Long-term follow-up of patients treated with neoadjuvant chemotherapy and radiotherapy for large, extremity soft tissue sarcomas

John T. Mullen, Wendy Kobayashi, Jing Jing Wang, David C. Harmon, Edwin Choy, Francis J. Hornicek, Andrew E. Rosenberg, Yen Lin Chen, Ira J. Spiro, Thomas F. Delaney

Research output: Contribution to journalArticle

54 Scopus citations

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.

Original languageEnglish (US)
Pages (from-to)3758-3765
Number of pages8
JournalCancer
Volume118
Issue number15
DOIs
StatePublished - Aug 1 2012
Externally publishedYes

Keywords

  • Adriamycin (doxorubicin)
  • and dacarbazine (MAID)
  • extremity sarcoma
  • follow-up
  • ifosfamide
  • mesna
  • neoadjuvant chemotherapy
  • radiotherapy
  • soft tissue sarcoma

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

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  • Cite this

    Mullen, J. T., Kobayashi, W., Wang, J. J., Harmon, D. C., Choy, E., Hornicek, F. J., Rosenberg, A. E., Chen, Y. L., Spiro, I. J., & Delaney, T. F. (2012). Long-term follow-up of patients treated with neoadjuvant chemotherapy and radiotherapy for large, extremity soft tissue sarcomas. Cancer, 118(15), 3758-3765. https://doi.org/10.1002/cncr.26696