combination chemotherapy, radiation therapy, and surgery in treating patients with primary or recurrent sarcoma

Conditions: Stage III Adult Soft Tissue Sarcoma; Recurrent Adult Soft Tissue Sarcoma; Stage IVA Adult Soft Tissue Sarcoma; Stage IIB Adult Soft Tissue Sarcoma; Stage IIC Adult Soft Tissue Sarcoma

Summary: rationale: drugs used in chemotherapy use different ways to stop tumor cells from dividing so they stop growing or die. radiation therapy uses high-energy x-rays to damage tumor cells. combining chemotherapy, radiation therapy, and surgery may kill more tumor cells. purpose: phase ii trial to study the effectiveness of combination chemotherapy, radiation therapy, and surgery in treating patients who have primary or recurrent sarcoma.

objectives: * determine the overall survival of patients with primary or recurrent retroperitoneal sarcomas treated with neoadjuvant doxorubicin and ifosfamide, radiotherapy, and surgical resection. * assess local-regional control in patients treated with this regimen. * determine the disease-free survival of patients treated with this regimen. * determine the pathologic response in patients treated with this regimen. * determine the toxic effects of this regimen in these patients. * determine the complications in patients treated with this regimen. outline: patients receive doxorubicin iv continuously on days 1-3 and ifosfamide iv over 3 hours on days 1-4. patients also receive filgrastim (g-csf) beginning on day 5 and continuing until blood counts recover. treatment repeats every 21 days for a maximum of 4 courses in the absence of unacceptable toxicity. beginning 2-4 weeks after chemotherapy, patients undergo radiotherapy daily, 5 days a week, for 5-6 weeks. beginning 4-7 weeks after radiotherapy, patients undergo complete surgical resection with intraoperative or postoperative radiotherapy or brachytherapy. patients are followed every 3 months for 2 years, every 6 months for 3 years, and then annually thereafter. projected accrual: a total of 48 patients will be accrued for this study within 24 months.

Eligibility criteria:
disease characteristics: * histologically confirmed primary or recurrent soft tissue sarcoma of the retroperitoneum or pelvis * no rhabdomyosarcoma, extraosseous ewing's sarcoma, primitive neuroectodermal tumor, osteosarcoma, chondrosarcoma, kaposi's sarcoma, or aggressive fibromatosis * no sarcoma that does not allow sparing of two-thirds of 1 kidney within planned irradiation field * radiographically measurable disease greater than 5 cm (t2) by ct scan or mri of the abdomen and pelvis * high-grade (grade 3/3, 3/4, 4/4) disease greater than 5 cm or * moderate-grade (grade 2/3, 2/4) recurrent disease greater than 10 cm * eligible for gross total resection (r0 or r1) * no prior subtotal (r2) resection * partial debulking or subtotal tumor resection with residual gross disease * fewer than 4 equivocal pulmonary lesions each less than 3 mm in diameter by ct scan * no multifocal disease suggestive of regional nodal involvement * no metastases patient characteristics: age: * not specified performance status: * zubrod 0-2 life expectancy: * at least 2 years hematopoietic: * absolute neutrophil count at least 1,500/mm\^3 * platelet count at least 100,000/mm\^3 hepatic: * bilirubin no greater than 1.5 mg/dl * ast no greater than 3 times upper limit of normal * albumin at least 3.5 g/dl renal: * creatinine no greater than 1.6 mg/dl * two functional kidneys cardiovascular: * no congestive heart failure * no myocardial infarction within the past 6 months * no new york heart association class iii or iv heart disease * ejection fraction at least 50% other: * no other malignancy within the past 5 years except surgically treated carcinoma in situ of the cervix or basal cell or squamous cell skin cancer * no serious medical or psychiatric illness that would preclude study entry * no obvious bowel obstruction * no hypersensitivity to e. coli-derived products * not pregnant or nursing * negative pregnancy test * fertile patients must use effective contraception * oral caloric intake at least 1,500 kcal/day prior concurrent therapy: biologic therapy: * not specified chemotherapy: * no prior doxorubicin or ifosfamide * no prior chemotherapy for sarcoma endocrine therapy: * not specified radiotherapy: * no prior abdominal or pelvic irradiation surgery: * see disease characteristics