The Impact of Neo-adjuvant and Adjuvant Chemotherapy in Treatment Outcome of Patients with High Risk Soft Tissue Sarcomas of the Extremities

Background: This prospective study assessed the efficacy of neoadjuvant and adjuvant chemotherapy on patients with high risk soft tissue sarcomasof the extremities.Methods: Enrolled patients received the following neoadjuvant chemotherapy: doxorubicin (۷۵ mg/m۲) on day۱, ifosfamide (۲.۵ g/m۲/d) and mesna (۲۰% of the ifosfamide dose) from days۱ to ۳, repeated every three weeks for a total of three cycles, followed by surgery and radiotherapy. Patients received an additional three cycles of adjuvant chemotherapy that was the same as the neoadjuvant protocol following completion of radiotherapy.Results: There were ۵۲ patients enrolled in the study, of which ۵۰ were included in data analysis. Neoadjuvant chemotherapy was completed by ۹۰% of enrolled patients and ۸۸% completed all planned chemotherapy. A total of ۹۶% of patients underwent surgery and ۹۲% of these had R۰ resections. Postoperative radiotherapy was administered to ۹۶% of patients. The estimated three-year local-regional failure was ۱۰%. Estimated three-year rate for distant disease-free survival was ۶۶% and overall survival was ۸۸%. One patient died with treatment secondary to leukopenic sepsis and respiratory failure. Grades ۳-۴ toxicities were experienced by ۸۶% of patients of which ۸۴% were grades ۳- ۴ hematologic toxicities and ۳۸% were grades ۳-۴ non- hematologic toxicities.Conclusion: The current protocol is feasible and associated with favorable distant disease-free survival, overall survival, and limb preservation. This protocol is tolerable and has a manageable toxicity level.