PREOPERATIVE MULTIDISCIPLINARY TREATMENT WITH HYPERTHERMIA FOR SOFT-TISSUE SARCOMA

We report the results of phase I/II studies of preoperative multidisci plinary treatment of 14 patients with soft tissue sarcoma using hypert hermia from November 1990 to April 1995. The preoperative treatment wa s conducted with thermo-radio-chemotherapy in 11 cases of stage III, a nd with thermo-radiotherapy as well as thermo-chemotherapy in three ca ses of stages I and II. Hyperthermia was carried out twice a week with totals ranging from 4 to 14 times (average: 8.4 times); each session lasted 60 min. Radiotherapy was administered four or five times per we ek, and the dose was 1.8-2Gy/fraction, with a total of 30-40 Gy in a f our week period. Chemotherapy was mainly in the form of MAID regimen ( 2-mercaptoethanesulphonic acid (mesna), adriamycin, ifosfamide and dac arbazine). The tumors were surgically resected in all patients after c ompleting the preoperative treatment. The efficacy rate, as expressed by the percentage of either tumors in which reduction rate was 50% or more, or tumors for which post-treatment contrast enhanced CT image re vealed low density volumes occupying 50% or more of the total mass, wa s 71% (ten of the 14 tumors). The mean tumor necrosis rate in the rese cted specimens was 78%. The tumor necrosis rate was significantly high (P <0.05) in patients whose Time greater than or equal to 42 degrees C was of long duration. Postoperative complications were observed in s ix patients; among these, two patients developed wound infection that required surgical treatment as a complication of surgery performed in the early stage following the preoperative treatment. After a mean pos toperative follow-up of 27 months, distant metastasis occurred in four patients resulting in three fatalities. The three-year cumulative sur vival rate was 64.3%. No local recurrence was observed in any patient during the follow-up, thus confirming our hypothesis that preoperative multidisciplinary treatment has an excellent local efficacy. We think that it would be valuable to conduct, at many facilities, phase III s tudies on the treatment of soft tissue sarcoma by a combination of sur gery and preoperative multidisciplinary treatment using hyperthermia, paying close attention to the interval between these two modalities.