PROSPECTIVE COHORT STUDY OF NEOADJUVANT TREATMENT IN CONSERVATIVE SURGERY OF SOFT-TISSUE SARCOMAS

Background: 1994 marked a decade since the inception of a prospective population-based study on the value of a neoadjuvant approach for soft tissue sarcomas of head, neck, and limbs at the Tom Baker Cancer Cent re, Calgary, Alberta. To date, 42 patients have been followed for a mi nimum of 5 years or until death.Methods: Each patient received a proto col of 60 mg to 90 mg of Adriamycin infused intraarterially or intrave nously over 3 days into a vessel feeding the involved area, 30 Gy of r adiotherapy given over 10 days, and complete resection of the sarcoma 4 to 6 weeks later. The lower dose was used empirically for smaller li mbs (e.g., arm). Results: Two of the 42 patients were immediate failur es of protocol, with one requiring amputation and one requiring later reexcision. In the 38 appendicular lesions, the ultimate limb salvage rate was 97.5%. All tumors were associated with a high risk of local r ecurrence, with 15 being previous local failures. The rest were deep a nd grade 2 or 3 lesions. Serious local complications were seen in one patient (2.5%) who had wound necrosis requiring reoperation. Minor wou nd complications were seen in five patients (12.5%) (one wound infecti on, one resolved edema, three long-term drainage). There was one local recurrence; thus 5-year local control was 97%. No patient had long-te rm morbidity related to the treatment. No effect on systemic control w as suggested. Conclusion: Our report demonstrates that this combined m odality approach provides superior local control of soft tissue sarcom as with low postoperative morbidity.