title: Preoperative doxorubicin plus ifosfamide in primary soft-tissue sarcomas of the extremities.
abstract: A total of 51 patients with large, primary, high-grade soft-tissue sarcomas of the extremities were treated at our institute with two preoperative and three postoperative cycles of doxorubicin plus ifosfamide/mesna. Preoperative doxorubicin was given intra-arterially for lesions of the lower extremities. Of 47 evaluable patients, 22 (47%) showed clinical responses and 21 (45%), pathologic responses. Clinical and pathologic responses, however, were not necessarily coincident in the same patient. Conservative limb-sparing surgery was performed in 41 cases (87%), and in 4 cases amputation was avoided as a result of the local improvement induced by chemotherapy. Local recurrence occurred in 12 cases (25%), 3 of which required further amputation. Although the follow-up period was only 28 months, the 4-year actuarial survival was 91% and the 4-year metastasis-free value was 69%. An evident difference existed between patients who showed a documented clinical response to chemotherapy and those who did not, the 4-year metastasis-free value being 85% and 59% (P = 0.1), respectively. Adjuvant preoperative chemotherapy may allow for limb-salvage surgical procedures in selected cases.
authors.affiliation: Division of Surgical Oncology, Istituto Nazionale Tumori, Milan, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Azzarelli
authors.forename: V
authors.initials: V
authors.lastname: Quagliuolo
authors.forename: P
authors.initials: P
authors.lastname: Casali
authors.forename: S
authors.initials: S
authors.lastname: Fissi
authors.forename: F
authors.initials: F
authors.lastname: Montalto
authors.forename: A
authors.initials: A
authors.lastname: Santoro
mesh_terms: D000206:Actuarial Analysis; D000293:Adolescent; D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001132:Arm; D017024:Chemotherapy, Adjuvant; D004317:Doxorubicin / Q000008:administration & dosage; D005260:Female; D006801:Humans; D007069:Ifosfamide / Q000008:administration & dosage; D007866:Leg; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D012509:Sarcoma / Q000188:drug therapy* / Q000556:secondary / Q000601:surgery; D012983:Soft Tissue Neoplasms / Q000188:drug therapy* / Q000601:surgery; D016019:Survival Analysis
chemical_list: D004317:Doxorubicin; D007069:Ifosfamide