Five-year results from a Scandinavian sarcoma group study (SSG XIII) of adjuvant chemotherapy combined with accelerated radiotherapy in high-risk soft tissue sarcome of extremities and trunk wall
2011 (English)In: International Journal of Radiation Oncology, Biology, Physics, ISSN 0360-3016, Vol. 81, no 5, 1359-1366 p.Article in journal (Refereed) Published
Purpose: To evaluate adjuvant chemotherapy and interpolated accelerated radiotherapy (RT) for adult patients with high-risk soft tissue sarcoma in the extremities or trunk wall. Methods and Materials: High-risk soft tissue sarcoma was defined as high-grade malignancy and at least two of the following criteria: size >= 8 cm, vascular invasion, or necrosis. Six cycles of doxorubicin and ifosfamide were prescribed for all patients. RT to a total dose of 36 Gy (1.8 Gy twice daily) was inserted between two chemotherapy cycles after marginal margin resection regardless of tumor depth or after wide-margin resection for deep-seated tumors. RT was boosted to 45 Gy in a split-course design in the case of intralesional margin resection. Results: A total of 119 patients were eligible, with a median follow-up of 5 years. The 5-year estimate of the local recurrence, metastasis-free survival, and overall survival rate was 12%, 59%, and 68%, respectively. The group receiving RT to 36 Gy had a local recurrence rate of 10%. In contrast, the local recurrence rate was 29% in the group treated with RT to 45 Gy. The presence of vascular invasion and low chemotherapy dose intensity had a negative effect on metastasis-free and overall survival. Toxicity was moderate after both the chemotherapy and the RT. Conclusions: Accelerated RT interposed between chemotherapy cycles in a selected population of patients with high-risk soft tissue sarcoma resulted in good local and distant disease control, with acceptable treatment-related morbidity. The greater radiation dose administered after intralesional surgery was not sufficient to compensate for the poorer surgical margin. Vascular invasion was the most important prognostic factor for metastasis-free and overall survival.
Place, publisher, year, edition, pages
2011. Vol. 81, no 5, 1359-1366 p.
Soft tissue sarcoma, Adjuvant treatment, Accelerated radiotherapy, Chemotherapy, Prognostic factors
Medical and Health Sciences
IdentifiersURN: urn:nbn:se:uu:diva-165617DOI: 10.1016/j.ijrobp.2010.07.037ISI: 000297602400022OAI: oai:DiVA.org:uu-165617DiVA: diva2:476934