Preoperative chemoradiotherapy (modified Eilber protocol) provides maximum local control and minimal morbidity in patients with soft tissue sarcoma

Local recurrence rates of 15% to 30% after treatment of soft tissue sarcoma (STS) are still common but unacceptable. Our hypothesis was that a refined neoadjuvant chemotherapy and radiation protocol (modified Eilber protocol) improves local control rates while minimizing major morbidity. Consecutive...

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Bibliographic Details
Published in:	Annals of surgical oncology Vol. 12; no. 8; pp. 646 - 653
Main Authors:	Mack, Lloyd A, Crowe, Phil J, Yang, Jia Lin, Schachar, Norman S, Morris, Don G, Kurien, Elizabeth C, Temple, Claire L F, Lindsay, Robert L, Magi, Enzio, DeHaas, William G, Temple, Walley J
Format:	Journal Article
Language:	English
Published:	United States Springer Nature B.V 01-08-2005
Subjects:	Adolescent Adult Aged Aged, 80 and over Antibiotics, Antineoplastic - administration & dosage Chemotherapy, Adjuvant Doxorubicin - administration & dosage Female Histiocytoma, Benign Fibrous - pathology Histiocytoma, Benign Fibrous - surgery Histiocytoma, Benign Fibrous - therapy Humans Leiomyosarcoma - pathology Leiomyosarcoma - surgery Leiomyosarcoma - therapy Liposarcoma - pathology Liposarcoma - surgery Liposarcoma - therapy Middle Aged Neoadjuvant Therapy - methods Neoplasm Recurrence, Local - prevention & control Radiotherapy Dosage Radiotherapy, Adjuvant Retrospective Studies Sarcoma - drug therapy Sarcoma - pathology Sarcoma - radiotherapy Sarcoma - surgery
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Summary:	Local recurrence rates of 15% to 30% after treatment of soft tissue sarcoma (STS) are still common but unacceptable. Our hypothesis was that a refined neoadjuvant chemotherapy and radiation protocol (modified Eilber protocol) improves local control rates while minimizing major morbidity. Consecutive patients with STS deep to the fascia of the extremity or trunk during 1984 to 1996 were treated with 3 days of doxorubicin (30 mg/day) and sequential radiation (300 cGy/day for 10 days). Wide excision with limb preservation was performed 4 to 8 weeks after radiation completion. Treatment complications, margins, local recurrence, and survival were prospectively documented. Of 75 patients, 66% had tumors >5 cm, and 71% were grade 2/3. In eight patients, negative margins were not achieved, and four of these had amputation (95% limb salvage). Three of the remaining four had local recurrence with a 5- and 7-year actuarial local control rate of 50% and 25%, respectively. In contrast, of the 67 patients with negative margins, a local control rate of 97% at 5 years and 94% at 7 years and an overall survival of 63% were achieved. Although margin (P = .001) and stage (P = .035) were correlated, these were not significant on multivariate Cox regression analysis. Risk factors for death included tumor stage (hazard ratio, 1.54; P = .001) and tumor grade (hazard ratio, 1.4; P = .02). Three patients (4%) required reoperation for tissue loss, and eight patients (10.6%) developed minor wound complications. This modified Eilber protocol seems to maximize local control and minimize major wound complications for extremity/truncal STS.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	1068-9265 1534-4681
DOI:	10.1245/ASO.2005.03.064