title: Neoadjuvant chemoradiotherapy for patients with high-risk extremity and truncal sarcomas: a 10-year single institution retrospective study.
abstract: BACKGROUND
  Patients with large, high-grade extremity and truncal soft tissue sarcomas (STS) are at considerable risk for recurrence. A regimen of pre-operative chemotherapy consisting of mesna, adriamycin, ifosfamide and dacarbazine (MAID), interdigitated with radiotherapy (RT), followed by resection and post-operative chemotherapy with or without RT, has demonstrated high rates of local and distant control. The goal of this study is to assess outcomes in a recent cohort of patients treated on this regimen.
  
  
  METHODS
  We retrospectively reviewed records of 66 consecutive patients with STS of the extremity or trunk who were treated with the aforementioned regimen from May 2000 to April 2011. Clinicopathologic characteristics and patient outcomes were analysed.
  
  
  RESULTS
  Sixty-six patients were analysed and were equally divided between grade 2 and 3 tumours. Margins were negative in 57 (89%) patients and positive in seven (11%) patients. At a median follow-up of 46 months, there were six (9%) locoregional and 20 (30%) distant recurrences. The locoregional and distant 5-year recurrence-free survival (RFS) rates were 91% and 64%, respectively. The 5-year overall (OS) and disease-specific survival rates were 86% and 89%, respectively. There were no treatment-related deaths or secondary myelodysplasias. Thirty-four (52%) patients had grade 3 or 4 acute haematologic chemotherapy-related toxicity. There were no statistically significant predictors of OS or RFS.
  
  
  CONCLUSIONS
  For a contemporary cohort of patients with high-risk extremity and truncal STS, a regimen of neoadjuvant chemoradiotherapy and surgery continues to result in high rates of survival with tolerable short- and long-term toxicity.
authors.affiliation: Department of Surgery, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA 02114, USA.
authors.forename: Nicole J
authors.initials: NJ
authors.lastname: Look Hong
authors.forename: Francis J
authors.initials: FJ
authors.lastname: Hornicek
authors.forename: David C
authors.initials: DC
authors.lastname: Harmon
authors.forename: Edwin
authors.initials: E
authors.lastname: Choy
authors.forename: Yen-Lin
authors.initials: YL
authors.lastname: Chen
authors.forename: Sam S
authors.initials: SS
authors.lastname: Yoon
authors.forename: G Petur
authors.initials: GP
authors.lastname: Nielsen
authors.forename: Jackie
authors.initials: J
authors.lastname: Szymonifka
authors.forename: Beow Y
authors.initials: BY
authors.lastname: Yeap
authors.forename: Thomas F
authors.initials: TF
authors.lastname: DeLaney
authors.forename: John T
authors.initials: JT
authors.lastname: Mullen
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D059248:Chemoradiotherapy; D017024:Chemotherapy, Adjuvant; D003606:Dacarbazine / Q000008:administration & dosage; D004317:Doxorubicin / Q000008:administration & dosage; D005121:Extremities / Q000473:pathology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007069:Ifosfamide / Q000008:administration & dosage; D008297:Male; D015080:Mesna / Q000008:administration & dosage; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D009367:Neoplasm Staging; D011379:Prognosis; D018714:Radiotherapy, Adjuvant; D012189:Retrospective Studies; D012509:Sarcoma / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D015996:Survival Rate; D013997:Time Factors; D055815:Young Adult
chemical_list: D003606:Dacarbazine; D004317:Doxorubicin; D015080:Mesna; D007069:Ifosfamide