Caffeine-potentiated chemotherapy and conservative surgery for high-grade soft-tissue sarcoma

We report here the results of preoperative and postoperative caffeine-poten tiated chemotherapy and limb-sparing surgery for soft-tissue sarcomas. Thir ty-six patients with histologically high-grade soft-tissue sarcomas were tr eated with caffeine-potentiated chemotherapy and conservative surgery (25 c ases of limb-sparing surgery and 11 of local tumor excision). There were 13 patients with malignant fibrous histiocytoma (MFH) eight with synovial sar coma, five with liposarcoma, four with malignant schwannoma, four with epit helioid sarcoma, one with leiomyosarcoma and one with extraskeletal chondro sarcoma. Nine patients were at stage III with lung metastasis and the other 27 at stage IIB without metastasis; 22 were male and 14 female with a mean age of 48 years, ranging from 16 to 77 For intra-arterial preoperative che motherapy we administered 2-5 courses of cisplatin (120 mg/m(2)) doxorubici n (30 mg/m(2) x 2 days), and caffeine (1.5 g/m(2) x 3 days) to 18 patients, and cisplatin and caffeine to the other 18 Although 15 patients had alread y undergone unplanned tumor excision at other hospitals before preoperative chemotherapy, all patients underwent definitive limb-sparing surgery after the preoperative chemotherapy. Surgical margins were wide for 28 patients, marginal for three and intralesional for five. Local tumor recurrence was seen in one patient with MFH and one with epithelioid sarcoma. Of the 27 st age IIB patients, lung metastasis newly developed in one with MFH, three wi th synovial sarcoma, two with malignant schwannoma and one with leiomyosarc oma. As for the effects of preoperative chemotherapy in the 33 eligible cas es, radiographically confirmed complete response was seen in two patients, partial response in 20 and no response in 11. Histological response to this preoperative chemotherapy consisted of grade I (no response) in 14 grade I I (50-90% necrosis) in four grade III (>90% necrosis) in eight, and grade I V (no viable cells) in seven cases. An overall objective response rate of 7 3% was obtained. With the mean follow-up period of 58 months (5-101 months) , the overall 5-year cumulative survival rate ascertained with the Kaplan-M eier method was 63% and that of stage II patients 81%. Eight of the nine st age III patients died of metastatic disease within two and a half years fro m the beginning of the treatment. In conclusion, caffeine-potentiated chemo therapy and limb-sparing surgery brought good results for stage II nonmetas tatic soft-tissue sarcomas. The problem of treatment for stage III metastat ic soft-tissue sarcomas, however, remains unsolved.