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Preoperative chemo-radiation therapy for localised retroperitoneal sarcoma: a phase I-II study from the Italian Sarcoma Group.
[dedifferentiated liposarcoma]
To
study
feasibility
,
safety
and
activity
of
the
combination
of
high
-dose
long
-infusion
ifosfamide
(
HLI
)
and
radiotherapy
(
RT
)
as
preoperative
treatment
for
resectable
localised
retroperitoneal
sarcoma
(
RPS
)
.
Patients
received
three
cycles
of
HLI
(
14
g
/
m
2
)
.
RT
was
started
in
combination
with
second
cycle
and
administered
up
to
a
total
dose
of
50
.
4
Gy
.
Surgery
was
scheduled
4
-
6
weeks
after
the
end
of
RT
.
Primary
end-point
was
3
-
year
relapse
free
survival
(
RFS
)
.
The
trial
is
registered
with
ITASARC
_
∗
II
_
2004
_
003
.
Between
December
2003
and
2010
,
83
patients
were
recruited
.
Main
histological
subtypes
were
well
differentiated
liposarcoma
(
19
/
83
,
23
%
)
,
dedifferentiated
liposarcoma
(
26
/
83
,
31
%
)
,
leiomyosarcoma
(
14
/
83
,
17
%
)
.
Median
tumour
size
was
120
mm
(
interquartile
(
IQ
)
range
=
82
-
160
)
.
The
overall
preoperative
treatment
was
completed
in
60
patients
.
Chemotherapy
(
CT
)
was
completed
in
65
,
while
RT
in
73
.
Four
patients
progressed
before
surgery
and
were
not
operated
.
79
patients
underwent
surgery
.
At
a
median
follow-up
of
4
.
8
years
(
IQ
range
=
3
-
6
.
1
)
,
23
and
15
patients
developed
local
recurrence
(
LR
)
and
distant
metastases
(
DM
)
;
30
patients
died
of
disease
.
3
and
5
-
year
RFS
and
overall
survival
were
0
.
56
(
90
%
confidence
interval
(
CI
)
:
0
.
45
,
0
.
65
)
and
0
.
44
(
90
%
CI
:
0
.
27
,
0
.
48
)
,
and
0
.
74
(
90
%
CI
:
0
.
62
,
0
.
81
)
and
0
.
59
(
90
%
CI
:
0
.
33
,
0
.
58
)
.
Crude
cumulative
incidence
of
LR
and
DM
at
5
years
were
0
.
37
(
standard
error
(
SE
)
:
0
.
06
)
and
0
.
26
(
SE
:
0
.
06
)
.
The
combination
of
preoperative
HLI
and
RT
was
feasible
in
two
thirds
of
patients
,
while
preoperative
RT
could
be
completed
in
most
(
73
/
83
)
.
Although
a
systemic
coverage
can
be
added
to
RT
when
this
is
felt
to
be
appropriate
,
the
ongoing
international
phase
III
trial
is
exploring
the
role
of
RT
alone
.
This
is
a
pure
academic
trial
.
No
funding
sources
contributed
to
it
.
Diseases
Validation
Diseases presenting
"leiomyosarcoma"
symptom
adrenal incidentaloma
alpha-thalassemia
dedifferentiated liposarcoma
focal myositis
liposarcoma
pleomorphic liposarcoma
well-differentiated liposarcoma
This symptom has already been validated