The impact of chemotherapy on the survival of patients with high-grade primary extremity liposarcoma Journal Article

   


Authors: Eilber, F. C.; Eilber, F. R.; Eckardt, J.; Rosen, G.; Riedel, E.; Maki, R. G.; Brennan, M. F.; Singer, S.
Article Title: The impact of chemotherapy on the survival of patients with high-grade primary extremity liposarcoma
Abstract: Objective: To determine if chemotherapy offers a survival benefit to patients with large, high-grade, primary extremity liposarcoma. Summary Background Data: The impact of chemotherapy on the survival of patients with primary extremity soft tissue sarcoma is controversial and its effect on individual histologic subtypes is not defined. Patient and Methods: Two prospectively collected sarcoma databases were used to identify all patients with >5 cm, high-grade, primary extremity liposarcoma that underwent surgical treatment of cure from 1975 to 2003 (n = 245). Clinical, pathologic and treatment variables were analyzed for disease-specific survival (DSS), distant recurrence-free survival (DRFS) and local recurrence-free survival (LRFS). Results: Sixty-three (26%) patients were treated with ifosfamide based chemotherapy (IF), 83 (34%) with doxorubicin based chemotherapy (DOX) and 99 (40%) received no chemotherapy (NoC). To assess the impact of DOX, a contemporary cohort analysis of patients treated from 1975 to 1990 was performed. The 5 year DSS of the DOX treated patients was 64% (53%-74%) compared with 56% (51%-79%) for the NoC patients (log-rank P value = 0.28). To assess the impact of IF, a contemporary cohort analysis of patients treated from 1990 to 2003 was performed. The 5 year DSS of the IF treated patients was 92% (84%-100%) compared with 65% (51%-79%) for the NoC patients (log-rank P value = 0.0003). Independent prognostic factors for improved DSS were smaller size (HR = 0.7, P = 0.01), myxoid/round cell histologic subtype (HR = 0.3, P = 0.03) and treatment with IF (HR = 0.3, P = 0.01). The five-year DRFS of the IF treated patients was 81% (70%-92%) compared with 63% (50%-76%) for the NoC patients (log-rank P value = 0.02). The 5 year LRFS of the IF treated patients was 86% (76%-96%) compared with 87% (77%-97%) for the NoC patients (log-rank P value = 0.99). Conclusions: In patients with large, high-grade, primary extremity liposarcoma; DOX is not associated with improved DSS and IF is associated with an improved DSS. Treatment with IF should be considered in patients with high-risk primary extremity liposarcoma.
Keywords: adult; cancer survival; controlled study; aged; aged, 80 and over; disease-free survival; middle aged; survival rate; major clinical study; clinical trial; mortality; cisplatin; doxorubicin; conference paper; cancer adjuvant therapy; cancer radiotherapy; chemotherapy, adjuvant; radiotherapy, adjuvant; methotrexate; prospective studies; controlled clinical trial; cohort studies; neoplasm recurrence, local; antineoplastic combined chemotherapy protocols; cohort analysis; cyclophosphamide; ifosfamide; antineoplastic agents, alkylating; soft tissue sarcoma; extremities; mesna; antibiotics, antineoplastic; soft tissue neoplasms; liposarcoma; limb amputation; humans; human; male; female; priority journal
Journal Title: Annals of Surgery
Volume: 240
Issue: 4
ISSN: 0003-4932
Publisher: Lippincott Williams & Wilkins  
Date Published: 2004-10-01
Start Page: 686
End Page: 697
Language: English
DOI: 10.1097/01.sla.0000141710.74073.0d
PROVIDER: scopus
PMCID: PMC1356470
PUBMED: 15383796
DOI/URL:

http://www.scopus.com/inward/record.url?eid=2-s2.0-4644341568&partnerID=40&md5=e1d9b4736938cf08404526b443814014
Notes: Ann. Surg. -- Cited By (since 1996):70 -- Export Date: 16 June 2014 -- CODEN: ANSUA -- Source: Scopus
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MSK Authors
  1. Frederick Christian Eilber
    6 Eilber
  2. Murray F Brennan
    1059 Brennan
  3. Elyn Renee Stubblefield
    203 Stubblefield
  4. Robert Maki
    239 Maki
  5. Samuel Singer
    337 Singer
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