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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

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.