title: Adjuvant therapy for resectable high-risk soft tissue sarcoma: feasibility and efficacy of a sandwich chemoradiotherapy strategy.
abstract: OBJECTIVE
  Radical definitive surgery is the only curative treatment approach in resectable soft tissue sarcoma. Despite complete resection, patients with grade 2 and 3 soft tissue sarcoma are at high risk of local or distant recurrence. Local and systemic adjuvant treatment includes radiotherapy and chemotherapy, but the optimal scheduling is not known.
  
  
  METHODS
  In this phase II clinical trial, we combined surgery with adjuvant chemotherapy and radiotherapy in a novel trimodality treatment sequence. Two to 6 weeks after surgery, patients received 2 cycles of chemotherapy containing doxorubicin and ifosfamide, then 50.4 Gy of percutaneous radiotherapy followed by additional 2 cycles of chemotherapy.
  
  
  RESULTS
  Chemotherapy and radiotherapy-related toxicity was generally mild, without treatment delays in the majority of patients. After a median follow-up of 57 months, 81.5% of patients are alive in complete remission.
  
  
  CONCLUSIONS
  The sandwich chemoradiation protocol proved to be feasible with manageable toxicity. The patient outcome compared favorably with other adjuvant trials in preventing relapse, particularly distant relapse which is predictive of poor outcome. This multidisciplinary approach warrants further investigation in a larger randomized trial.
authors.affiliation: Department of Medicine, Hematology and Oncology, University Hospital Muenster, Albert-Schweitzer-Str. 33, 48149, Muenster, Germany. brandts@em.uni-frankfurt.de
authors.forename: Christian H
authors.initials: CH
authors.lastname: Brandts
authors.forename: Christiane
authors.initials: C
authors.lastname: Schulz
authors.forename: Normann
authors.initials: N
authors.lastname: Willich
authors.forename: Björn
authors.initials: B
authors.lastname: Steffen
authors.forename: Jendrik
authors.initials: J
authors.lastname: Hardes
authors.forename: Georg
authors.initials: G
authors.lastname: Gosheger
authors.forename: Winfried
authors.initials: W
authors.lastname: Winkelmann
authors.forename: Hubert
authors.initials: H
authors.lastname: Serve
authors.forename: Achim
authors.initials: A
authors.lastname: Heinecke
authors.forename: Wolfgang E
authors.initials: WE
authors.lastname: Berdel
authors.forename: Michael
authors.initials: M
authors.lastname: Thomas
mesh_terms: D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D001918:Brachytherapy / Q000009:adverse effects / Q000379:methods*; D059186:Chemoradiotherapy, Adjuvant / Q000009:adverse effects / Q000379:methods*; D018572:Disease-Free Survival; D004317:Doxorubicin / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D005240:Feasibility Studies; D006801:Humans; D007069:Ifosfamide / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D009364:Neoplasm Recurrence, Local / Q000517:prevention & control*; D009367:Neoplasm Staging; D011446:Prospective Studies; D012509:Sarcoma / Q000473:pathology / Q000601:surgery* / Q000628:therapy*; D055815:Young Adult
chemical_list: D004317:Doxorubicin; D007069:Ifosfamide