Preoperative chemotherapy for soft tissue sarcomas: reinventing the wheel

Excerpt

Over 30 years ago we published the first experience using preoperative chemotherapy for osteosarcoma of bone [1]. It was initially conceived with Dr. Ralph Marcove to allow time to custom produce an endoprosthesis for the first limb salvage treatment for osteosarcoma (rather than the standard amputation). Although criticized by some surgeons claiming that we wouldn’t even cure the 10% that were cured with immediate amputation, we continued with the hope that immediate shrinkage of the primary tumor with systemic therapy would not only allow limb salvage surgery, but would lead to fewer metastasizing tumors and a higher cure rate. We monitored the tumors with daily examinations, determination of the alkaline phosphatase (if elevated) and by 1979 the first positron emission tomography (PET) scans (that’s right 29 years ago) done before and within weeks of starting therapy to ensure against failure [2]. Those first results reported in 1979 were so spectacular that many found them hard to believe. Not only were we able to perform limb salvage therapy, but the cure rate for that first cohort of 31 patients was (and still is) in excess of 80% [3]. With Dr. Andrew Huvos we designed a grading system for the histologic effect of preoperative chemotherapy on the resected primary tumor. To our surprise 100% of those that had a favorable histologic effect were disease-free survivors at the time of the data analysis [3]. A larger study published in 1982 confirmed these significant findings [4]. Following this publication numerous studies around the world confirmed the fact that the response to preoperative chemotherapy was the most important prognostic indicator for survival. …