Modern Management of High-risk Soft Tissue Sarcoma with Neoadjuvant Chemoradiation: A Single-center Experience

David J. Byun, Leah M. Katz, Julie Xiao, Timothy B. Rapp, Luca Paoluzzi, Gerald Rosen, Peter B. Schiff

Research output: Contribution to journalArticlepeer-review

Abstract

Objective:Neoadjuvant chemoradiation (NA-CRT), followed by resection of high-risk soft tissue sarcoma (STS), may offer good disease control and toxicity outcomes. We report on a single institution's modern NA-CRT experience.Materials and Methods:Delay to surgical resection, resection margin status, extent of necrosis, tumor cell viability, presence of hyalinization, positron emission tomography (PET)/computed tomography data, and treatment toxicities were collected. Using the Kaplan-Meier survival analysis, 5-year overall survival, disease-free survival, distant metastasis-free survival, and local control (LC) were estimated. Clinicopathologic features and PET/computed tomography avidity changes were assessed for their potential predictive impact using the log-rank test.Results:From 2011 to 2018, 37 consecutive cases of localized high-risk STS were identified. Twenty-nine patients underwent ifosfamide-based NA-CRT to a median dose of 50 Gy before en bloc resection. At a median follow-up of 40.3 months, estimated 5-year overall survival was 86.1%, disease-free survival 70.2%, distant metastasis-free survival 75.2%, and LC 86.7%. Following NA-CRT, a median reduction of 54.7% was observed in tumor PET avidity; once resected, median tumor necrosis of 60.0% with no viable tumor cells was detected in 13.8% of the cases. Posttreatment resection margins were negative in all patients, with 27.6% having a margin of ≤1 mm. Delays of over 6 weeks following the end of radiation treatment to surgical resection occurred in 20.7% cases and was suggestive of inferior LC (92.8% vs. 68.6%, P=0.025).Conclusions:This single-institution series of NA-CRT demonstrates favorable disease control. Delay in surgical resection was associated with inferior LC, a finding that deserves further evaluation in a larger cohort.Level of Evidence:Level III - retrospective cohort study.

Original languageEnglish (US)
Pages (from-to)24-31
Number of pages8
JournalAmerican Journal of Clinical Oncology: Cancer Clinical Trials
Volume44
Issue number1
DOIs
StatePublished - Jan 2021
Externally publishedYes

Keywords

  • ifosfamide
  • neoadjuvant chemoradiation
  • radiation therapy
  • soft tissue sarcoma
  • treatment delay

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

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