Combined modality management of local and disseminated adult soft tissue XXXX : a review of 257 cases seen over 10 years at the Christie Hospital _ Holt Radium Institute, Manchester.

@entity1 @entity82 @entity242 @entity5 @entity1492 @entity1822 @entity1442 @entity1500 @entity1260 @entity204 @entity1821
Over a 10 year period, between 1974-1984, 257 adult cases of tissue @entity242 have been evaluated in the Department of Medical Oncology, Christie Hospital, Manchester. At registration locally advanced or metastatic diseases was present in 162 (63%). The male/female ratio was 1.5:1 and median age 54 years (range 14-85). The commonest sites were lower limb (33%), visceral (21%), trunk (13%), retroperitoneum (12%) and upper limb (10%). @entity1822 (27%), @entity1821 (14%) malignant @entity82 (10%) and neuro plus @entity1492 (15%) were the most frequent histological subtypes. A high proportion of uterine @entity242 (17%) is a point of distinction from many other series. Histological grade was specified in 72% of cases and the distribution (Grade I--27%; II--6%; III--67%) reflected a referral bias towards @entity1442 . Local resection of the primary @entity5 was performed in 76% of cases. In many instances this only amounted to 'shelling out' and true compartmental excisions were rare. Amputation was performed in 31% of @entity1 with limb @entity242 . Ninety-eight @entity1 (38%) had experienced one or more local recurrences prior to referral and the overall local recurrence rate was 56%. Suitable @entity1 (78%) received chemotherapy, 50% entering multicentre trials in collaboration with the EORTC. The commonest regime used in @entity1 with @entity1442 was CYVADIC which produced an overall response rate of 37%. @entity1260 , used as a single agent in 16 @entity1 , induced 3CR and 5PR for an overall response rate of 50%. When used in combination with @entity1500 and VADIC, there was no difference in response rate, but numbers in these pilot studies were small. Seventeen high risk @entity1 received adjuvant chemotherapy with VAC, but the results (11 relapses) were disappointing. An EORTC trial, comparing adjuvant CYVADIC chemotherapy with control has accrued 307 @entity1 , 49 of these from the Christie Hospital. Preliminary results within this centre - 13/25 relapses in the control arm, 5/23 in the chemotherapy arm-suggest an advantage for chemotherapy but the data are statistically not significant. Post-operative radical radiotherapy after resection of the primary @entity5 or local recurrence was performed in 51 @entity1 , with local control in 65% of cases, although metastases developed in 41%. At the time of analysis (1st April 1984) 98 (38%) were alive, of whom 72 showed no evidence of disease and 52 had never relapsed. @entity5 was the cause of @entity204 in 92%. Overall survival was not influenced by sex, but @entity1 less than 40 years of age fared significantly better (P less than 0.001).(ABSTRACT TRUNCATED AT 400 WORDS)
