Neoadjuvant chemotherapy for extremity soft tissue sarcomas：twenty-eight cases report
WANG Bing
YU Xiu-chun
XU Song-feng
XU Ming
ZHENG Kai
LIU Jiang
Abstract：Objective To investigate and analyze the clinical effects and value of neoadjuvant chemotherapy in the treatment of extremity soft tissue sarcomas ( STS ).Methods A total of 28 patients with extremity STS were treated by neoadjuvant chemotherapy from May 2009 to June 2012, namely preoperative chemotherapy for 2 cycles, surgical treatment and postoperative chemotherapy for 6 cycles. There were 18 males and 10 females, whose median age was 35 years old ( range: 15-62 years ). Combination therapy with cisplatin ( DDP ), ifosfamide ( IFO ) and adriamycin ( ADM ) was performed before and after the surgery, which was also called DIA chemotherapy. The patients were treated with DDP 120 mg/m2 on the 1st day, ADM 30 mg/m2 and IFO 2.0 g/m2 on the 7th-9th day in sequence and IFO 2.0 g/m2 on the 10th-11th day for a cycle. All the patients were followed up, and CT scans of the lungs and X-ray iflms of the lesion sites were reviewed. The cases of recurrences, metastases and death were recorded. The chemotherapeutic effects were evaluated according to Response Evaluation Criteria in Solid Tumors ( RECIST 1.1 ) guidelines. Common Terminology Criteria for Adverse Events, Version 4.0 ( CTCAE 4.0 ) was used to observe the adverse reaction of chemotherapy.Results All the surgeries were successful, and complete wound healing was achieved as scheduled in all the cases. The mean total blood loss was 260 ml ( range: 50-600 ml ). It took 38 weeks in DIA chemotherapy, including 2 cycles of preoperative chemotherapy and 6 cycles of postoperative chemotherapy. A total of 224 cycles of chemotherapy were carried out in the 28 patients. They were followed up for 12-59 months.At the end of the follow-up, 23 patients survived. Disease-free survival was realized in 20 patients and survival with tumors in 3 patients, and the survival time was 24-59 months. The 2-year disease-free survival rate was 71.4% and the overall 2-year survival rate was 82.1%. Postoperative metastases were noticed in 5 patients, who all died of lung metastases. Postoperative recurrences were found in 4 patients, and the recurrence rate was 12.3%. Three dimensional conformal radiation therapy was performed on 4 patients with recurrences and 3 patients with lung metastases. The size of tumors was reduced by ( 30.2±11.3 ) % on average after the preoperative chemotherapy, which was reduced by ( 42.7±7.8 ) % in 22 patients whose tumors were more than 15cm in the diameter. Complete remssion ( CR ) was noticed in 0 case, partial remission ( PR ) in 12 cases, stable disease ( SD ) in 14 cases and progression disease ( PD ) in 2 cases. The objective response rate ( ORR ) was 42.9%, and the disease control rate ( DCR ) was 92.9%. The chemotherapy was well tolerated in all the patients, whose main adverse reaction was transient. And the symptoms disappeared after drug treatment.Conclusions The neoadjuvant chemotherapy is important and effective in the treatment of extremity STS. The size of STS can be signiifcantly reduced and the surrounding soft tissue edema can be relieved after the preoperative chemotherapy. The micrometastases can be inhibited, which helps the surgical resection. Both the overall survival rate and disease-free survival rate are improved, which beneifts the limb salvage therapy. The short- and medium-term effects are satisfactory and the adverse reactions are tolerable.
Keywords：ChemoradiotherapyadjuvantSoft tissue neoplasmsSarcomaExtremities
Publication Date：2015-01-01
Online Publishing Date：2025-08-15(First online date of this platform, not the publication date of the document)
Pages：6( 4-9 )