Adjuvant chemotherapy for patients with high-grade soft-tissue sarcoma of the extremity

A. E. Chang, T. Kinsella, E. Glastein, A. R. Baker, W. F. Sindelar, M. T. Lotze, D. N. Danforth, P. H. Sugarbaker, E. E. Lack, S. M. Steinberg, D. E. White, S. A. Rosenberg

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148 Scopus citations


We have previously reported the results of a randomized trial that demonstrated the survival benefit of adjuvant chemotherapy in the treatment of patients with high-grade extremity sarcomas compared with no chemotherapy. This regimen included doxorubicin, cyclophosphamide, and methotrexate. This report updates and extends our experience. The median follow-up of this trial is now 7.1 years and reveals a 5-year disease-free survival of 75% and 54% for chemotherapy and no chemotherapy groups, respectively (two-sided P [P2] = .037). The 5-year overall survival for patients in this trial was 83% and 60% for the chemotherapy and no chemotherapy groups, respectively, with a trend towards improved survival in the chemotherapy arm (P2 = .124). Because of doxorubicin-induced cardiomyopathy we performed a subsequent randomized trial comparing this high-dose regimen to reduced cumulative doses of doxorubicin and cyclophosphamide without methotrexate. Eighty-eight patients were entered into this trial which has a median follow-up of 4.4 years. The 5-year disease-free and overall survival for patients treated with the reduced doses of chemotherapy was 72% and 75%, respectively, and was not significantly different from the high-dose regimen. No patients developed congestive heart failure on this study. We conclude that adjuvant chemotherapy improves disease-free survival in patients with extremity soft-tissue sarcomas. The overall survival advantage in patients receiving adjuvant chemotherapy in our initial randomized high-dose chemotherapy trial has diminished though it continues to favor the chemotherapy group. A reduced-dose chemotherapy regimen was found to be comparable to the high-dose regimen.

Original languageEnglish (US)
Pages (from-to)1491-1500
Number of pages10
JournalJournal of Clinical Oncology
Issue number9
StatePublished - 1988
Externally publishedYes

ASJC Scopus subject areas

  • Oncology
  • Cancer Research


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