Twenty-five patients (male = 17, female = 8) with a median age of 51 years who were treated with THP, IFO, and VP-16 combination therapy were included in the study. Seven patients underwent this regimen as neoadjuvant chemotherapy, and 18 patients were treated to control surgically unresectable sarcoma or metastatic tumors. Histological subtypes included synovial sarcoma (n = 7, 28%), undifferentiated pleomorphic sarcoma (n = 6, 24%), myxofibrosarcoma (n = 3, 12%), epithelioid sarcoma (n = 2, 8%), myxoid liposarcoma (n = 2, 8%), alveolar soft part sarcoma (n = 2, 8%), and others (n = 3, 12%). Their characteristics are shown in Table I with additional details supplied in the Supplementary Table. As for the best responses to chemotherapy, 9 patients were evaluated as PR (the overall response rate = 36%), while 9 patients were classified as having SD and 7 had PD.
Serious adverse events of grade 3 or higher were white blood cell decreases (96%), febrile neutropenia (68%), anemia (68%), platelet count decreases (48%), Alanine aminotransferase increases (20%), and Aspartate aminotransferase increases (12%). These adverse events were appropriately managed with blood transfusion, G-CSF administration, or the induction of short-term antibiotics. None of these treatment-related serious adverse events were fatal. The non-hematological toxicities were relatively tolerable, while 2 patients discontinued chemotherapy because of delirium or urticaria. During the study, there were no cases of cardiac or renal toxicity reported (Table II).
A 67-year-old man with a tumor in the right anterior chest wall was referred to our department. The patient was diagnosed with high grade myxofibrosarcoma by needle biopsy. Although there was no metastatic lesion, the tumor was located in his pectoralis minor muscle and adjacent to his ribs, brachial plexus, subclavian artery and vein (Figure 2a, 2b).
The patient received THP, IFO and VP-16 as neoadjuvant chemotherapy. Six cycles were performed, and adverse events of grade 3 or higher were white blood cell decrease, febrile neutropenia, anemia, and platelet count decrease, lower than grade 2 toxicities were alopecia, fatigue and nausea. After chemotherapy, the tumor showed remarkable shrinkage (Figure 2c, 2d), and tumor resection was performed. Although wide resection including a part of the pectoralis major muscle and pectoralis minor muscle was performed, rib, nerves and blood vessels were spared. Histological evaluation, showed hyaline or sclerotic change in most tumor cells (Figure 2f, 2g) and the surgical margin was negative. The patient received a further three courses of adjuvant chemotherapy with this regimen after surgery. No evidence of disease and no signs of recurrence were seen at outpatient follow-up 2 years after the definitive surgery.