{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,16]],"date-time":"2026-04-16T22:18:38Z","timestamp":1776377918265,"version":"3.51.2"},"reference-count":16,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2002,1,31]],"date-time":"2002-01-31T00:00:00Z","timestamp":1012435200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cancer"],"published-print":{"date-parts":[[2002,2]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>BACKGROUND<\/jats:title><jats:p>Most institutional teams utilize multimodality therapy in their efforts to cure patients with primary high\u2010grade extremity soft tissue sarcomas, although the value of adjuvant systemic chemotherapy is still disputed by some oncologists. This single\u2010institution Phase II study describes an effort to control metastasis by the use of two cycles of chemotherapy as the initial preoperative treatment.<\/jats:p><\/jats:sec><jats:sec><jats:title>METHODS<\/jats:title><jats:p>Between March 1994 and October 1997, 20 women and 19 men with primary extremity or limb girdle high\u2010grade soft tissue sarcomas were registered to a study of preoperative ifosfamide, mitomycin, doxorubicin, cisplatin (IMAP) plus granulocyte macrophage\u2013colony\u2010stimulating factor (GM\u2010CSF) followed by preoperative irradiation and subsequent limb\u2010sparing surgery. The two sequential monthly cycles of IMAP involved intravenous ifosfamide, 2500 mg\/m<jats:sup>2<\/jats:sup>, and mesna, 2500 mg\/m<jats:sup>2<\/jats:sup>, on Day 0, followed by identical doses of these agents plus intravenous mitomycin, 4 mg\/m<jats:sup>2<\/jats:sup>, doxorubicin, 40 mg\/m<jats:sup>2<\/jats:sup>, and cisplatin, 60 mg\/m<jats:sup>2<\/jats:sup>, on Day 1. Sargramostim (GM\u2010CSF) 250 \u03bcg\/m<jats:sup>2<\/jats:sup> was given subcutaneously every 12 hours for 4 days beginning 6 days before the chemotherapy, and then for 14 more days beginning the day after chemotherapy was completed. At the beginning of the third month, external beam irradiation was administered daily, 5 days each week for 5 consecutive weeks to total preoperative doses of 4500 centigrays (cGy). This was accompanied by reduced doses of MAP chemotherapy (mitomycin, 6 mg\/m<jats:sup>2<\/jats:sup>, doxorubicin, 30 mg\/m<jats:sup>2<\/jats:sup>, and cisplatin, 45 mg\/m<jats:sup>2<\/jats:sup>) intravenously on Days 0, 21, and 42 of the radiation therapy segment. Approximately 1 month after preoperative irradiation ended, each patient had complete surgical excision with curative intent, using limb\u2010sparing techniques when possible. Radiation to total doses of 5500\u20136500 cGy was accomplished by delivery of an additional 1000\u20132000 cGy to the tumor bed via intraoperative electron beam, brachytherapy, or external beam irradiation at the completion of surgery.<\/jats:p><\/jats:sec><jats:sec><jats:title>RESULTS<\/jats:title><jats:p>All except 5 patients had tumors at least 5 cm in diameter. Chemotherapy toxicity grade three or higher consisted primarily of vomiting (23%), leukopenia (54%), and thrombocytopenia (77%). Six patients have died of metastatic sarcoma, and one other died in a motorcycle accident. Kaplan\u2013Meier curves indicate estimated 5\u2010year survival of approximately 80% and freedom from metastasis at 2 years of approximately 85%.<\/jats:p><\/jats:sec><jats:sec><jats:title>CONCLUSIONS<\/jats:title><jats:p>IMAP plus GM\u2010CSF is satisfactory as initial treatment for primary extremity soft tissue sarcomas in two monthly cycles preceding irradiation. The prescribed irradiation was generally tolerable and effective in permitting limb\u2010sparing surgery. Although the outcome of patients treated on this regimen has been favorable, the metastasis problem has not been eliminated. Cancer 2002;94:786\u201392. \u00a9 2002 American Cancer Society.<\/jats:p><jats:p>DOI 10.1002\/cncr.10259<\/jats:p><\/jats:sec>","DOI":"10.1002\/cncr.10259","type":"journal-article","created":{"date-parts":[[2002,8,25]],"date-time":"2002-08-25T00:51:41Z","timestamp":1030236701000},"page":"786-792","source":"Crossref","is-referenced-by-count":78,"title":["Chemotherapy, irradiation, and surgery for function\u2010preserving therapy of primary extremity soft tissue sarcomas"],"prefix":"10.1002","volume":"94","author":[{"given":"John H.","family":"Edmonson","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ivy A.","family":"Petersen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Thomas C.","family":"Shives","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michelle 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