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Five-year Results From A Scandinavian Sarcoma Group Study (SSG XIII) Of Adjuvant Chemotherapy Combined With Accelerated Radiotherapy In High-Risk Soft Tissue Sarcoma Of Extremities And Trunk Wall

Jebsen, Nina L.; Bruland, Oyvind S.; Eriksson, Mikael LU ; Engellau, Jacob LU ; Turesson, Ingela; Folin, Annika; Trovik, Clement S. and Hall, Kirsten Sundby (2011) In International Journal of Radiation Oncology, Biology, Physics 81(5). p.1359-1366
Abstract
Purpose: To evaluate adjuvant chemotherapy and interpolated accelerated radiotherapy (RT) for adult patients with high-risk soft tissue sarcoma in the extremities or trunk wall. Methods and Materials: High-risk soft tissue sarcoma was defined as high-grade malignancy and at least two of the following criteria: size >= 8 cm, vascular invasion, or necrosis. Six cycles of doxorubicin and ifosfamide were prescribed for all patients. RT to a total dose of 36 Gy (1.8 Gy twice daily) was inserted between two chemotherapy cycles after marginal margin resection regardless of tumor depth or after wide-margin resection for deep-seated tumors. RT was boosted to 45 Gy in a split-course design in the case of intralesional margin resection. Results: A... (More)
Purpose: To evaluate adjuvant chemotherapy and interpolated accelerated radiotherapy (RT) for adult patients with high-risk soft tissue sarcoma in the extremities or trunk wall. Methods and Materials: High-risk soft tissue sarcoma was defined as high-grade malignancy and at least two of the following criteria: size >= 8 cm, vascular invasion, or necrosis. Six cycles of doxorubicin and ifosfamide were prescribed for all patients. RT to a total dose of 36 Gy (1.8 Gy twice daily) was inserted between two chemotherapy cycles after marginal margin resection regardless of tumor depth or after wide-margin resection for deep-seated tumors. RT was boosted to 45 Gy in a split-course design in the case of intralesional margin resection. Results: A total of 119 patients were eligible, with a median follow-up of 5 years. The 5-year estimate of the local recurrence, metastasis-free survival, and overall survival rate was 12%, 59%, and 68%, respectively. The group receiving RT to 36 Gy had a local recurrence rate of 10%. In contrast, the local recurrence rate was 29% in the group treated with RT to 45 Gy. The presence of vascular invasion and low chemotherapy dose intensity had a negative effect on metastasis-free and overall survival. Toxicity was moderate after both the chemotherapy and the RT. Conclusions: Accelerated RT interposed between chemotherapy cycles in a selected population of patients with high-risk soft tissue sarcoma resulted in good local and distant disease control, with acceptable treatment-related morbidity. The greater radiation dose administered after intralesional surgery was not sufficient to compensate for the poorer surgical margin. Vascular invasion was the most important prognostic factor for metastasis-free and overall survival. (C) 2011 Elsevier Inc. (Less)
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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Soft tissue sarcoma, Adjuvant treatment, Accelerated radiotherapy, Chemotherapy, Prognostic factors
in
International Journal of Radiation Oncology, Biology, Physics
volume
81
issue
5
pages
1359 - 1366
publisher
Elsevier
external identifiers
  • wos:000297602400022
  • scopus:81855194701
ISSN
0360-3016
DOI
10.1016/j.ijrobp.2010.07.037
language
English
LU publication?
yes
id
d2655b51-b32f-41ba-a4a9-afae3db771b4 (old id 2291788)
date added to LUP
2012-01-11 15:59:35
date last changed
2017-05-21 03:20:29
@article{d2655b51-b32f-41ba-a4a9-afae3db771b4,
  abstract     = {Purpose: To evaluate adjuvant chemotherapy and interpolated accelerated radiotherapy (RT) for adult patients with high-risk soft tissue sarcoma in the extremities or trunk wall. Methods and Materials: High-risk soft tissue sarcoma was defined as high-grade malignancy and at least two of the following criteria: size >= 8 cm, vascular invasion, or necrosis. Six cycles of doxorubicin and ifosfamide were prescribed for all patients. RT to a total dose of 36 Gy (1.8 Gy twice daily) was inserted between two chemotherapy cycles after marginal margin resection regardless of tumor depth or after wide-margin resection for deep-seated tumors. RT was boosted to 45 Gy in a split-course design in the case of intralesional margin resection. Results: A total of 119 patients were eligible, with a median follow-up of 5 years. The 5-year estimate of the local recurrence, metastasis-free survival, and overall survival rate was 12%, 59%, and 68%, respectively. The group receiving RT to 36 Gy had a local recurrence rate of 10%. In contrast, the local recurrence rate was 29% in the group treated with RT to 45 Gy. The presence of vascular invasion and low chemotherapy dose intensity had a negative effect on metastasis-free and overall survival. Toxicity was moderate after both the chemotherapy and the RT. Conclusions: Accelerated RT interposed between chemotherapy cycles in a selected population of patients with high-risk soft tissue sarcoma resulted in good local and distant disease control, with acceptable treatment-related morbidity. The greater radiation dose administered after intralesional surgery was not sufficient to compensate for the poorer surgical margin. Vascular invasion was the most important prognostic factor for metastasis-free and overall survival. (C) 2011 Elsevier Inc.},
  author       = {Jebsen, Nina L. and Bruland, Oyvind S. and Eriksson, Mikael and Engellau, Jacob and Turesson, Ingela and Folin, Annika and Trovik, Clement S. and Hall, Kirsten Sundby},
  issn         = {0360-3016},
  keyword      = {Soft tissue sarcoma,Adjuvant treatment,Accelerated radiotherapy,Chemotherapy,Prognostic factors},
  language     = {eng},
  number       = {5},
  pages        = {1359--1366},
  publisher    = {Elsevier},
  series       = {International Journal of Radiation Oncology, Biology, Physics},
  title        = {Five-year Results From A Scandinavian Sarcoma Group Study (SSG XIII) Of Adjuvant Chemotherapy Combined With Accelerated Radiotherapy In High-Risk Soft Tissue Sarcoma Of Extremities And Trunk Wall},
  url          = {http://dx.doi.org/10.1016/j.ijrobp.2010.07.037},
  volume       = {81},
  year         = {2011},
}