Preoperative multimodality treatment for soft tissue sarcomas

Frequently, soft tissue sarcomas (STS) do not present until they are large, thus making local control difficult. Consequently, different methods of preoperative cytoreduction should be evaluated.

This study evaluated a 10-day preoperative regimen of intraarterial doxorubicin (10 mg/m2/d), with concomitant radiation therapy (25 Gy), administered to 55 adult patients with either Stage T2 (n = 41) or distal Stage T1 (n = 14) STS. Seven of the tumors were low grade. All patients were treated by the Division of Surgical Oncology at the University of Illinois between 1978-1991.

This regimen was successful and obviated the need for amputation in 47 patients who underwent wide soft tissue excision, an initial limb-salvage rate of 87%. Complications related to the therapy occurred in 26% of patients, which resulted in additional operative procedures in 7%. The mean follow-up time was 94 months. The 5-year overall survival rate was 69%, with a disease-free survival rate of 51%. Local control was unsuccessful in 15% of the patients. Three additional patients required amputation for recurrent disease (n = 2) or complications of therapy (n = 1), resulting in an ultimate limb-salvage rate of 81%.

The long-term results of this preoperative protocol for adults with limb-threatening STS appears to justify the utilization of a multimodality approach. This preoperative regimen was useful in minimizing limb loss in patients with limb-threatening STS. However, intraarterial doxorubicin administration is associated with significant morbidity, and its role in multimodality treatment of STS requires further clarification.