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