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Preoperative Chemoradiation for High Stage Extremity Sarcoma Facilitates Limb Salvage and Excellent Long Term Local Control
Harold J Wanebo1, Walley B Temple2, Martin B Popp3
1Roger Williams Medical Center, Providence, RI;2Tom Baker Cancer Center, Calgary, AB, Canada3TriState Surgical Consultants, Cincinatti, OH
Background: We are reporting a multi-institutional experience with preoperative chemoradiation for extremity sarcoma with focus on limb salvage and long term control.
Methods: Preoperative intra-arterial (IA) infusion with doxorubicin hydrochloride 30mg/M2/24hr x 3 days was combined with radiation 30-35 Gy in 10 fractions or 46 Gy in 23-25 fractions (Institutional preference) followed by planned microscopic clear resection (RO).
Results: Of 66 patients, (32 females, 34 males), median age 46 years, 73% had lower and 27% had upper extremity tumors. There were 55 soft-tissue, and 9 malignant bone tumors. AJCC stages were: 1, IIB (17%), IIIA/B (59%), and IIIC/4A (24%). Limb salvage surgery included radical resection in 21 with extensive tumors, wide local excision in 32 patients. Primary amputation was required in 4 patients and delayed amputation in 2 because of wound complications. Pulmonary metastasectomy occurred at time of primary resection in 3 patients and later in 3; 4 are surviving >5 years. No postoperative deaths occurred, but 41% had wound complications. Overall and disease free 5 year survival was 59 and 49%; 6 patients (10%) died between 5-10 years. One patient (1.5%) had local recurrence 9 years after resection of an extensive shoulder synovial sarcoma and had a limb sparing (Tikhof Linberg) resection. Distant metastases occurred in 37 patients (56%) mostly lung (21 patients) +/- bone 9 patients, at 24 months (Av) with median survival of 7 months.
Conclusion: Preoperative chemoradiation with RO resection is associated with high local control rates (98%). Distant failure continues as the major challenge.
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