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Evaluating the Role of Interdigitated Neoadjuvant Chemotherapy and Radiation in the Management of High-Grade Soft-Tissue Sarcoma: The Johns Hopkins Experience

Raval, Raju R. MD, DPhil; Frassica, Deborah MD; Thornton, Katherine MD; Meyer, Christian MD, PhD; Ettinger, David S. MD; Frassica, Frank MD; Weber, Kristin MD; Terezakis, Stephanie A. MD

American Journal of Clinical Oncology: April 2017 - Volume 40 - Issue 2 - p 214–217
doi: 10.1097/COC.0000000000000131
Original Articles: Soft Tissue

Objectives: High-grade soft-tissue sarcoma (STS) has a poor prognosis. The goal of this study was to review treatment outcomes of patients with high-grade STS treated with interdigitated neoadjuvant chemotherapy (CT) and radiation at our institution.

Materials and Methods: Patients with high-grade STS (1997 to 2010) were planned for treatment with 3 cycles of neoadjuvant CT, interdigitated preoperative radiation therapy (44 Gy administered in split courses with a potential 16 Gy postoperative boost), and 3 cycles of postoperative CT. Cancer control outcomes at 3 years were analyzed.

Results: Sixteen patients with high-grade STS were evaluated. Median age was 53 years, the median longest tumor diameter was 14.6 cm, and median follow-up was 33 months. All 16 patients received 2 or 3 cycles of neoadjuvant CT and all patients completed neoadjuvant RT. The estimated 3-year rate for local control was 100%, disease-free survival 62.5%, and overall survival 73.4%.

Conclusions: Patients with high-grade STS treated with interdigitated neoadjuvant CT and radiation before surgical resection had excellent rates of local control, along with disease-free survival and overall survival similar to previously published reports. This combined-modality approach continues to have a role in the treatment of patients with high-grade STS.

*Department of Radiation Oncology and Molecular Radiation Sciences, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine

Departments of Medical Oncology

Orthopaedic Surgery, Johns Hopkins University School of Medicine, Baltimore, MD

§Department of Orthopaedic Surgery, University of Pennsylvania School of Medicine, Philadelphia, PA

D.S.E. has been a prior consultant for GlaxoSmithKline, Eli Lilly, Gilead, Roche/Genentech, Boehringer Ingelheim, Sanofi Aventis, Biodesix, AstraZeneca, Bristol-Meyers Squibb, Cell Therapeutics, Pfizer, Merck, MGI Pharma, and has previously received honoraria from GlaxoSmithKline, Eli Lilly, Sanofi Aventis, and Novartis. C.M. has been a prior consultant for Sanofi Aventis. The other authors declare no conflicts of interest.

Reprints: Stephanie A. Terezakis, MD, 401 North Broadway, Suite 1440, Weinberg Building, Departments of Radiation Oncology and Molecular Radiation Sciences, Sidney Kimmel Comprehensive Cancer Center, The Johns Hopkins University School of Medicine, Baltimore, MD 21231. E-mail: sterezak@jhmi.edu.

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