title: Prognostic variables in patients with primary soft tissue sarcoma of the extremity and trunk treated with neoadjuvant radiotherapy or neoadjuvant sequential chemoradiotherapy.
abstract: BACKGROUND
  Neoadjuvant radiotherapy (NRT) is an effective strategy to treat soft tissue sarcomas (STS). However, the role of neoadjuvant chemoradiotherapy (NCRT) remains to be determined.
  
  
  METHODS
  From May 1999 to July 2010, 112 patients with localized STS of the extremity and trunk who were treated with NRT or NCRT followed by surgery were retrospectively reviewed. Clinical outcomes including overall survival (OS), disease-free survival (DFS), and distant metastasis free survival (DMFS) were calculated using Kaplan-Meier survival analyses. Prognostic variables were determined by univariate (UVA) and multivariate analyses (MVA).
  
  
  RESULTS
  Median follow-up was 37 months. Median RT dose was 50 Gy. Forty-nine patients received NCRT. Overall limb-preservation rate was 99% and local control was 97%. The estimated 3-year OS, DFS, and DMFS were 86%, 68%, and 72%, respectively. Age was the only variable to predict for OS, DFS and DMFS on UVA. Age ≥ 70 predicted for poor OS, stage III disease predicted for poor DFS and DMFS, and the addition of chemotherapy predicted for improved DMFS on MVA.
  
  
  CONCLUSIONS
  Excellent rates of local control and limb-preservation were observed in patients with primary STS treated with neoadjuvant therapy followed by surgery. Neoadjuvant sequential chemotherapy followed by radiotherapy may be considered for young patients with stage III STS.
authors.affiliation: Department of Radiation Oncology, Medical College of Wisconsin, 8701 Watertown Plank Rd, Milwaukee, WI 53045, USA.
authors.forename: Meena
authors.initials: M
authors.lastname: Bedi
authors.forename: David M
authors.initials: DM
authors.lastname: King
authors.forename: Mikesh
authors.initials: M
authors.lastname: Shivakoti
authors.forename: Tao
authors.initials: T
authors.lastname: Wang
authors.forename: Eduardo V
authors.initials: EV
authors.lastname: Zambrano
authors.forename: John
authors.initials: J
authors.lastname: Charlson
authors.forename: Donald
authors.initials: D
authors.lastname: Hackbarth
authors.forename: John
authors.initials: J
authors.lastname: Neilson
authors.forename: Robert
authors.initials: R
authors.lastname: Whitfield
authors.forename: Dian
authors.initials: D
authors.lastname: Wang
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; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy / Q000379:methods*; D011379:Prognosis; D018714:Radiotherapy, Adjuvant; D012189:Retrospective Studies; D012509:Sarcoma / Q000188:drug therapy* / Q000401:mortality / Q000532:radiotherapy*; D055815:Young Adult