Connective Tissue Oncology Society

2001 CTOS Annual Meeting Posters— Radiation Oncology

NEOADJUVANT CHEMOTHERAPY AND RADIOTHERAPY FOR LARGE EXTREMITY SOFT TISSUE SARCOMAS
Thomas F. DeLaney¹, Ira J. Spiro¹, Herman D. Suit¹, Mark C. Gebhardt², Francis J. Hornicek², Henry J. Mankin², Andrew L. Rosenberg³, Fariba Miryousefi¹, Marek Ancukiewicz¹, David C. Harmon⁴
¹Dept. of Radiation Oncology, Massachusetts General Hospital, ²Dept. of Orthopedic Surgery, Massachusetts General Hospital, ³Dept. of Pathology, Massachusetts General Hospital, ⁴Section of Hematology/Oncology, Massachusetts General Hospital

OBJECTIVE: Treatment of extremity soft tissue sarcomas (STS) yields excellent local control but distant failure is common with large, high-grade tumors. A regimen of pre-operative chemotherapy consisting of Mesna, Adriamycin, Ifosfamide, and Dacarbazine (MAID) interdigitated with radiotherapy followed by resection and postoperative chemotherapy +/- radiotherapy was designed to improve treatment outcome. We report mature outcome data on 48 treated patients and compare with an historical matched control patient population.

METHODS: Adult patients with high-grade extremity STS 8 cm or larger were treated with three cycles of preoperative chemotherapy combined with 44 Gy of radiotherapy followed by surgery. Three cycles of postop MAID were planned. For patients with positive surgical margins, 16 Gy was delivered postoperatively.

RESULTS: 48 M0 patients received MAID protocol treatment and outcome was superior to 48 historical control patients. Respective five-year actuarial MAID and control patient figures for local control are 92% and 86% (p=0.1155), freedom from distant metastases are 75% and 44% (p=0.0016), disease-free survival are 70% and 42% (p=0.0002), and overall survival are 87% and 58% (p=0.0003). Acute hematologic toxicity in the MAID group included febrile neutropenia in 7 patients (15%). RTOG grade 3 acute skin toxicity occurred in 14 patients (29%). One MAID patient developed late fatal myelodysplasia.

CONCLUSION: Following aggressive chemoradiation and surgery, these patients show a significant reduction in distant metastases with a highly significant gain in disease-free and overall survival when compared to historical control. Based on this experience, the Radiation Therapy Oncology Group has conducted a multi-institutional trial.