A retrospective clinical study of the efficacy of chemotherapy combined with adjuvant radiation therapy in the treatment of AJCC stage II or stage III soft tissue sarcoma of the extremity after wide excision

Objective To compare the therapeutic effect of chemotherapy combined with adjuvant radiation therapy and chemotherapy alone in the treatment of soft tissue sarcoma of the extremity after wide excision. Methods Between June 2007 and December 2012, a total of 81 patients with AJCC stage II or stage III soft tissue sarcoma of the extremity after wide excision were analyzed retrospectively. There were 59 patients in chemotherapy combined with adjuvant radiation therapy (CRT) group and 22 patients in chemotherapy alone (CA) group. Univariate and multivariate analyses were performed to determine clinicopathologic factors associated with disease-free survival (DFS) and overall survival (OS). Results All of the 81 patients were followed. The CRT group was followed up with a median time of 29 months, ranging from 2 to 66 months, while the CA group was followed up with a median time of 19 months, ranging 2 to 59 months. There were 13 cases (22%) of local recurrence, 14 cases (23.7%) of distant metastasis and 8 (13.6%) cases of death in the CRT group. There were 5 cases (22.7%) of local recurrence, 10 cases (45.5%) of distant metastasis and 4 cases (18.2%) of death in the CA group. In the univariate analysis, the median DFS was associated with the treatment after surgery (CRT group 44 months while CA group 14 months, χ2=5.87, P=0.015) and AJCC stages (stage II 42 months while stage III 24 months, χ2=4.404, P=0.036). The multivariate analysis demonstrated a favorable impact of treatment after surgery on DFS (P=0.02, OR=0.44, 95% CI=0.221-0.877). In the univariate analysis, there was no significant difference between the two groups of different treatments in the median OS, which was associate with tumor sizes (≤ 5 cm on 60 months while>5 cm on 45 months, χ2=4.478, P=0.034)、histological grades (G2 on 52 months while G3 on 50 months, χ2=4.325, P= 0.038) and AJCC stages (stage II on 61 months while stage III on 39 months, χ2=9.935, P=0.002). In the multivariate analysis, there were no clinical factors to demonstrate a favorable impact on OS. Conclusion For AJCC stage II or stage III soft tissue sarcoma of the extremity after wide excision, chemotherapy combined with adjuvant radiation therapy could achieve longer DFS than chemotherapy alone. Key words: Sarcoma; Surgical procedures, operative; Chemoradiotherapy, adjuvant