NCI                                                  sarcoma(135)
 _________________________________________________________________
  adriamycin...... 50 [If WBC ok increase by 10 per cycle to 70] 
                   mg/sqm IV day 1.
  cytoxan......... 500 [If well tolerated and WBC ok increase by 
                   100 per cycle to 700] mg/sqm IV day 1.
  radiation....... 180 to 200 rad per fraction to 4,500 to 5,000 
                   rad, started three days after the initiation of 
                   chemotherapy. The tumor bed may be irradiated 
                   to a maximum of 6,000 to 7,000 rads over the 
                   next two weeks.
  methotrexate.... When adriamycin cummulative dose reaches 550 
                   mg/sqm, susbtitute with methotrexate at 50 [If 
                   well tolerated, increase by 50 per cycle to 
                   250] mg/kg IV over 6 h on day 1.
  leucovorin...... 15 mg/sqm IV, 2 h after completion of 
                   methotrexate, then repeated every 6 h times 8.
  FREQUENCY....... Repeat cycle every 28 days.


  reference...
    Rosenberg SA.  Tepper J.  Glatstein E.  Costa J.  Young R. 
    Baker A.  Brennan MF.  Demoss EV.  Seipp C.  Sindelar WF.  
    Sugarbaker P. Wesley R. Prospective randomized evaluation of 
    adjuvant chemotherapy in adults with soft tissue sarcomas of 
    the extremities. Cancer.  52(3):424-34, 1983 Aug 1. 
  abstract...
    Sixty-five patients with high-grade soft tissue sarcomas of 
    the extremities were treated in a prospective randomized trial 
    evaluating the efficacy of adjuvant chemotherapy with 
    doxorubicin, cyclophosphamide, and high-dose methotrexate. 
    Local therapy was administered using either amputation or wide 
    local resection plus radiation therapy and the chemotherapy 
    was begun in the immediate postoperative period. Actuarial 
    analysis with median follow-up of 653 days revealed an 
    advantage in continuous disease-free and overall survival in 
    the patient group receiving chemotherapy (P = 0.0008 and P = 
    0.04, respectively, one-sided Mantel-Haenszel test). The 
    continuous disease-free survival at three years is 92% in the 
    chemotherapy group compared to 60% in the no chemotherapy 
    group. Overall survival is 95% and 74% in these two patient 
    groups. Fifty-eight percent of patients had limb-sparing 
    surgery plus radiation therapy and 42% underwent amputation. 
    In both treatment subgroups analyzed separately, chemotherapy 
    resulted in an improvement in disease-free survival compared 
    to randomized controls not receiving chemotherapy (P = 0.006 
    and P = 0.04 for groups receiving amputation and limb sparing, 
    respectively). There were no local failures in the patients 
    receiving chemotherapy and two local failures in the no 
    chemotherapy group. The results of this trial confirm the 
    historically controlled pilot trial performed in 26 patients 
    between 1975 and 1977. A current update of the patients in the 
    pilot trial, with a minimum four-year follow-up, reveals an 
    improvement in disease-free and overall survival due to 
    chemotherapy (P less than 0.002). Analysis of the previous 
    pilot trial indicates that only few recurrences are seen 
    beyond three years. Thus, it appears that adjuvant 
    chemotherapy should be a part of the treatment adult patients 
    with soft tissue sarcomas of the extremities.