Concurrent ifosfamide-based chemotherapy and irradiation - Analysis of treatment-related toxicity in 43 patients with sarcoma

BACKGROUND. The current study was performed to evaluate the toxicity profil e of therapeutic doses of ifosfamide (IFX) given concurrently with full-dos e external beam radiotherapy (EBRT) in patients with soft tissue and bone s arcomas. METHODS. The medical records of 43 consecutive patients with soft tissue or bone sarcomas who were treated with concurrent IFX and EBRT were reviewed. RESULTS. The median patient age was 20 years. Histologies were rhabdomyosar coma (n = 16 patients), Ewing sarcoma (n = 10 patients), malignant fibrous histiocytoma (n = 9 patients), and other soft tissue sarcomas (n = 8 patien ts). Thirty-one patients (72%) had localized disease, and 12 patients (28%) had synchronous local and distant disease. Treatment consisted of EBRT (me dian dose, 50.4 gray [Gy]) with concomitant IFX (median dose per cycle, 10. 2 g/m(2)). All patients with Ewing sarcoma or rhabdomyosarcoma received add itional concurrent chemotherapy. Twenty-six patients (60%) received two or more cycles of IFX, and 17 patients (40%) were treated with one cycle of IF X and EBRT. The incidences of World Health Organization Grade 3 and Grade 4 toxicities were 29% (21 of 73 cycles) and 22% (16 of 73 cycles), respectiv ely. Grade 4 systemic toxicities included leukopenia (n = 14 patients), neu rotoxicity (suicidal ideation; n = I patient), and diarrhea (n = I patient) . Confluent moist desquamation (Grade 3) occurred in nine patients in the t reatment field; no patient experienced Grade 4 local toxicity. Among 14 pat ients who were treated preoperatively, 2 patients (14%) had a pathologic co mplete response, and 6 patients (43%) had a pathologic near-complete respon se ( greater than or equal to 90% necrosis). CONCLUSIONS. Local and systemic toxicities after the administration of ther apeutic doses of IFX with concomitant EBRT appear comparable to those obser ved with either treatment alone. These results support the design of prospe ctive studies evaluating concurrent ifosfamide and radiation therapy for pa tients with sarcomas. Cancer 2001;92:1550-5. (C) 2001 American Cancer Socie ty.