Abstract
BackgroundNeoadjuvant radiotherapy (NRT) is an effective strategy to treat soft tissue sarcomas (STS). However, the role of neoadjuvant chemoradiotherapy (NCRT) remains to be determined.MethodsFrom May 1999 to July 2010, 112 patients with localized STS of the extremity and trunk who were treated with NRT or NCRT followed by surgery were retrospectively reviewed. Clinical outcomes including overall survival (OS), disease-free survival (DFS), and distant metastasis free survival (DMFS) were calculated using Kaplan-Meier survival analyses. Prognostic variables were determined by univariate (UVA) and multivariate analyses (MVA).ResultsMedian follow-up was 37 months. Median RT dose was 50 Gy. Forty-nine patients received NCRT. Overall limb-preservation rate was 99% and local control was 97%. The estimated 3-year OS, DFS, and DMFS were 86%, 68%, and 72%, respectively. Age was the only variable to predict for OS, DFS and DMFS on UVA. Age ≥ 70 predicted for poor OS, stage III disease predicted for poor DFS and DMFS, and the addition of chemotherapy predicted for improved DMFS on MVA.ConclusionsExcellent rates of local control and limb-preservation were observed in patients with primary STS treated with neoadjuvant therapy followed by surgery. Neoadjuvant sequential chemotherapy followed by radiotherapy may be considered for young patients with stage III STS.
Highlights
The management of soft tissue sarcomas (STS) of extremity and trunk has evolved in the past two decades
Neoadjuvant chemotherapy (MAID regimen) interdigitated with neoadjuvant radiotherapy (44 Gy in 22 fractions) has been shown to decrease the rate of distant metastasis (DM) and to increase disease free survival (DFS) and overall survival (OS) in patients with STS of the extremity and trunk with ≥ 8 cm tumors compared with historical control [8]
The results from this study show that the use of neoadjuvant sequential chemotherapy was associated with a higher distant metastasis-free survival (DMFS) in patients
Summary
The management of soft tissue sarcomas (STS) of extremity and trunk has evolved in the past two decades. Neoadjuvant chemotherapy (MAID regimen) interdigitated with neoadjuvant radiotherapy (44 Gy in 22 fractions) has been shown to decrease the rate of distant metastasis (DM) and to increase disease free survival (DFS) and overall survival (OS) in patients with STS of the extremity and trunk with ≥ 8 cm tumors compared with historical control [8]. This prompted RTOG 9514, which was a single-arm phase II trial that enrolled 64 patients with intermediate-to-high grade, ≥ 8 cm STS of the extremity or torso with expected margin-negative (R0) resection. The role of neoadjuvant chemoradiotherapy (NCRT) remains to be determined
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