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 Rosenberg, Yen Lin Chen, Ira J. Spiro, Thomas F. Delaney

Research output: Contribution to journalArticle

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

Fingerprint

Sarcoma
Radiotherapy
Extremities
Drug Therapy
Doxorubicin
Mesna
Dacarbazine
Ifosfamide
Chemoradiotherapy
Survival Rate
Recurrence

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

Cite this

Mullen, J. T., Kobayashi, W., Wang, J. J., Harmon, D. C., Choy, E., Hornicek, F. 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

Long-term follow-up of patients treated with neoadjuvant chemotherapy and radiotherapy for large, extremity soft tissue sarcomas. / Mullen, John T.; Kobayashi, Wendy; Wang, Jing Jing; Harmon, David C.; Choy, Edwin; Hornicek, Francis J.; Rosenberg, Andrew; Chen, Yen Lin; Spiro, Ira J.; Delaney, Thomas F.

In: Cancer, Vol. 118, No. 15, 01.08.2012, p. 3758-3765.

Research output: Contribution to journalArticle

Mullen, JT, Kobayashi, W, Wang, JJ, Harmon, DC, Choy, E, Hornicek, FJ, Rosenberg, A, Chen, YL, Spiro, IJ & Delaney, TF 2012, 'Long-term follow-up of patients treated with neoadjuvant chemotherapy and radiotherapy for large, extremity soft tissue sarcomas', Cancer, vol. 118, no. 15, pp. 3758-3765. https://doi.org/10.1002/cncr.26696
Mullen, John T. ; Kobayashi, Wendy ; Wang, Jing Jing ; Harmon, David C. ; Choy, Edwin ; Hornicek, Francis J. ; Rosenberg, Andrew ; Chen, Yen Lin ; Spiro, Ira J. ; Delaney, Thomas F. / Long-term follow-up of patients treated with neoadjuvant chemotherapy and radiotherapy for large, extremity soft tissue sarcomas. In: Cancer. 2012 ; Vol. 118, No. 15. pp. 3758-3765.
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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.",
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T1 - Long-term follow-up of patients treated with neoadjuvant chemotherapy and radiotherapy for large, extremity soft tissue sarcomas

AU - Mullen, John T.

AU - Kobayashi, Wendy

AU - Wang, Jing Jing

AU - Harmon, David C.

AU - Choy, Edwin

AU - Hornicek, Francis J.

AU - Rosenberg, Andrew

AU - Chen, Yen Lin

AU - Spiro, Ira J.

AU - Delaney, Thomas F.

PY - 2012/8/1

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N2 - 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.

AB - 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.

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KW - extremity sarcoma

KW - follow-up

KW - ifosfamide

KW - mesna

KW - neoadjuvant chemotherapy

KW - radiotherapy

KW - soft tissue sarcoma

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