The impact of an aggressive local control policy and of adjuvant chemotherapy in primary presentation extremity adult soft-tissue sarcoma in sequential cohorts over 20 years at the Princess Margaret Hospital

James Metz, MD
OncoLink Associate Editor
Last Modified: October 25, 2000

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Presenter: B. O'Sullivan
Affiliation: Princess Margaret Hospital


Background:

Some controversy remains over the optimal management of adult patients with extremity soft tissue sarcomas. This study was performed to determine the impact of different treatment policies over a 20 year period.


Materials and Methods:

  • 592 patients were divided into two major cohorts treated at the Princess Margaret Hospital between 1975-1996.

  • The first cohort of patients was treated between 1975-1986 with limb conservation including a gross total resection, adjuvant radiation therapy, and chemotherapy in 41%.

  • The second cohort was treated from 1986-1996 and had more aggressive local therapy with aggressive surgery and reoperation for positive margins, frequent radiation, but adjuvant chemotherapy was rarely used (5%).

  • The cohorts were well balanced except the second cohort had more tumors > 10 cm with more local extension. Also, there were clear margins in 75% of the second cohort vs 46% in the first cohort.


Results:

  • The 3 year local control was better for the second cohort at 89% vs 73%.

  • The rate of distant metastases was not different between the two cohorts.

  • Multivariate analysis showed two important points:
    • The higher local control in the second cohort protected against distant metastases.
    • The chemotherapy in cohort 1 also protected against distant metastases.


Authors' Conclusions

  • This unique population allows insight into the competing benefits of two different treatment stratagies in different eras.

  • The value of both local control and systemic chemotherapy are supported by multivariate analysis.


Clinical/Scientific Implications:

  • This is an interesting study that gives us some important information regarding treatment policies over a 20 year period at PMH.

  • Because this is a retrospective review with numberous confounding factors it is difficult to draw conclusions that we can apply to individual patients.

  • However, this does support the concept that BOTH aggressive local treatments and systemic therapies may have an impact on distant metastasis rates.