Feasibility and activity of concurrent neoadjuvant chemotherapy and radiation therapy in patients with high-risk soft tissue sarcoma

OBJECTIVE: The ISG-STS 1001 was an international, randomized, phase III, trial for localized, high-risk, STS comparing neoadjuvant ChT with epirubicin and ifosfamide (EI) versus a histology-tailored regimen. The trial included also a cohort of patients not randomized but just registered and treated with EI. Herein, we analyzed tolerability and activity of concurrent EI and RT in the ISG-STS 1001. METHODS AND PATIENTS: EI was made up of epirubicin 120 mg/m² plus ifosfamide 9 g/m² per cycle. RT was delivered at a dose of 44-50 Gy pre-operatively or 60-66 Gy post-operatively. ChT dose-intensity (DI), grade ≥3 hematological toxicities, acute RT-related toxicities, post-operative local complications, and radiological response by RECIST were compared between the group of patients receiving concurrent pre-operative ChT and RT (ChT/RT group) and the group receiving pre-operative ChT alone (ChT group). RESULTS: Among the 548 patients enrolled in the ISG-STS 1001, 287 were included in the current analysis (146 received pre-operative RT). Median ChT DI was >90% in both groups. Hematological toxicities were comparable between the two groups. Concerning post-operative complications, a higher number of wound dehiscence (9% vs 3.5%, respectively, p = 0.06) and seroma (10.4% vs 2.8%, respectively, p = 0.01) were observed in the ChT/RT group compared to the ChT group. A statistically significant association between RECIST response and pre-operative RT was found (20.3% and 9.8% in the ChT/RT group and in the ChT group, respectively, p = 0.02). CONCLUSIONS: Concurrent EI and RT is feasible and safe, resulting in increased proportion of dimensional responses.

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Journal
Clinical Cancer Research
Published
2026-07-30
DOI
https://doi.org/10.1158/1078-0432.ccr-26-0400
Primary Topic
Sarcoma Diagnosis and Treatment
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article
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article

Feasibility and activity of concurrent neoadjuvant chemotherapy and radiation therapy in patients with high-risk soft tissue sarcoma

Robert Díaz Beveridge, Paolo Verderio, Javier Martín‐Broto, Vittorio Quagliuolo et al.
Clinical Cancer Research
Sarcoma Diagnosis and Treatment
article

Feasibility and activity of concurrent neoadjuvant chemotherapy and radiation therapy in patients with high-risk soft tissue sarcoma

Robert Díaz Beveridge, Paolo Verderio, Javier Martín‐Broto, Vittorio Quagliuolo, Angelo Paolo Dei Tos, Andrea Marrari, Paolo G. Casali, Virginia Ferraresi, Iwona Ługowska, Jean‐Yves Blay, Giuseppe Bianchi, Jean‐Michel Coindre, Valeria Fontana, Silvia Stacchiotti, Elena Palassini, Claudia Sangalli, Alessandro Gronchi, Oscar Tendero, Valeria Duroni, Sílvia Bagué, Sara Pizzamiglio, S. Aliberti, Carlo Morosi, Emanuela Palmerini, Antonella Brunello, Antonio López–Pousa, Davide María Donati, Sandro Pasquali
article en

Abstract

OBJECTIVE: The ISG-STS 1001 was an international, randomized, phase III, trial for localized, high-risk, STS comparing neoadjuvant ChT with epirubicin and ifosfamide (EI) versus a histology-tailored regimen. The trial included also a cohort of patients not randomized but just registered and treated with EI. Herein, we analyzed tolerability and activity of concurrent EI and RT in the ISG-STS 1001. METHODS AND PATIENTS: EI was made up of epirubicin 120 mg/m² plus ifosfamide 9 g/m² per cycle. RT was delivered at a dose of 44-50 Gy pre-operatively or 60-66 Gy post-operatively. ChT dose-intensity (DI), grade ≥3 hematological toxicities, acute RT-related toxicities, post-operative local complications, and radiological response by RECIST were compared between the group of patients receiving concurrent pre-operative ChT and RT (ChT/RT group) and the group receiving pre-operative ChT alone (ChT group). RESULTS: Among the 548 patients enrolled in the ISG-STS 1001, 287 were included in the current analysis (146 received pre-operative RT). Median ChT DI was >90% in both groups. Hematological toxicities were comparable between the two groups. Concerning post-operative complications, a higher number of wound dehiscence (9% vs 3.5%, respectively, p = 0.06) and seroma (10.4% vs 2.8%, respectively, p = 0.01) were observed in the ChT/RT group compared to the ChT group. A statistically significant association between RECIST response and pre-operative RT was found (20.3% and 9.8% in the ChT/RT group and in the ChT group, respectively, p = 0.02). CONCLUSIONS: Concurrent EI and RT is feasible and safe, resulting in increased proportion of dimensional responses.

Clinical Cancer Research
University of Padua (IT), University of Miami (US), Hospital de Sant Pau (ES), Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico (IT), Hospital Universitari i Politècnic La Fe (ES), Centre Léon Bérard (FR), Istituto Oncologico Veneto (IT), National Institute of Oncology (HU), Istituto Ortopedico Rizzoli (IT), Hospital Universitario Fundación Jiménez Díaz (ES), Institut Bergonié (FR), Tumori Foundation (US), Ospedale Policlinico San Martino (IT), The Maria Sklodowska-Curie National Research Institute of Oncology (PL), Candiolo Cancer Institute (IT), Hospital Universitario Son Espases (ES), Fondazione IRCCS Istituto Nazionale dei Tumori (IT), IRCCS Humanitas Research Hospital (IT)
Good health and well-being
Openalex Percentile: Top 10%
Sarcoma Diagnosis and Treatment
DOISourceOpenAlex
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