Adriamycin-ifosfamide induction chemotherapy for extremity soft tissue sarcoma: Comparison of two non-randomized protocols

Citation
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
Citations number
17
Categorie Soggetti
Oncology
Journal title
ONCOLOGY REPORTS
ISSN journal
1021335X → ACNP
Volume
6
Issue
4
Year of publication
1999
Pages
913 - 920
Database
ISI
SICI code
1021-335X(199907/08)6:4<913:AICFES>2.0.ZU;2-Z
Abstract
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.