Preoperative Thalidomide With Radiation Therapy For Patients With Low-Grade Primary Soft Tissue Sarcoma or Thalidomide With Radiation Therapy and Chemotherapy For Patients With High-Grade or Intermediate-Grade Primary Soft Tissue Sarcoma of the Arm, Leg, or Body Wall
Condition: Recurrent Adult Soft Tissue Sarcoma; Stage I Adult Soft Tissue Sarcoma AJCC v7; Stage II Adult Soft Tissue Sarcoma AJCC v7; Stage III Adult Soft Tissue Sarcoma AJCC v7
MeSH terms: Sarcoma
Intervention: Dacarbazine; Doxorubicin Hydrochloride; Filgrastim; Ifosfamide; Laboratory Biomarker Analysis; Radiation Therapy; Thalidomide; Therapeutic Conventional Surgery
Intervention description: Given IV; Given IV; Given subcutaneously; Given IV; Correlative studies; Undergo radiotherapy; Given orally; Undergo surgical resection
Intervention MeSH terms: Thalidomide; Doxorubicin; Liposomal doxorubicin; Ifosfamide; Isophosphamide mustard; Dacarbazine; Imidazole; Lenograstim
Phase: Phase 2
Study type: Interventional
Primary purpose: Treatment
Allocation: Non-Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Enrollment: 23.0
Sex: All
Minimum age: 16 Years
Healthy volunteers: No

Summary:

      Thalidomide may stop the growth of soft tissue sarcoma by stopping blood flow to the tumor.
      Radiation therapy uses high-energy x-rays to damage tumor cells. Drugs used in chemotherapy,
      such as doxorubicin, ifosfamide, and dacarbazine, work in different ways to stop tumor cells
      from dividing so they stop growing or die. Giving thalidomide together with radiation therapy
      and/or chemotherapy before surgery may shrink the tumor so that it can be removed. This phase
      II trial is studying how well giving preoperative (before surgery) thalidomide together with
      radiation therapy works in treating patients with low-grade primary soft tissue sarcoma, and
      how well giving thalidomide together with radiation therapy, doxorubicin, ifosfamide, and
      dacarbazine works in treating patients with high-grade or intermediate-grade primary soft
      tissue sarcoma of the arm, leg, chest wall, or abdominal wall.
    

Eligibility criteria:

        Inclusion Criteria:

          -  Diagnosis of primary soft tissue sarcoma

               -  T2a or T2b disease

               -  Superficial or deep tumor

               -  Grade 1, 2, 3, or 4

               -  Tumor located on the upper extremity (including shoulder), lower extremity
                  (including hip), or trunk

          -  Meets 1 of the following criteria:

               -  Tumor ? 8 cm in maximal diameter and grade 3 or 4 (intermediate or high grade)
                  (cohort A)

               -  Tumor > 5 cm in maximal diameter and grade 1 or 2 (low grade) (cohort B)

          -  Locally recurrent disease allowed provided there has been no prior radiotherapy to the
             primary tumor

          -  No histologically confirmed rhabdomyosarcoma, extraosseous Ewing's primitive
             neuroectodermal tumors, osteosarcoma or chondrosarcoma, Kaposi's sarcoma,
             angiosarcoma, desmoid tumors, or dermatofibrosarcoma protuberans

          -  No overt evidence of lung metastases (CT scan evidence of small incidental lesions
             without histologic diagnosis allowed)

          -  No evidence of other metastases

          -  No sarcoma of the head, neck, intra-abdominal, or retroperitoneal region

          -  Performance status - Zubrod 0-1

          -  At least 2 years

          -  Absolute neutrophil count ? 1,500/mm^3

          -  Platelet count ? 120,000/mm^3

          -  Hemoglobin ? 8.0 g/dL (cohort A)

          -  No known hypercoagulable disorders, such as the following:

               -  APC resistance (factor V Leiden)

               -  Protein S deficiency

               -  Protein C deficiency

               -  Antithrombin III deficiency

               -  Hyperhomocystinemia

               -  Dysplasminogenemia

               -  High plasminogen activator inhibitor

               -  Dysfibrinogenemia

               -  Antiphospholipid syndrome

               -  Thrombocythemia

               -  Dysproteinemia

          -  Fibrin split products < 2 times upper limit of normal (ULN)

          -  Fibrinogen > 200 mg/dL

          -  Bilirubin ? 1.5 mg/dL (1.0 mg/dL for patients with Gilbert's syndrome)

          -  AST and ALT ? 2.0 times ULN

          -  PT and PTT < 1.25 times ULN (except in patients treated with anticoagulants for
             unrelated medical conditions [e.g., atrial fibrillation])

          -  No history of hepatic cirrhosis

          -  Creatinine ? 1.5 mg/dL

          -  Creatinine clearance > 60 mL/min

          -  No atherosclerotic coronary artery disease that required bypass surgery within the
             past year

          -  No uncompensated coronary artery disease by ECG or physical examination

          -  No myocardial infarction within the past 6 months

          -  No severe or unstable angina within the past 6 months

          -  No uncompensated congestive heart failure

          -  No New York Heart Association class II-IV heart disease

          -  No symptomatic peripheral vascular disease

          -  No history of deep vein thrombosis

          -  Cohort A only:

               -  EF ? 50% within the past 6 months

               -  LVEF > 50%

          -  No pulmonary embolus except if caused directly by foreign body implants (e.g., central
             venous catheters or portacaths)

          -  No global neurocognitive symptomatology

          -  No fatigue ? grade 2

          -  No history of uncontrolled seizures or uncontrolled seizure disorder

          -  No sensory neuropathy ? grade 2 except for localized neuropathy due to mechanical
             cause or trauma

          -  No other malignancies within the past 3 years except non-invasive malignancies (e.g.,
             carcinoma in situ of the cervix, breast, or oral cavity) or squamous or basal cell
             skin cancer

          -  No history of uncontrolled myxedema

          -  No hypothyroidism ? grade 3

          -  No active uncontrolled bacterial, viral, or fungal infection

          -  No other significant illness that would preclude surgery

          -  No other major illness or psychiatric impairment that would preclude study therapy

          -  No known AIDS

          -  Not pregnant or nursing

          -  Negative pregnancy test

          -  Fertile patients must use 2 effective barrier methods of contraception for 4 weeks
             before, during, and for at least 4 weeks after study treatment

          -  No prior thalidomide

          -  No prior biologic therapy for this tumor

          -  No prior chemotherapy for this tumor

          -  See Disease Characteristics

          -  No prior radiotherapy for this tumor

          -  See Cardiovascular

          -  No other concurrent investigational drugs

          -  No concurrent sedating drugs

          -  No concurrent illegal sedating "recreational" drugs

          -  No concurrent alcohol intake of more than 1 drink per day