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Preoperative Chemoradiotherapy (Modified Eilber Protocol) Provides Maximum Local Control and Minimal Morbidity in Patients With Soft Tissue Sarcoma

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Abstract

Background

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.

Methods

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.

Results

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.

Conclusions

This modified Eilber protocol seems to maximize local control and minimize major wound complications for extremity/truncal STS.

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Reference

  1. Eilber FR, Mirra JJ, Grant TT, Weisenburger T, Morton DL. Is amputation necessary for sarcomas? Ann Surg 1980;192:431–8

    Google Scholar 

  2. Rosenberg SA, Tepper J, Glatstein E, et al. The treatment of soft-tissue sarcomas of the extremities: prospective randomized evaluations of (1) limb-sparing surgery plus radiation therapy compared with amputation and (2) the role of adjuvant chemotherapy. Ann Surg 1982;196:305–15

    Google Scholar 

  3. Pisters PWT, Leung DHY, Woodruff J, Shi W, Brennan MF. Analysis of prognostic factors in 1,041 patients with localized soft tissue sarcomas of the extremities. J Clin Oncol 1996;14:1679–89

    Google Scholar 

  4. Coindre J, Terrier P, Bui NB, et al. Prognostic factors in adult patients with locally controlled soft tissue sarcoma: a study of 546 patients from the French Federation of Cancer Centers Sarcoma Group. J Clin Oncol 1996;14:869–77

    Google Scholar 

  5. Trovik CS, Bauer HCR, Berlin O, et al. Local recurrence of deep-seated, high-grade, soft tissue sarcoma: 459 patients from the Scandinavian Sarcoma Group Register. Acta Ortop Scand 2001;72:160–6

    Google Scholar 

  6. Fabrizio PL, Stafford SL, Pritchard DJ. Extremity soft-tissue sarcomas selectively treated with surgery alone. Int J Radiat Oncol Biol Phys 2000;48:227–32

    Google Scholar 

  7. Yang JC, Chang AE, Baker AR, et al. Randomized prospective study of the benefit of adjuvant radiation therapy in the treatment of soft tissue sarcomas of the extremity. J Clin Oncol 1998;16:197–203

    Google Scholar 

  8. Zagars GK, Ballo MT, Pisters PWT, et al. Prognostic factors for patients with localized soft-tissue sarcoma treated with conservation surgery and radiation therapy: an analysis of 1225 patients. Cancer 2003;97:2530–43

    Google Scholar 

  9. Temple WJ, Temple CLF, Arthur KA, Schachar NS, Paterson AHG, Crabtree TS. Prospective cohort study of neoadjuvant treatment in conservative surgery of soft tissue sarcomas. Ann Surg Oncol 1997;4:586–90

    Google Scholar 

  10. Coindre J, Bui NB, Bonichon F, De Mascarel I, Trojani M. Histopathologic grading in spindle cell soft tissue sarcomas. Cancer 1988;61:2305–9

    Google Scholar 

  11. Brennan MF. Staging of soft tissue sarcomas. Ann Surg Oncol 1999;6:8–9

    Google Scholar 

  12. Kaplan EL, Meier P. Nonparametric estimation from incomplete observations. J Am Stat Assoc 1958;53:457–81

    Google Scholar 

  13. Cox DR. Regression models and life-tables. J R Stat Soc B 1972;34:187–220

    Google Scholar 

  14. Pollack A, Zagars GK, Goswitz MS, Pollock RE, Feig BW, Pisters PWT. Preoperative vs. postoperative radiotherapy in the treatment of primary soft tissue sarcoma. Int J Radiat Oncol Biol Phys 1998;42:563–72

    Google Scholar 

  15. Suit HD, Mankin HJ, Wood WC, Proppe KH. Preoperative, intraoperative, and postoperative radiation in the treatment of primary soft tissue sarcoma. Cancer 1985;55:2659–67

    Google Scholar 

  16. O’Sullivan B, Davis AM, Turcotte R, et al. Preoperative versus postoperative radiotherapy in soft-tissue sarcoma of the limbs: a randomised trial. Lancet 2002;359:2235–41

    Google Scholar 

  17. Eilber FC, Rosen G, Nelson SD, et al. High-grade extremity soft tissue sarcomas: factors predictive of local recurrence and its effect on morbidity and mortality. Ann Surg 2003;237:218–26

    Google Scholar 

  18. Eilber FC, Rosen G, Eckardt J, et al. Treatment-induced pathologic necrosis: a predictor of local recurrence and survival in patients receiving neoadjuvant therapy for high-grade extremity soft tissue sarcomas. J Clin Oncol 2001;19:3203–9

    Google Scholar 

  19. Eilber F, Eckardt J, Rosen G, Forscher C, Fu Y. Preoperative therapy for soft tissue sarcoma. Hematol Oncol Clin North Am 1995;9:817–23

    Google Scholar 

  20. Mollabashy A, Virkus WW, Zlotecki RA, Berry BH, Scarborough MT. Radiation therapy for low-grade soft tissue sarcoma. Clin Orthop Res 2002;397:190–5

    Google Scholar 

  21. Baldini EH, Goldberg J, Jenner C, et al. Long-term outcomes after function-sparing surgery without radiotherapy for soft tissue sarcoma of the extremities and trunk. J Clin Oncol 1999;17:3252–9

    Google Scholar 

  22. Rydholm A, Gustafson P, Rooser B, et al. Limb-sparing surgery without radiotherapy based on anatomic location of soft tissue sarcoma. J Clin Oncol 1991;9:1757–65

    Google Scholar 

  23. Popov P, Tukiainen E, Asko-Seljaavaara S, et al. Soft tissue sarcomas of the lower extremity: surgical treatment and outcome. Eur J Surg Oncol 2000;26:679–85

    Google Scholar 

  24. Nielsen OS, Cummings B, O’Sullivan B, Catton C, Bell RS, Fornasier VI. Preoperative and postoperative irradiation of soft tissue sarcomas: effect of radiation field size. Int J Radiat Oncol Biol Phys 1991;21:1595–9

    Google Scholar 

  25. Eilber FC, Eckardt JJ, Rosen G, Nelson SD, Selch M, Eilber FR. Large, deep, high-grade extremity sarcomas: treating tumors of the flexor fossae. Surg Oncol 1999;8:211–4

    Google Scholar 

  26. Davis AM, O’Sullivan B, Bell RS, et al. Function and health status outcomes in a randomized trial comparing preoperative and postoperative radiotherapy in extremity soft tissue sarcoma. J Clin Oncol 2002;20:4472–7

    Google Scholar 

  27. Pisters PWT. Chemoradiation treatment strategies for localized sarcoma: conventional and investigation approaches. Semin Surg Oncol 1999;17:66–71

    Google Scholar 

  28. Eilber FR, Giuliano AE, Huth JF, Weisenburger TH, Eckardt J. Intravenous (IV) vs. intraarterial (IA) Adriamycin, 2800r radiation and surgical excision for extremity soft tissue sarcomas: a randomized prospective trial Proc Am Soc Clin Oncol 1990;9:309. (abstract)

    Google Scholar 

  29. Pisters PWT, Harrison LB, Leung DHY, Woodruff JM, Casper ES, Brennan MF. Long-term results of a prospective randomized trial of adjuvant brachytherapy in soft tissue sarcoma. J Clin Oncol 1996;14:859–68

    Google Scholar 

  30. Harrison LB, Franzese F, Gaynor JJ, Brennan MF. Long-term results of a prospective randomized trial of adjuvant brachytherapy in the management of completely resected soft tissue sarcomas of the extremity and superficial trunk. Int J Radiat Oncol Biol Phys 1993;27:259–65

    Google Scholar 

  31. Mack LA, Temple WJ, DeHaas WG, Schachar NS, Morris DG, Kurien E. Groin soft tissue tumors—a challenge for local control and reconstruction: a prospective cohort analysis. J Surg Oncol 2004;86:147–51

    Google Scholar 

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Authors and Affiliations

  1. Division of Surgical Oncology, University of Calgary, Tom Baker Cancer Centre, 1331 29th Street N.W., Calgary, Alberta, Canada, T2N 4N2

    Lloyd A. Mack MD, Don G. Morris MD, PhD, Elizabeth C. Kurien MD & Walley J. Temple MD, FRCSC, FACS

  2. Department of Surgery, University of New South Wales, Prince of Wales Hospital, High Street, Randwick, New South Wales, 2031, Australia

    Phil J. Crowe MD & Jia Lin Yang MEd, PhD

  3. Department of Surgery, University of Calgary,Foothills Medical Centre, 1403 29th Street, N. W., Calgary, Alberta, T2N 2T9, Canada

    Norman S. Schachar MD, Claire L. F. Temple MD, Robert L. Lindsay MD, Enzio Magi MD & William G. DeHaas MD

Authors
  1. Lloyd A. Mack MD
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  2. Phil J. Crowe MD
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  3. Jia Lin Yang MEd, PhD
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  4. Norman S. Schachar MD
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  5. Don G. Morris MD, PhD
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  6. Elizabeth C. Kurien MD
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  7. Claire L. F. Temple MD
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  10. William G. DeHaas MD
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  11. Walley J. Temple MD, FRCSC, FACS
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Corresponding author

Correspondence to Walley J. Temple MD, FRCSC, FACS.

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Published by Springer Science+Business Media, Inc. © 2005 The Society of Surgical Oncology, Inc.

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Mack, L.A., Crowe, P.J., Yang, J.L. et al. Preoperative Chemoradiotherapy (Modified Eilber Protocol) Provides Maximum Local Control and Minimal Morbidity in Patients With Soft Tissue Sarcoma. Ann Surg Oncol 12, 646–653 (2005). https://doi.org/10.1245/ASO.2005.03.064

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  • DOI: https://doi.org/10.1245/ASO.2005.03.064

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