What is the overall survival rate for patients with retroperitoneal liposarcoma treated with doxorubicin (anthracycline antibiotic) and ifosfamide (alkylating agent)?

Overall Survival Rate for Doxorubicin and Ifosfamide in Retroperitoneal Liposarcoma

The overall survival rate for patients with retroperitoneal liposarcoma treated with doxorubicin and ifosfamide is approximately 16.8-17.9 months for advanced/metastatic disease, while adjuvant chemotherapy with these agents shows no significant survival benefit over surgery alone for resectable disease. 1

Evidence for Advanced/Metastatic Disease

Survival Outcomes with Doxorubicin and Ifosfamide

• For advanced/metastatic soft tissue sarcomas (including retroperitoneal liposarcoma):
  • Median overall survival with doxorubicin plus ifosfamide: 17.9 months 1
  • For intra-abdominal well-differentiated/dedifferentiated liposarcoma specifically:
    • Median overall survival with doxorubicin plus ifosfamide: 31 months (though not statistically significant compared to other regimens due to small sample size) 2

Response Rates

• Doxorubicin plus ifosfamide shows higher response rates compared to single-agent therapy:
  • Response rate in intra-abdominal liposarcoma: 22% for doxorubicin plus ifosfamide vs. 6.3% for anthracycline alone 2
  • Progression-free survival: 12 months for combination therapy vs. 4 months overall 2

Evidence for Adjuvant Setting (Post-Surgery)

No Proven Survival Benefit

• Multiple randomized controlled trials show no significant overall survival benefit for adjuvant chemotherapy with doxorubicin and ifosfamide in retroperitoneal sarcomas:
  • EORTC-62931 trial: 5-year overall survival rates were 64% for adjuvant chemotherapy vs. 69% for observation 1
  • A systematic review by the Australia and New Zealand Sarcoma Association found no evidence that adjuvant chemotherapy improves recurrence-free or overall survival in primary localized resectable retroperitoneal sarcoma 1

Potential Harm in Some Subgroups

• Some studies suggest potential harm:
  • Perez et al. reported worse median overall survival in the chemotherapy group compared to surgery alone (53 vs. 86 months) 1
  • Klooster et al. found an adverse association with long-term (>5 years) survival (HR 2.15) despite short-term benefit 1

Specific Liposarcoma Subtypes

• Well-differentiated/dedifferentiated liposarcoma shows limited sensitivity to chemotherapy 3
• For dedifferentiated liposarcoma specifically:
  • Complete responses have been reported in case reports with doxorubicin and ifosfamide for metastatic disease 4
  • High-dose continuous infusion ifosfamide has shown activity even in patients previously treated with standard-dose regimens 3

Neoadjuvant Setting

• Limited data exists for neoadjuvant (pre-surgical) chemoradiotherapy:
  • A single-institution study reported 5-year overall survival of 60.3% with neoadjuvant chemoradiotherapy (doxorubicin and ifosfamide) plus surgery 5
  • This approach may be considered for high-risk tumors but is not standard of care

Clinical Considerations and Toxicity

• Toxicity is significant with doxorubicin and ifosfamide combination:
  • Common grade 3-4 toxicities include leukocytopenia (85%), thrombocytopenia (33%), and anemia (11%) 5
  • Dose reductions are frequently required (60-80% of patients in some studies) 6

Conclusion

For retroperitoneal liposarcoma, doxorubicin and ifosfamide combination therapy provides modest survival benefit in the advanced/metastatic setting but has not demonstrated significant survival advantage in the adjuvant setting. The decision to use this regimen should be based on disease stage, patient fitness, and tumor characteristics, with careful consideration of the significant toxicity profile.