Thermochemotherapy in patients with extremity high-risk soft tissue sarcomas (HR-STS)
- 1 January 2010
- journal article
- research article
- Published by Informa UK Limited in International Journal of Hyperthermia
- Vol. 26 (2), 127-135
- https://doi.org/10.3109/02656730903335995
Abstract
We report data from phase II trials examining the efficacy of multimodality treatment with neoadjuvant chemotherapy, hyperthermia, surgery, radiation and postoperative thermochemotherapy in adult patients with high-risk sarcomas of the extremities.From 1991 to 2001 47 patients with high risk soft tissue sarcoma of the extremities were prospectively treated in two clinical trials with a treatment plan of four cycles of etoposide, ifosfamide and doxorubicin combined with regional hyperthermia followed by surgery, radiation and adjuvant chemotherapy.Objective response rate assessable in 39 patients was 21% (one complete and seven partial responses). A favourable histological response (>75% tumour necrosis) was observed in 34% of the 35 evaluable patients who had surgical resection. Median overall survival (OS) was 105 months. The five-year probability of local failure-free survival (LFFS), distant disease-free survival (DDFS), event-free survival (EFS) and OS were 48%, 55%, 35% and 57%, respectively. There were no significant differences between responders and non-responders of minimum temperatures (Tmin) and time-averaged temperatures achieved in 50% (T(50)) and 90% (T(90)) at all measured tumour sites. Response to this neoadjuvant regimen predicted for prolonged LFFS (p = 0.0123), but not for OS (p = 0.2). Limb preservation was achieved in 37 patients (79%) and did not result in inferior DDFS (52% versus 50%) or OS (61% versus 50%) at five years (p = 0.8) in comparison to patients who underwent amputation.Response to combined modality treatment with RHT and neoadjuvant chemotherapy was predictive for an improved LFFS and led to limb preservation in 79% of patients with extremity sarcomas.Keywords
This publication has 26 references indexed in Scilit:
- Delaying surgery with chemotherapy for osteosarcoma of the extremitiesExpert Opinion on Pharmacotherapy, 2004
- The prognostic significance of margin width for extremity and trunk sarcomaJournal of Surgical Oncology, 2004
- Isolated limb perfusion with tumor necrosis factor‐α and melphalan for patients with unresectable soft tissue sarcoma of the extremitiesCancer, 2003
- Localized Extremity Soft Tissue Sarcoma: Improved Knowledge With Unchanged Survival Over TimeJournal of Clinical Oncology, 2003
- Response to Neoadjuvant Chemotherapy Combined With Regional Hyperthermia Predicts Long-Term Survival for Adult Patients With Retroperitoneal and Visceral High-Risk Soft Tissue SarcomasJournal of Clinical Oncology, 2002
- Treatment of primary, recurrent or inadequately resected high-risk soft-tissue sarcomas (STS) of adults: results of a phase II pilot study (RHT-95) of neoadjuvant chemotherapy combined with regional hyperthermiaEuropean Journal Of Cancer, 2001
- Neoadjuvant chemotherapy combined with regional hyperthermia (RHT) for locally advanced primary or recurrent high-risk adult soft-tissue sarcomas (STS) of adults: long-term results of a phase II studyEuropean Journal Of Cancer, 2001
- Common toxicity criteria: version 2.0. an improved reference for grading the acute effects of cancer treatment: impact on radiotherapyInternational Journal of Radiation Oncology*Biology*Physics, 2000
- Nonparametric Estimation from Incomplete ObservationsJournal of the American Statistical Association, 1958
- On a Test of Whether one of Two Random Variables is Stochastically Larger than the OtherThe Annals of Mathematical Statistics, 1947