Survival after induction chemotherapy and surgical resection for high-grade soft tissue sarcoma. Is radiation necessary?

Background: Induction chemotherapy can produce dramatic necrosis in sarcoma s-raising the question of whether or not radiation is necessary. This study reviews the clinical outcome of a subset of patients with high-grade extre mity soft tissue sarcomas (STS) who were treated with induction chemotherap y 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, i fosfamide. After induction, oncologic resection and histologic evaluation w ere 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 in cluded. Limb salvage rate was 94%. Median tumor necrosis was 95%. Four pati ents developed metastatic disease with three subsequent deaths. Two local r ecurrences occurred; both patients were salvaged with reresection and adjuv ant 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 y ears by Kaplan-Meier analysis. Conclusions: Intensive induction chemotherapy can be extremely effective fo r high-grade STS, permitting limb-sparing surgery in lieu of amputation. Ra diation may not be necessary if a good response to induction chemotherapy a nd negative wide margins are achieved. All patients with large, deep, high- grade STS of the extremities should be considered candidates for induction chemotherapy.