Neoadjuvant Chemoradiation Compared to Neoadjuvant Radiation Alone in the Management of High-Grade Soft Tissue Extremity Sarcomas

Abstract Objectives Patients with large, high-grade soft tissue sarcomas (STS) are commonly treated with aggressive limb preservation regimens. This study aimed to assess cancer control outcomes of patients treated with neoadjuvant chemoradiation (CRT) compared to radiation (RT) alone. Methods We reviewed records of patients with high-grade extremity or trunk STS ≥5 cm who were treated with neoadjuvant radiation with or without chemotherapy. Patient and disease characteristics were compared using t-test and Chi square tests. Standardized mortality ratio weighted method was used to compare overall survival (OS), local control (LC), and disease-free (DFS) survival. Acute radiation and surgical toxicity were reported. Results 64 patients (34 CRT and 30 RT) treated between 1997 and 2015 were analyzed. In the RT group as compared to the CRT group, the patient population was older, with a median age of 65 vs. 50 years (p 0.05). Acute dermatitis occurred in 18% vs. 3% and surgical complications occurred in 32% vs. 17% of CRT and RT patients, respectively. Conclusions In this study, patients receiving RT alone were more likely to be older and have comorbid CVD. When controlling for baseline differences, neoadjuvant CRT and RT provided similar rates of LC, DFS, and OS.