The treatment of soft-tissue sarcomas of the extremities. Prospective randomized evaluations of (1) limb-sparing surgery plus radiation therapy compared with amputation and (2) the role of adjuvant chemotherapy

Gerrand, CH; Rankin, K

doi:10.1007/978-1-4471-5451-8_125

The treatment of soft-tissue sarcomas of the extremities. Prospective randomized evaluations of (1) limb-sparing surgery plus radiation therapy compared with amputation and (2) the role of adjuvant chemotherapy

Lookup NU author(s): Craig Gerrand, Dr Kenneth Rankin ORCiD

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Abstract

© 2014 Springer-Verlag London. All rights are reserved. Background This is a randomized prospective study comparing amputation with limb sparing surgery and adjuvant radiotherapy for patients with high-grade soft tissue sarcomas of the extremities. Forty-three adult patients were enrolled into the study from between May 1975 and April 1981. Methodology For those undergoing amputation this was performed at or above the joint proximal to the tumour, including all involved muscle groups. The limb-sparing resection group received wide local excision followed by 5,000 rads to the entire anatomic area at risk for local spread and 6,000-7,000 rads to the tumour bed. Both groups received postoperative chemotherapy with doxorubicin, cyclophosphamide, and high-dose methotrexate. Twenty-seven patients received limb-sparing resection and radiotherapy, and 16 received amputation (randomization was 2:1). Results There were four local recurrences in the limb-sparing group and none in the amputation group (p1 = 0.06 generalized Wilcoxon test). There were no differences in diseasefree survival rates (71 and 78 % at 5 years; p2 = 0.75) or overall survival rates (83 and 88 % at 5 years; p2 = 0.99). Multivariate analysis indicated that the only correlate of local recurrence was the fi nal margin of resection. Patients with positive margins of resection had a higher likelihood of local recurrence compared with those with negative margins (p1 < 0.0001) even when postoperative radiotherapy was used. A simultaneous prospective randomized study of postoperative chemotherapy in 65 patients with high-grade softtissue sarcomas of the extremities revealed a marked survival advantage for patients receiving chemotherapy 3-year continuous disease-free survival (92 % vs. 60 %; p1 = 0.0008), and overall survival (95 % vs. 74 %; p1 = 0.04). Conclusion Limb-sparing surgery, radiation therapy, and adjuvant chemotherapy appear capable of successfully treating the great majority of adult patients with soft tissue sarcomas of the extremity.