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Preoperative Chemoradiotherapy (Modified Eilber Protocol) Provides Maximum Local Control and Minimal Morbidity in Patients With Soft Tissue Sarcoma

¹ Division of Surgical Oncology, University of Calgary, Tom Baker Cancer Centre, 1331 29th Street N.W., Calgary, Alberta, Canada, T2N 4N2
² Department of Surgery, University of New South Wales, Prince of Wales Hospital, High Street, Randwick, New South Wales, Australia 2031
³ Department of Surgery, University of Calgary, Foothills Medical Centre, 1403 29th Street, N. W., Calgary, Alberta, Canada, T2N 2T9

Correspondence: Address correspondence and reprint requests to: Walley J. Temple, MD, FRCSC, FACS; E-mail: walleyte{at}cancerboard.ab.ca.

Background: Local recurrence rates of 15% to 30% after treatment of soft tissue sarcoma (STS) are still common but unacceptable. Our hypothesis was that a refined neoadjuvant chemotherapy and radiation protocol (modified Eilber protocol) improves local control rates while minimizing major morbidity.

Methods: Consecutive patients with STS deep to the fascia of the extremity or trunk during 1984 to 1996 were treated with 3 days of doxorubicin (30 mg/day) and sequential radiation (300 cGy/day for 10 days). Wide excision with limb preservation was performed 4 to 8 weeks after radiation completion. Treatment complications, margins, local recurrence, and survival were prospectively documented.

Results: Of 75 patients, 66% had tumors >5 cm, and 71% were grade 2/3. In eight patients, negative margins were not achieved, and four of these had amputation (95% limb salvage). Three of the remaining four had local recurrence with a 5- and 7-year actuarial local control rate of 50% and 25%, respectively. In contrast, of the 67 patients with negative margins, a local control rate of 97% at 5 years and 94% at 7 years and an overall survival of 63% were achieved. Although margin (P = .001) and stage (P = .035) were correlated, these were not significant on multivariate Cox regression analysis. Risk factors for death included tumor stage (hazard ratio, 1.54; P = .001) and tumor grade (hazard ratio, 1.4; P = .02). Three patients (4%) required reoperation for tissue loss, and eight patients (10.6%) developed minor wound complications.

Conclusions: This modified Eilber protocol seems to maximize local control and minimize major wound complications for extremity/truncal STS.

Key Words: Soft tissue sarcoma • Limb-sparing surgery • Combined-modality therapy • Local control

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