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Annals of Oncology 2004 15(11):1667-1672; doi:10.1093/annonc/mdh431
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© 2004 European Society for Medical Oncology

Original Article

Neo-adjuvant chemotherapy for primary high-grade extremity soft tissue sarcoma

S. R. Grobmyer1, R. G. Maki2, G. D. Demetri3, M. Mazumdar4, E. Riedel4, M. F. Brennan1 and S. Singer1,*

Departments of 1 Surgery, 2 Medicine and 3 Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY; 4 Department of Medicine, Dana Farber Cancer Institute, Boston, MA, USA

* Correspondence to: Dr S. Singer, The Department of Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10021, USA. Tel: +1-212-639-2940; Fax: +1-646-422-2300; Email: singers{at}mskcc.org

Background: The purpose of this study was to retrospectively analyze the relationship between neo-adjuvant chemotherapy (NAC) and outcome in patients with high-grade extremity sarcomas.

Patients and methods: Inclusion criteria were high-grade, deep, >5 cm extremity soft tissue sarcomas. Patients diagnosed between 1990 and 2001 were treated with surgery only (n=282) or NAC containing doxorubicin/ifosfamide/mesna (AIM) (n=74). The stratified Cox proportional hazards model was used to test the effect of NAC on disease-specific survival and recurrence while adjusting for known prognostic factors.

Results: NAC was associated with improved disease-specific survival for this cohort of patients (P=0.02). This overall improvement appears to be driven by the benefit of NAC on disease-specific survival for patient with tumors >10 cm. The 3-year disease-specific survival for tumors >10 cm was 0.62 (95% CI: 0.53–0.71) for patients not receiving NAC and 0.83 (95% CI: 0.72–0.95) for patients receiving NAC.

Conclusion: NAC with AIM was associated with a significant improvement in disease-specific survival in patients with high-grade extremity soft tissue sarcomas >10 cm. These data emphasize the need for further prospective clinical studies of neo-adjuvant or adjuvant chemotherapy for patients with large high-grade extremity sarcomas.

Key words: chemotherapy, doxorubicin, ifosfamide, neo-adjuvant, sarcoma


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