Long-term follow-up of patients treated with neoadjuvant chemotherapy and radiotherapy for large extremity soft tissue sarcomas.

Abstract

10022 Background: Patients with large, high-grade, extremity soft tissue sarcomas (STS) are at significant risk for distant recurrence and death. A regimen of preoperative chemotherapy consisting of mesna, adriamycin, ifosfamide, and dacarbazine (MAID), interdigitated with radiotherapy (XRT) and followed by resection and postoperative chemotherapy with or without XRT, has demonstrated high rates of local and distant control. We report the long-term follow-up data on 48 patients treated with this regimen compared to an historical matched control patient population. This is the pilot study on which the RTOG based a multi-institutional study. Methods: Adult patients with high-grade extremity STS ≥ 8 cmwere treated with three cycles of preoperative chemotherapy combined with 44 Gray of XRT followed by surgery. Three cycles of postoperative MAID were planned. For patients with positive surgical margins, 16 Gray of XRT was delivered postoperatively. Results: Patients received the MAID/XRT regimen from 1989 through 1999. Forty (83%) patients received all 6 cycles of planned chemotherapy, and 41 (85%) patients had R0 resections. Of the control patients, all 48 received XRT (39 preoperatively), but only 12 (25%) patients received chemotherapy of some kind, and 39 (81%) patients had R0 resections. After a median follow-up of 90.5 months (range 10–208 months) for the MAID group and 73 months (range 1–257 months) for the control group, the 10-year disease-specific and overall survival rates were 84% and 46% (p = 0.0008) and 69% and 37% (p = 0.0016) for the MAID and control patients, respectively. One MAID patient developed a fatal myelodysplasia at 53 months. Conclusions: For patients with high-risk, extremity STS, the significant clinical benefits conferred by an intense regimen of chemoradiotherapy and surgeryare sustained even with long-term follow-up beyond 10 years. No significant financial relationships to disclose.