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From the Division of Orthopedic Oncology (RMH, MMM) and the Department of Hematology/Oncology (DAP, DJP), George Washington University, Washington Cancer Institute; and the Department of Pathology (BMS), Washington Hospital Center, Washington, DC.
Correspondence: Address correspondence and reprint requests to: Robert Mikael Henshaw, MD, Assistant Professor, Orthopedic Surgery, The Washington Cancer Institute at Washington Hospital Center, 110 Irving Street, NW, Washington DC 20010; Fax: 202-877-8959; E-mail: rmh4{at}mhg.edu
Background: Induction chemotherapy can produce dramatic necrosis in sarcomas—raising the question of whether or not radiation is necessary. This study reviews the clinical outcome of a subset of patients with high-grade extremity soft tissue sarcomas (STS) who were treated with induction chemotherapy and surgical resection but without radiation.
Methods: Nonmetastatic, large, high-grade STS of the pelvis and extremities were treated with intra-arterial cisplatin, adriamycin, and, after 1995, ifosfamide. After induction, oncologic resection and histologic evaluation were performed. Good responders with good surgical margins were not treated with radiation.
Results: Thirty-three patients, with a median follow-up of 5 years, were included. Limb salvage rate was 94%. Median tumor necrosis was 95%. Four patients developed metastatic disease with three subsequent deaths. Two local recurrences occurred; both patients were salvaged with re-resection and adjuvant external beam radiotherapy, although one died of metastatic disease 10 years later. Relapse-free and overall survival is 80% and 88% at 5 and 10 years by Kaplan-Meier analysis.
Conclusions: Intensive induction chemotherapy can be extremely effective for high-grade STS, permitting limb-sparing surgery in lieu of amputation. Radiation may not be necessary if a good response to induction chemotherapy and negative wide margins are achieved. All patients with large, deep, high-grade STS of the extremities should be considered candidates for induction chemotherapy.
Key Words: Induction chemotherapy • Soft tissue sarcoma • Survival rates • Surgical Resection • Treatment
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