O. Merimsky et al., Adriamycin-ifosfamide induction chemotherapy for extremity soft tissue sarcoma: Comparison of two non-randomized protocols, ONCOL REP, 6(4), 1999, pp. 913-920
Chemotherapeutic cytoreduction of soft tissue sarcomas may permit less radi
cal operation. In cases of large or multi-compartmental masses, deeply seat
ed tumors or involvement of a neurovascular bundle, down-sizing of the mass
is required before limb sparing surgery can be considered. We have applied
a combination chemotherapy consisting of intravenous adriamycin and ifosfa
mide with intra-arterial cisplatin for patients with soft tissue sarcomas o
f the extremity as induction treatment, and switched to an intravenous-only
protocol due to toxicity and management difficulties. Adjuvant chemotherap
y and radiation therapy were given after limb-sparing surgery in both regim
ens. Fresh tumor specimens were obtained and were examined for tumor size,
surgical margins, percent of necrosis, evidence of vascular or perineural i
nvasion, and the presence of Pgp, Ki-67, p53, PCNA and bcl-2-oncoprotein, O
ur results in terms of percentage of tumor necrosis were comparable and eve
n better in favor of the second regimen [38% good histological response wit
h intravenous (i.v.)-only versus 12.5% for combined i.v. + intra-arterial (
i.a.]. The clinical and radiological responses were also better for the sec
ond (i.v. only) regimen (45%) than for the first (i.v. + i.a.) regimen (12.
5%). The toxicity and the inconvenience to the patients and to the treating
staff were greater in the first regimen that combined intra-arterial and i
ntravenous infusions. In the first group the failure rate is 75% within 33
months of follow-up, while it is 33% within 12 months follow-up in the seco
nd group. The immunohistochemical markers did not correlate with disease co
ntrol nor with the patient outcome. Intravenous administration of ADR-IFX i
nduction chemotherapy was more feasible than combined i.v. ADR-IFX plus i.a
. cisplatin and achieved better results.