Feasibility and Activity of Concurrent Neoadjuvant Chemotherapy and Radiotherapy in Patients with High-risk Soft-Tissue Sarcoma.
Elena Palassini, Sara Pizzamiglio, Emanuela Palmerini et al.
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In 30 seconds
This analysis of the international, randomized phase III ISG-STS 1001 trial assessed concurrent epirubicin–ifosfamide chemotherapy (EI) and radiotherapy in patients with localized, high-risk soft-tissue sarcoma. Among 287 patients included, 146 received preoperative radiotherapy. Chemotherapy dose intensity and severe hematologic toxicity were comparable with preoperative chemotherapy alone. RECIST response was more frequent with concurrent preoperative radiotherapy (20.3% vs. 9.8%; P = 0.02), while seroma was also more frequent (10.4% vs. 2.8%; P = 0.01). The authors concluded that concurrent treatment was feasible and safe.
Key findings
- Median chemotherapy dose intensity exceeded 90% in both the concurrent chemotherapy–radiotherapy and chemotherapy-alone groups.
- Grade ≥3 hematologic toxicities were comparable between groups.
- RECIST response occurred in 20.3% with concurrent preoperative radiotherapy versus 9.8% with chemotherapy alone (P = 0.02).
- Seroma occurred in 10.4% versus 2.8%, respectively (P = 0.01); wound dehiscence was 9% versus 3.5% (P = 0.06).
Why it matters
The findings suggest that concurrent EI and radiotherapy can be delivered without an apparent reduction in chemotherapy dose intensity or increase in severe hematologic toxicity, while being associated with more dimensional responses. The higher seroma rate highlights a postoperative complication to weigh alongside response when considering this treatment approach.
What to keep in mind
This analysis included 287 of the 548 trial participants, and the comparison of concurrent preoperative radiotherapy with chemotherapy alone was not described as randomized.