title: Long-term follow-up of patients treated with neoadjuvant chemotherapy and radiotherapy for large, extremity soft tissue sarcomas.
abstract: 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 (doxorubicin), ifosfamide, and dacarbazine (MAID), interdigitated with radiotherapy (RT) and followed by resection and postoperative chemotherapy with or without RT, 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.
  
  
  METHODS
  Adult patients with high-grade extremity STS ≥ 8 cm were treated with 3 cycles of preoperative chemotherapy combined with 44 Gy of RT followed by surgery. Three cycles of postoperative MAID were planned. For patients with positive surgical margins, 16 Gy of RT was delivered postoperatively.
  
  
  RESULTS
  Patients received the MAID/RT regimen from 1989 through 1999. After a median follow-up of 9.3 years in surviving patients in the MAID group and 13.2 years in surviving patients in the control group, the 7-year disease-specific and overall survival rates were 81% and 50% (P = .004) and 79% and 45% (P = .003) for the MAID and control patients, respectively. Five of 11 patients in the MAID group and 7 of 25 control patients died of sarcoma ≥5 years after treatment. One patient in the MAID group developed a fatal myelodysplasia at 53 months.
  
  
  CONCLUSIONS
  For patients with high-risk, extremity STS, the significant survival benefits conferred by an intense regimen of neoadjuvant chemoradiotherapy and surgery are sustained even with long-term follow-up.
authors.affiliation: Department of Surgery, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA. jmullen@partners.org
authors.forename: John T
authors.initials: JT
authors.lastname: Mullen
authors.forename: Wendy
authors.initials: W
authors.lastname: Kobayashi
authors.forename: Jing Jing
authors.initials: JJ
authors.lastname: Wang
authors.forename: David C
authors.initials: DC
authors.lastname: Harmon
authors.forename: Edwin
authors.initials: E
authors.lastname: Choy
authors.forename: Francis J
authors.initials: FJ
authors.lastname: Hornicek
authors.forename: Andrew E
authors.initials: AE
authors.lastname: Rosenberg
authors.forename: Yen-Lin
authors.initials: YL
authors.lastname: Chen
authors.forename: Ira J
authors.initials: IJ
authors.lastname: Spiro
authors.forename: Thomas F
authors.initials: TF
authors.lastname: DeLaney
mesh_terms: D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D059248:Chemoradiotherapy; D017024:Chemotherapy, Adjuvant; D003606:Dacarbazine / Q000627:therapeutic use; D018572:Disease-Free Survival; D004317:Doxorubicin / Q000627:therapeutic use; D005121:Extremities; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007069:Ifosfamide / Q000627:therapeutic use; D008297:Male; D015080:Mesna / Q000627:therapeutic use; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D018714:Radiotherapy, Adjuvant; D012509:Sarcoma / Q000401:mortality / Q000473:pathology / Q000601:surgery / Q000628:therapy*; D015996:Survival Rate; D016896:Treatment Outcome
chemical_list: D003606:Dacarbazine; D004317:Doxorubicin; D015080:Mesna; D007069:Ifosfamide