Effect of concurrent chemotherapy and hyperthermia on outcome of preoperative radiotherapy of high-risk soft tissue sarc
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1, 4 · C. Gani1, 4 · T. Kluba3, 4 · F. Mayer2, 4 · H.-G. Kopp2, 4 · D. Zips1, 4 · M. Bamberg1, 4 · A.-C. Müller1, 4 1 Department of Radiation Oncology, Eberhard-Karls-University Tübingen 2 Department of Medical Oncology, Eberhard-Karls-University Tübingen 3 Department of Orthopaedic Surgery, Eberhard-Karls-University Tübingen 4 Center for soft tissue sarcoma, GIST and bone tumours, Eberhard-Karls-University Tübingen
Effect of concurrent chemotherapy and hyperthermia on outcome of preoperative radiotherapy of high-risk soft tissue sarcomas Despite improved treatment including multimodal therapies the outcome of high-risk adult-type soft tissue sarcomas remains unsatisfying with a substantial proportion of local and/or distant failure. About half of the patients die from the disease within 5 years [24]. Current standard treatment consists of surgery, i.e., wide excision or compartmental resection [21] and radiotherapy administered either pre- or postoperatively [5]. Given the high rate of distant metastases there is a rationale for adding systemic treatment to local therapies. Yet, according to a recent analysis, the benefit from sequential adjuvant chemotherapy is in the range of 10% for overall survival and seems to be limited to grade 3 tumors [14]. Integration of chemotherapy into preoperative radiotherapy has been explored in the last two decades starting with the use of iododeoxyuridine [11]. Different agents have been applied since then including doxorubicin [1], ifosfamide [3] and cisplatin [4] or combined regimens [6, 22]. At our institution we established an ifosfamide-based, concurrent radiochemotherapy which has been described in the treatment of unresectable lesions [7]. Another interesting approach is the integration of locoregional hyperthermia [2] into preoperative treatment of soft tissue sarcoma. Combination with radiotherapy showed excellent local control rates [20]. Recently, a large randomized phase 3 tri-
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Strahlentherapie und Onkologie 6 · 2013
al demonstrated a survival benefit for hyperthermia combined with sequential chemotherapy in localized high-risk soft tissue sarcoma [13]. Trimodal therapy has been described for pancreatic cancer [17]. In this study, we compare the outcome of patients treated with preoperative radiotherapy for soft tissue sarcoma either alone or in combination with concurrent chemotherapy and/or locoregional hyperthermia.
Patients and methods All patients treated in the Center for Soft Tissue Sarcoma, GIST and Bone Tumors of the Comprehensive Cancer Center Tübingen between 1999 and 2011 were evaluated retrospectively. Patients with neoadjuvant radiotherapy and resection for intermediate or high grade tumors were included, whereas patients presenting with metastases, secondary cancers, low grade tumors or treated in prospective trials were excluded from the analysis. All patients had pretreatment staging consisting of at least history and physical examination, biopsy, cross-sectional imaging of the tumor region, and laboratory data. Pulmonary metastases were e
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