title: Neoadjuvant chemoradiation compared to neoadjuvant radiation alone and surgery alone for Stage II and III soft tissue sarcoma of the extremities.
abstract: BACKGROUND
  Neoadjuvant chemoradiation (NCR) prior to resection of extremity soft tissue sarcoma (STS) has been studied, but data are limited. We present outcomes with NCR using a variety of chemotherapy regimens compared to neoadjuvant radiation without chemotherapy (NR) and surgery alone (SA).
  
  
  METHODS
  We conducted a retrospective chart review of 112 cases.
  
  
  RESULTS
  Treatments included SA (36 patients), NCR (39 patients), and NR (37 patients). NCR did not improve the rate of margin-negative resections over SA or NR. Loco-regional relapse-free survival, distant metastases-free survival, and overall survival (OS) were not different among the treatment groups. Patients with relapsed disease (OR 11.6; p = 0.01), and tumor size greater than 5 cm (OR 9.4; p = 0.01) were more likely to have a loco-regional recurrence on logistic regression analysis. Significantly increased OS was found among NCR-treated patients with tumors greater than 5 cm compared to SA (3 year OS 69 vs. 40%; p = 0.03). Wound complication rates were higher after NCR compared to SA (50 vs. 11%; p = 0.003) but not compared to NR (p = 0.36). Wet desquamation was the most common adverse event of NCR.
  
  
  CONCLUSIONS
  NCR and NR are acceptable strategies for patients with STS. NCR is well-tolerated, but not clearly superior to NR.
authors.affiliation: Department of Radiation Oncology, Mayo Clinic, Scottsdale, AZ 85259, USA.
authors.forename: Kelly K
authors.initials: KK
authors.lastname: Curtis
authors.forename: Jonathan B
authors.initials: JB
authors.lastname: Ashman
authors.forename: Christopher P
authors.initials: CP
authors.lastname: Beauchamp
authors.forename: Adam J
authors.initials: AJ
authors.lastname: Schwartz
authors.forename: Matthew D
authors.initials: MD
authors.lastname: Callister
authors.forename: Amylou C
authors.initials: AC
authors.lastname: Dueck
authors.forename: Leonard L
authors.initials: LL
authors.lastname: Gunderson
authors.forename: Tom R
authors.initials: TR
authors.lastname: Fitch
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D059248:Chemoradiotherapy / Q000379:methods*; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy / Q000379:methods*; D009362:Neoplasm Metastasis; D011878:Radiotherapy / Q000379:methods*; D012008:Recurrence; D012044:Regression Analysis; D012189:Retrospective Studies; D012983:Soft Tissue Neoplasms / Q000188:drug therapy* / Q000532:radiotherapy*; D016896:Treatment Outcome