ABSTRACT
This pilot study was conducted to evaluate the feasibility and tolerance of a multimodal therapy of retroperitoneal soft tissue sarcoma (STS), including intraoperative radiation therapy (IORT). Nineteen patients (14 primarily treated patients and 5 treated for a recurrent tumor) were included. Surgery included a complete resection (14), a partial resection (2), and no resection (2). The median IORT dose was 17 Gy. Thirteen patients also received an external radiation therapy (ERT). Nine patients received chemotherapy. There was no postoperative mortality. Immediate postoperative complications occurred in four patients (21%). Delayed complications occurred in six patients, including one lethal iliac artery disruption. With a median follow-up of 17 months, the 2-year disease-free survival rate was 60%, and the 2-year actuarial local control rate was 76%. A multimodality approach of treatment, including IORT and ERT and eventually chemotherapy, appears feasible in patients with retroperitoneal STS. However, the treatment-related morbidity appeared relatively high in this study.
Subject(s)
Intraoperative Care , Retroperitoneal Neoplasms/radiotherapy , Sarcoma/radiotherapy , Adolescent , Adult , Aged , Combined Modality Therapy , Disease-Free Survival , Feasibility Studies , Female , Follow-Up Studies , Humans , Male , Middle Aged , Neoplasm Metastasis , Neoplasm Recurrence, Local , Pilot Projects , Radiotherapy Dosage , Retroperitoneal Neoplasms/pathology , Retroperitoneal Neoplasms/surgery , Sarcoma/pathology , Sarcoma/surgeryABSTRACT
BACKGROUND: Palliative chemotherapy remains a challenge for oncologists. The combination of high dose folinic acid (HDFA) with 5-fluorouracil (5-FU) improves response rates, as do continuous infusions of 5-FU. These protocols have limiting toxicities such as diarrhea, stomatitis, and leukopenia. Another schedule of 5-FU and folinic acid has proven effective and is very well tolerated. The results of a similar regimen are reported. METHODS: Eighty-six eligible patients with evolutive advanced colorectal cancer were treated, after informed consent was obtained, with chemotherapy consisting of HDFA (200 mg/m2 in a 2-hour infusion, followed by 5-FU (400 mg/m2 IV bolus injection, then 600 mg/m2 in a 22-hour infusion) on days 1 and 2, every 15 days. Seven of 86 had received prior therapy for metastatic disease. RESULTS: Two complete and 31 partial responses were noted for an overall response rate of 38.3% (95% confidence interval, 0.25-0.45). Toxicity was low, as more than 60% of the patients had no or minor toxicity. Grade III or IV World Health Organization toxicities included stomatitis (7 patients), leukopenia (3 patients), diarrhea (2 patients), and cardiac toxicity (3 patients). The overall median survival was 10.3 months, and for those having a response, 17.1 months. CONCLUSIONS: High dose folinic acid combined with 5-FU bolus and continuous infusion for 2 days every 2 weeks is an effective regimen. Its toxicity appears low. Moreover, this chemotherapy is feasible on an outpatient basis.
