Neoadjuvant chemotherapy and radiotherapy for large extremity soft-tissue XXXX .

@entity632 @entity1 @entity2699 @entity242 @entity5 @entity532 @entity2590 @entity1503 @entity1398 @entity3 @entity1260
PURPOSE: Treatment of extremity soft-tissue @entity242 yields excellent local control, but distant failure is common with large, high-grade @entity5 . A regimen of preoperative chemotherapy consisting of mesna, @entity632 , @entity1260 , and @entity2699 (MAID) interdigitated with radiotherapy followed by resection and postoperative chemotherapy with or without radiotherapy was designed to improve treatment outcome. We report the mature outcome data on 48 treated @entity1 and compare them with the data of an historical matched control @entity1 population. METHODS AND MATERIALS: Adult @entity1 with high-grade extremity soft-tissue @entity242 >or=8 cm were treated with three cycles of preoperative chemotherapy combined with 44 Gy of radiotherapy followed by surgery. Three cycles of postoperative MAID were planned. For @entity1 with positive surgical margins, 16 Gy was delivered postoperatively. RESULTS: All 48 @entity1 (M0) received the MAID protocol treatment, and their outcome was superior to that of the historical control @entity1 . The 5-year actuarial local control, freedom from distant @entity3 , disease-free survival, and overall survival rate was 92% and 86% (p = 0.1155), 75% and 44% (p = 0.0016), 70% and 42% (p = 0.0002), and 87% and 58% (p = 0.0003) for the MAID and control @entity1 groups, respectively. Acute @entity1503 in the MAID group included @entity1398 in 12 @entity1 (25%). @entity532 occurred in 14 (29%) of 48 MAID @entity1 . One MAID @entity1 developed late fatal @entity2590 . CONCLUSION: After aggressive chemoradiation and surgery, these @entity1 showed a significant reduction in distant metastases, with a highly significant gain in disease-free and overall survival compared with a historical control group. On the basis of this experience, the Radiation Therapy Oncology Group conducted a multi-institutional trial.
