Neoadjuvant chemotherapy and local radiotherapy for high-grade XXXX .

@entity1 @entity421 @entity66
OBJECTIVE: To determine the effectiveness of radiation therapy for local control of nonmetastatic @entity421 after induction chemotherapy. @entity1 AND METHODS: Of 187 @entity1 with nonmetastatic @entity421 treated with induction chemotherapy since 1986, 31 refused surgery and underwent standard, fractionated external beam radiotherapy for local control. The median radiation dose to the limb was 60 Gy (range 40-68 Gy). Records were reviewed through April 2002, and outcomes including radiologic and biochemical response, local control, limb function, and survival were analyzed. The end points were local progression-free survival, metastases-free survival, and overall survival. RESULTS: Overall survival, local progression-free survival, and metastases-free survival at 5 years were a mean +/- SD of 61%+/-11%, 56%+/-12%, and 62%+/-10%, respectively. The outcome correlated significantly with @entity1 ' imaging and biochemical response. In @entity1 who had a pronounced response, overall survival and metastases-free survival at 5 years were 90%+/-9% and 91%+/-9%, respectively, but it was only 35%+/-15% and 42%+/-13% in the nonresponders (P=.005 and P=.005, respectively). Local control was also related to response after induction chemotherapy. None of the 11 @entity1 with both a good imaging and a good biochemical response had local relapse; median follow-up was 67 months. The estimated local progression-free survival among nonresponders was 31%+/-16% at 3 years and 0% at 5 years. Of 22 @entity1 surviving without @entity66 progression, 19 (86%) had excellent limb function (Enneking score between 90% and 100%) at the time of most recent evaluation. CONCLUSION: When used after effective induction chemotherapy for @entity421 , radiation therapy can be a reliable modality to control @entity66 and preserve limb function.
