Adjuvant chemotherapy—Radiotherapy—Chemotherapy sandwich protocol in resectable soft tissue sarcoma: An updated single-center analysis of 104 cases

Adjuvant therapy of local soft tissue sarcomas (STS) after wide surgical excision still is a topic under controversial scientific debate. In this single center report we have offered an adjuvant “sandwich” therapy protocol consisting of 4 cycles of doxorubicin (75 mg/m2 i.v. over 1 h on day 1) follo...

Authors: Schliemann, Christoph
Kerkhoff, Andrea
Hesse, Paula
Bröckling, Sebastian
Hardes, Jendrik
Streitbürger, Arne
Andreou, Dimosthenis
Gosheger, Georg
Elges, Sandra
Wardelmann, Eva
Hartmann, Wolfgang
Mesters, Rolf
Lenz, Georg
Willich, Normann
Kriz, Jan
Eich, Hans-Theodor
Berdel, Wolfgang E.
Keßler, Torsten
Division/Institute:FB 05: Medizinische Fakultät
Document types:Article
Media types:Text
Publication date:2018
Date of publication on miami:09.05.2019
Modification date:09.05.2019
Edition statement:[Electronic ed.]
Source:PLoS ONE 13 (2018) 5, e0197315, 1-12
DDC Subject:610: Medizin und Gesundheit
License:CC BY 4.0
Language:English
Funding:Finanziert durch den Open-Access-Publikationsfonds 2018 der Deutschen Forschungsgemeinschaft (DFG) und der Westfälischen Wilhelms-Universität Münster (WWU Münster).
Format:PDF document
URN:urn:nbn:de:hbz:6-55109474001
Permalink:http://nbn-resolving.de/urn:nbn:de:hbz:6-55109474001
Other Identifiers:DOI: 10.1371/journal.pone.0197315
Digital documents:artikel_kessler_2018.pdf

Adjuvant therapy of local soft tissue sarcomas (STS) after wide surgical excision still is a topic under controversial scientific debate. In this single center report we have offered an adjuvant “sandwich” therapy protocol consisting of 4 cycles of doxorubicin (75 mg/m2 i.v. over 1 h on day 1) followed by ifosfamide (5 g/m2 i.v. over 24 h starting on day 1) and local radiotherapy scheduled between chemotherapy cycles 2 and 3 to 104 consecutive patients after wide surgical excision (R0) of histologically proven high-grade STS. After a mean follow-up of 39 months (range 5–194 months) relapse free survival (RFS) at 2 and 5 years was 68.1% (95% CI, 58.5–77.7%) and 61.2% (95% CI, 50.4–71.6%). When analyzing the 82 STS cases of the extremities only 2- and 5-year RFS was 74.0% (95% CI, 64.0–84.0%) and 65.3% (95% CI, 53.7–76.9%). By intent-to-treat analysis, the overall survival (OS) at 2 years was 87.3% (95% CI, 80.5–94.1%) and 75.6% (95% CI, 65.2–86.0%) at 5 years, while OS for STS of the extremities only cohort was 90.5% (95% CI, 83.7–97.3%) and 79.0% (95% CI, 68.4–89.6%), respectively. Tolerability of the treatment was good. This analysis demonstrates the feasibility of adjuvant chemoradiotherapy and reflects the results of the long lasting intensive multidisciplinary team approach at our “high-volume” sarcoma center. The long-term survival in our patients is among the highest reported and the low local and distant recurrence rate in high-risk STS is at least comparable to the published data.