SARCOMA SYSTEMIC MANAGEMENT

Chemotherapy
* Rationale :~50% stage II, III patients succumb to disease 2∞ to DM
* Sarcoma meta-anlysis collaboration (Lancet 1997)
* DFS-10 45% v 55% p = 0.0001
* Local DFS-10 75% vs 81% p = 0.016
* OS-10 50% vs 54% p = 0.12
* Largest difference in OS found in patients with extremity sarcoma with absolute 7% increase in absolute overall survival (p = 0.029)

Prospective Randomized Trials
EORTC Miser 1992
7y DFS 7y LC
181 pts. randomized to cyclo/vin/Adria/DTIC 56 83
136 pts. observation 43 69
p=0.007 p=0.004
No difference in DM(66%) or AS(60%)

There are 8 other RMT’s

Problems with the trials
* Large #’s of pts. did not get planned tx

  • Included low and intermediate grades
  • Chemo doses low by today’s standards
  • Ifosfamide not used

UF Chemo Experience
VP-16 600mg 3 day infusion
Cytoxan (800mg/6 divided does (BID x 3d)
2-3 cycles preop Rt

Conclusions
Significantly improved local control but not survival.

Little enthusiasm as randomized trials show no survival benefit

MGH has recently shown 3 cycles of MAID preop + 44Gy preop + 3 cycles postop significantly improves Actuarial 5y LC, DFS, AS compared to historic controls.

Intra-arterial Chemotherapy – most commonly Doxorubicin
Drugs given intrarterially ± tourniquet to ≠ concentration; uses isolation perfusion and extracoporeal circulation
Hypothermia

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