The Impact of Neo-adjuvant and Adjuvant Chemotherapy in Treatment Outcome of Patients with High Risk Soft Tissue Sarcomas of the Extremities

Background: This prospective study assessed the efficacy of neoadjuvant and adjuvant chemotherapy on patients with high risk soft tissue sarcomasof the extremities. Methods: Enrolled patients received the following neoadjuvant chemotherapy: doxorubicin (75 mg/m2) on day1, ifosfamide (2.5 g/m2/d) and mesna (20% of the ifosfamide dose) from days1 to 3, repeated every three weeks for a total of three cycles, followed by surgery and radiotherapy. Patients received an additional three cycles of adjuvant chemotherapy that was the same as the neoadjuvant protocol following completion of radiotherapy. Results: There were 52 patients enrolled in the study, of which 50 were included in data analysis. Neoadjuvant chemotherapy was completed by 90% of enrolledpatients and 88% completed all planned chemotherapy. A total of 96% of patients underwent surgery and 92% of these had R0 resections. Postoperative radiotherapy was administered to 96% of patients. The estimated three-year local-regional failure was 10%. Estimated three-year rate for distant disease-free survival was 66% and overall survival was 88%. One patient died with treatment secondary to leukopenic sepsis and respiratory failure. Grades 3-4 toxicities were experienced by 86% of patients of which 84% were grades 3- 4 hematologic toxicities and 38% were grades 3-4 nonhematologic toxicities. Conclusion: The current protocol is feasible and associated with favorable distant disease-free survival, overall survival, and limb preservation. This protocol is tolerableand has a manageable toxicity level.