Neoadjuvant treatment in conservative surgery of peripheral sarcomas

Twenty-five patients with soft-tissue and bony sarcomas of the head and neck and limbs were treated by local neoadjuvant therapy. It consisted of 90 mg of Adriamycin infused intra-arterially over 3 days into a vessel feeding the involved area and 30 Gy of radiotherapy given over 10 days; this was followed by a complete resection of the sarcoma 4 to 6 weeks later. All the tumors were associated with a high risk of local recurrence; eight were locally recurrent and the remainder were stage II to stage IV tumours. Serious local complications were seen in 4% of the patients. This rate compares well with other higher dose neoadjuvant regimens (35 Gy over 10 days), which are associated with a 35% local complication rate. Follow-up at a mean of 30 months demonstrated no local recurrence. All limbs were spared. Long-term morbidity was negligible. No effect on systemic control is suggested; only 63% of the patients were free of systemic disease. This report substantiates other similar experiences supporting neoadjuvant therapy followed by resection as the treatment of choice for local control of sarcomas.