title: Neoadjuvant treatment with preoperative radiotherapy for extremity soft tissue sarcomas: long-term results from a single institution in Turkey.
abstract: BACKGROUND
  To assess the long term clinical outcome of preoperative radiotherapy with or without chemotherapy followed by limb sparing surgery in patients with non-metastatic soft tissue sarcomas (STS) of the extremities.
  
  
  METHODS
  Sixty patients with locally advanced STS were retrospectively analyzed. The median tumor diameter was 12 cm. All patients were treated with preoperative radiotherapy delivered with two different fractionation schedules (35Gy/10fr or 46-50Gy/23-25fr). Neoadjuvant chemotherapy was added to 44 patients with large and/or high grade tumors. Surgery was performed 2-6 weeks after radiotherapy. Chemotherapy was completed up to 6 courses after surgery in patients who had good responses.
  
  
  RESULTS
  Median follow-up time was 67 months (8-268 months). All of the patients had limb sparing surgery. The 5-year local control (LC), disease free (DFS) and overall survival (OSS) rates for all of the patients were 81%, 48.1% and 68.3% respectively. 5-year LC, DFS and cause specific survival (CSS) were 81.7%, 47%, 69.8%, and 80%, 60%, 60% in the chemoradiotherapy and radiotherapy groups, respectively. On univariate analysis, patients who were treated with hypofractionation experienced significantly superior LC, DFS and CSS rates with similar rates of late toxicity when compared with patients who were treated with conventional fractionation and statistical significance was retained on multivariate analysis.
  
  
  CONCLUSIONS
  Treatment results are consistent with the literature. As neoadjuvant chemoradiotherapy provides effective LC and CSS with acceptable morbidity, it should be preferred for patients with large and borderline resectable STS.
authors.affiliation: Department of Radiation Oncology, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey E-mail : faziletonerdincbas@hotmail.com.
authors.forename: Fazilet Oner
authors.initials: FO
authors.lastname: Dincbas
authors.forename: Didem Colpan
authors.initials: DC
authors.lastname: Oksuz
authors.forename: Ozlem
authors.initials: O
authors.lastname: Yetmen
authors.forename: Murat
authors.initials: M
authors.lastname: Hiz
authors.forename: Sergulen
authors.initials: S
authors.lastname: Dervisoglu
authors.forename: Hande
authors.initials: H
authors.lastname: Turna
authors.forename: Fatih
authors.initials: F
authors.lastname: Kantarci
authors.forename: Nil Molinas
authors.initials: NM
authors.lastname: Mandel
authors.forename: Sedat
authors.initials: S
authors.lastname: Koca
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000903:Antibiotics, Antineoplastic / Q000008:administration & dosage / Q000627:therapeutic use; D018906:Antineoplastic Agents, Alkylating / Q000008:administration & dosage / Q000627:therapeutic use; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D059248:Chemoradiotherapy; D017024:Chemotherapy, Adjuvant; D018572:Disease-Free Survival; D004317:Doxorubicin / Q000008:administration & dosage / Q000627:therapeutic use; D005121:Extremities / Q000473:pathology; D005260:Female; D016179:Granulocyte Colony-Stimulating Factor / Q000008:administration & dosage / Q000627:therapeutic use; D006801:Humans; D007069:Ifosfamide / Q000008:administration & dosage / Q000627:therapeutic use; D008297:Male; D015080:Mesna / Q000008:administration & dosage / Q000627:therapeutic use; D008875:Middle Aged; D011300:Preoperative Care; D020011:Protective Agents / Q000008:administration & dosage / Q000627:therapeutic use; D018714:Radiotherapy, Adjuvant; D012189:Retrospective Studies; D012509:Sarcoma / Q000188:drug therapy* / Q000401:mortality / Q000532:radiotherapy* / Q000601:surgery; D016896:Treatment Outcome; D014421:Turkey; D055815:Young Adult
chemical_list: D000903:Antibiotics, Antineoplastic; D018906:Antineoplastic Agents, Alkylating; D020011:Protective Agents; D016179:Granulocyte Colony-Stimulating Factor; D004317:Doxorubicin; D015080:Mesna; D007069:Ifosfamide