Neoadjuvant chemoradiation therapy for soft tissue sarcomas of the extremities.
OBJECTIVE
Neoadjuvant and adjuvant therapies for soft tissue sarcomas of the extremities are still controversial. The aim of this study was to analyze the results of a protocol of neoadjuvant chemoradiation therapy for extremity sarcomas.


METHODS
A retrospective analysis was carried out in a consecutive series of 49 adult patients with advanced extremity soft tissue sarcomas that could not be resected with adequate margins during the primary resection. All patients were treated with a protocol of preoperative radiation therapy at a total dose of 30 Gy, concomitant with doxorubicin (60 mg/m(2)) chemotherapy. The main endpoints assessed were local recurrence-free survival, metastasis-free survival and overall survival. The median follow-up time was 32.1 months.


RESULTS
The five-year local recurrence-free survival, metastasis-free survival and overall survival rates were 81.5%, 46.7% and 58.3%, respectively. For high-grade tumors, the five-year metastasis-free and overall survival rates were only 36.3% and 41.2%, respectively. Severe wound complications were observed in 41.8% of the patients who underwent surgery. These complications precluded adjuvant chemotherapy in 73.7% (14/19) of the patients eligible to receive it.


CONCLUSIONS
In this study, neoadjuvant chemoradiation therapy was associated with a good local control rate, but the distant relapse-free rate and overall survival rate were still poor. The high rate of wound complications modified the planning of adjuvant treatment in most patients.
Aguiar Junior
Samuel
S
Departamento de Cirurgia Pélvica, Hospital do Câncer A.C. Camargo, Fundação Antônio Prudente - São Paulo/SP, Brasil. samuel.aguiar.jr@uol.com.br
Ferreira
Fábio de Oliveira
Fde O
Rossi
Benedito Mauro
BM
Santos
Erika Maria Monteiro
EM
Salvajoli
João Victor
JV
Lopes
Ademar
A
D000293:Adolescent; D000328:Adult; D000368:Aged; D017024:Chemotherapy, Adjuvant / Q000009:adverse effects; D004317:Doxorubicin / Q000009:adverse effects; D004812:Epidemiologic Methods; D005121:Extremities; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy / Q000009:adverse effects*; D009364:Neoplasm Recurrence, Local; D018714:Radiotherapy, Adjuvant / Q000009:adverse effects; D012509:Sarcoma / Q000401:mortality* / Q000628:therapy; D012983:Soft Tissue Neoplasms / Q000401:mortality* / Q000628:therapy; D016896:Treatment Outcome; D055815:Young Adult
D004317:Doxorubicin