Radiation Therapy Oncology Group (RTOG) 95-14; a phase II study of neoadjuvant chemotherapy (CT) and radiation therapy (RT) in high risk (HR), high grade, soft tissue sarcomas (STS) of the extremities and body wall: a preliminary report

Li Liu, MD

University of Pennsylvania Cancer
Last Modified: May 15, 2001

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Presenter: W.G.Kraybill
Affiliation: RTOG

Background:

    Radiation therapy plays a central role in the management of many soft tissue sarcomas and allows for a substantial reduction in the extent of surgical resection. The addition of chemotherapy to preoperative irradiation has been investigated

Materials and Methods:

  • A total of 45 patients with high-grade, HR, STS of the extremities and body wall were included in this prospective phase II study.
  • Patients were treated with MAID chemotherapy plus G-CSF and RT and post-operative chemotherapy.

Results:

  • 42/45 patients underwent radical surgery. Of them, 34 patients achieved negative surgical margins
  • With a median follow up of 2.35 years, 3 patients died of sarcoma, 3 died of second primary, and one died from possible treatment related toxicity
  • Toxicities included 66% grade 4 neutropenia, 29% grade 4 thrombocytopenia, and 12% grade 4 skin toxicity
  • 26% patients had delayed wound healing
  • 2-year local failure was 12.6% and overall survival was 95%

Authors' Conclusions

  • Short-term outcome of these patients with very high-risk STS treated with aggressive neoadjuvant chemoradiation appear encouraging
  • Neoadjuvant MAID chemotherapy plus G-CSF and RT was tolerable.

Clinical/Scientific Implications:

  • The most significant challenge in the management of soft tissue sarcomas is to reduce the mortality related to systemic disease in patients who present with M0 disease.
  • Clinical research efforts should be aimed at better selection of candidates for therapy, identification of newer drugs, and improving the methods of implementing the currently available therapeutic approaches.

ASCO Abstract 1387

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