease in 7, and progressive disease in 2 patients. Ten patients underwent surgery: 7 were resected with clear margins (R0), and 2 patients had an R1 resection; in 1 patient the tumor was not resectable. Postoperative complications occurred in 4 patients. Five patients did not undergo surgery because of intercurrent metastatic disease, unresectable disease, or refusal.
  
  
  CONCLUSIONS
  Preoperative chemoradiation with temozolomide and IMRT can be administered safely and with promising efficacy in patients with locally advanced STS.
authors.affiliation: Division of Surgical Oncology and Thoracic Surgery, Department of Surgery, University Hospital and Medical Faculty of Mannheim, Mannheim, Germany.
authors.forename: Jens
authors.initials: J
authors.lastname: Jakob
authors.forename: Frederik
authors.initials: F
authors.lastname: Wenz
authors.forename: Dietmar J
authors.initials: DJ
authors.lastname: Dinter
authors.forename: Philipp
authors.initials: P
authors.lastname: Ströbel
authors.forename: Peter
authors.initials: P
authors.lastname: Hohenberger
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018906:Antineoplastic Agents, Alkylating / Q000009:adverse effects / Q000627:therapeutic use*; D003131:Combined Modality Therapy / Q000009:adverse effects / Q000379:methods; D003606:Dacarbazine / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009325:Nausea / Q000209:etiology; D011183:Postoperative Complications; D011446:Prospective Studies; D011832:Radiation Injuries / Q000209:etiology; D011879:Radiotherapy Dosage; D050397:Radiotherapy, Intensity-Modulated / Q000009:adverse effects; D012074:Remission Induction; D012509:Sarcoma / Q000188:drug therapy / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery; D000077204:Temozolomide; D047368:Tumor Burden; D014839:Vomiting / Q000209:etiology
chemical_list: D018906:Antineoplastic Agents, Alkylating; D003606:Dacarbazine; D000077204:Temozolomide