Connective Tissue Oncology Society

2001 CTOS Annual Meeting Posters— Surgery

NEOADJUVENT ADRIAMYCIN AND TWICE DAILY RADIOTHERAPY IN ADULT SOFT TISSUE SARCOMA
John Heiner, Minesh Mehta, Howard Bailey, Jack Fowler, Timothy Kinsella, Michael Lamson, F. Kristian Storm
University of Wisconsin Medical School Department of Surgery - Surgical Oncology, Orthopedics, Biostatistics and the Department of Human Oncology - Radiation Therapy, Medical Oncology

OBJECTIVE: A series of limb salvage trials at UCLA employing preoperative continuous infusion of adriamycin (ADR), either intraarterially (IA) or intravenously (IV), followed by daily radiotherapy treatments were performed. External beam radiation (XRT) to total doses of 35 Gy (3.5 Gy x 10), 28 Gy (3.5 Gy x 8), or 17.5 Gy (3.5 x 5), were analyzed with the findings that both local recurrence and wound complications were radiation dose dependent but independent of the route of ADR administration. ADR and 28-35 Gy XRT daily over 8-10 days resulted in effective limb salvage (96%-100%) with 5%-10% local recurrence (LR) at 36 month median, but there were 10%-23% major wound complications requiring reoperation. We postulated that twice-daily doses of lower fraction size XRT might achieve a similarly low incidence of local recurrence with a further reduction in postoperative wound complications.

METHODS: The patients in Group 1 (n=10) were treated with intraarterial adriamycin by continuous infusion to a total dose of 90 mg over a 3 day period. The patients in Group 2 (n=43) were treated with the same dose intravenously. Radiation was begun 1 to 2 days after the completion of chemotherapy. The patients in Group 1 were treated with 3.5 Gy qd X 8 days. The patients in Group 2 were treated with 2 Gy BID X 8 days. Patients were evaluated for perioperative wound complications using the late effects on normal tissues scoring system. Patients were also evaluated for local recurrence.

RESULTS: 53 patients with Grade IIB and Grade IIIB lesions underwent treatment. Average follow-up was 47 months. Average greatest tumor diameter was 8.00 cm in Group 1 and 8.82 cm in Group 2. There was 1 (10%) local recurrence in Group 1 and 1 (2.33%) local recurrence in Group 2. There were 3 major complications (30%) and 2 minor complications (20%) in Group 1. There were 2 (4.65%) major complications and 9 (20.93%) minor complications in Group 2. This suggested a decreased complication rate with twice daily dosing however statistical significance was not achieved (p=0.091).

CONCLUSION: We interpret these results to indicate that preoperative IV-ADR and 28-32 Gy XRT over 8 days results in effective limb salvage and similarly low rates of LR, but that 2.0 Gy delivered twice daily to a total dose of 32 Gy appears to lower the incidence of postoperative complications.