Radiation Oncology Journal

The Korean Society for Radiation Oncology (대한방사선종양학회)
권호 표지
DOI QR코드

DOI QR Code

Treatment outcome of conservative surgery plus postoperative radiotherapy for extremity soft tissue sarcoma

  • Lee, Ji-Eun (Department of Radiation Oncology, Korea University Medical Center) ;
  • Park, Young-Je (Department of Radiation Oncology, Korea University Medical Center) ;
  • Yang, Dae-Sik (Department of Radiation Oncology, Korea University Medical Center) ;
  • Yoon, Won-Sup (Department of Radiation Oncology, Korea University Medical Center) ;
  • Lee, Jung-Ae (Department of Radiation Oncology, Korea University Medical Center) ;
  • Rim, Chai-Hong (Department of Radiation Oncology, Korea University Medical Center) ;
  • Kim, Chul-Yong (Department of Radiation Oncology, Korea University Medical Center)
  • Received : 2012.04.18
  • Accepted : 2012.06.14
  • Published : 2012.06.30
Download PDF
⟨ Previous Next ⟩

Abstract

Purpose: To evaluate the treatment outcome and prognostic factor of postoperative radiotherapy for extremity soft tissue sarcoma (STS). Materials and Methods: Forty three patients with extremity STS were treated with conservative surgery and postoperative radiotherapy from January 1981 to December 2010 at Korea University Medical Center. Median total 60 Gy (range, 50 to 74.4 Gy) of radiation was delivered and 7 patients were treated with chemotherapy. Results: The median follow-up period was 70 months (range, 5 to 302 months). Twelve patients (27.9%) sustained relapse of their disease. Local recurrence occurred in 3 patients (7.0%) and distant metastases developed in 10 patients (23.3%). The 5-year overall survival (OS) was 69.2% and disease free survival was 67.9%. The 5-year local relapse-free survival was 90.7% and distant relapse-free survival was 73.3%. On univariate analysis, no significant prognostic factors were associated with development of local recurrence. Histologic grade (p = 0.005) and stage (p = 0.02) influenced the development of distant metastases. Histologic grade was unique significant prognostic factor for the OS on univariate and multivariate analysis. Severe acute treatment-related complications, Common Terminology Criteria for Adverse Events (CTCAE) grade 3 or 4, developed in 6 patients (14.0%) and severe late complications in 2 patients (4.7%). Conclusion: Conservative surgery with postoperative radiotherapy achieved a satisfactory rate of local control with acceptable complication rate in extremity STS. Most failures were distant metastases that correlate with tumor grade and stage. The majority of local recurrences developed within the field. Selective dose escalation of radiotherapy or development of effective systemic treatment might be considered.

Keywords

References

  1. Korah MP, Deyrup AT, Monson DK, et al. Anatomic tumor location infl uences the success of contemporary limb-sparing surgery and radiation among adults with soft tissue sarcomas of the extremities. Int J Radiat Oncol Biol Phys 2012;82:933-9. https://doi.org/10.1016/j.ijrobp.2010.11.020
  2. Rosenberg SA, Tepper J, Glatstein E, et al. The treatment of softtissue sarcomas of the extremities: prospective randomized evaluations of (1) limb-sparing surgery plus radiation therapy compared with amputation and (2) the role of adjuvant chemotherapy. Ann Surg 1982;196:305-15. https://doi.org/10.1097/00000658-198209000-00009
  3. Strander H, Turesson I, Cavallin-Stahl E. A systematic overview of radiation therapy effects in soft tissue sarcomas. Acta Oncol 2003;42:516-31. https://doi.org/10.1080/02841860310014732
  4. Lewis JJ, Leung D, Heslin M, Woodruff JM, Brennan MF. Association of local recurrence with subsequent survival in extremity soft tissue sarcoma. J Clin Oncol 1997;15:646-52. https://doi.org/10.1200/JCO.1997.15.2.646
  5. Singer S, Demetri GD, Baldini EH, Fletcher CD. Management of soft-tissue sarcomas: an overview and update. Lancet Oncol 2000;1:75-85. https://doi.org/10.1016/S1470-2045(00)00016-4
  6. Spear MA, Jennings LC, Mankin HJ, et al. Individualizing management of aggressive fibromatoses. Int J Radiat Oncol Biol Phys 1998;40:637-45. https://doi.org/10.1016/S0360-3016(97)00845-6
  7. Fiore M, Miceli R, Mussi C, et al. Dermatofibrosarcoma protuberans treated at a single institution: a surgical disease with a high cure rate. J Clin Oncol 2005;23:7669-75. https://doi.org/10.1200/JCO.2005.02.5122
  8. Hornback NB, Shidnia H. Rhabdomyosarcoma in the pediatric age group. AJR Am J Roentgenol 1976;126:542-9. https://doi.org/10.2214/ajr.126.3.542
  9. Rubin BP, Cooper K, Fletcher CD, et al. Protocol for the examination of specimens from patients with tumors of soft tissue. Arch Pathol Lab Med 2010;134:e31-9.
  10. Fein DA, Lee WR, Lanciano RM, et al. Management of extremity soft tissue sarcomas with limb-sparing surgery and postoperative irradiation: do total dose, overall treatment time, and the surgery-radiotherapy interval impact on local control? Int J Radiat Oncol Biol Phys 1995;32:969-76. https://doi.org/10.1016/0360-3016(95)00105-8
  11. Pisters PW, Harrison LB, Leung DH, Woodruff JM, Casper ES, Brennan MF. Long-term results of a prospective randomized trial of adjuvant brachytherapy in soft tissue sarcoma. J Clin Oncol 1996;14:859-68.
  12. Yang JC, Chang AE, Baker AR, et al. Randomized prospective study of the benefit of adjuvant radiation therapy in the treatment of soft tissue sarcomas of the extremity. J Clin Oncol 1998;16:197-203.
  13. Mundt AJ, Awan A, Sibley GS, et al. Conservative surgery and adjuvant radiation therapy in the management of adult soft tissue sarcoma of the extremities: clinical and radiobiological results. Int J Radiat Oncol Biol Phys 1995;32:977-85. https://doi.org/10.1016/0360-3016(95)00111-B
  14. Cleator SJ, Cottrill C, Harmer C. Pattern of local recurrence after conservative surgery and radiotherapy for soft tissue sarcoma. Sarcoma 2001;5:83-8. https://doi.org/10.1155/S1357714X01000160
  15. Jebsen NL, Trovik CS, Bauer HC, et al. Radiotherapy to improve local control regardless of surgical margin and malignancy grade in extremity and trunk wall soft tissue sarcoma: a Scandinavian sarcoma group study. Int J Radiat Oncol Biol Phys 2008;71:1196-203. https://doi.org/10.1016/j.ijrobp.2007.11.023
  16. Dickie CI, Griffi n AM, Parent AL, et al. The relationship between local recurrence and radiotherapy treatment volume for soft tissue sarcomas treated with external beam radiotherapy and function preservation surgery. Int J Radiat Oncol Biol Phys 2012;82:1528-34. https://doi.org/10.1016/j.ijrobp.2011.03.061
  17. Delaney TF, Kepka L, Goldberg SI, et al. Radiation therapy for control of soft-tissue sarcomas resected with positive margins. Int J Radiat Oncol Biol Phys 2007;67:1460-9. https://doi.org/10.1016/j.ijrobp.2006.11.035
  18. Kim WD, Oh DH, Ha SW. Postoperative radiotherapy in the treatment of soft tissue sarcomas. J Korean Soc Ther Radiol 1995;13:69-78.

Cited by

  1. Excellent local control with IOERT and postoperative EBRT in high grade extremity sarcoma: results from a subgroup analysis of a prospective trial vol.14, pp.None, 2012, https://doi.org/10.1186/1471-2407-14-350
  2. Emerging therapies for adult soft tissue sarcoma vol.14, pp.6, 2014, https://doi.org/10.1586/14737140.2014.885840
  3. MET Gene Copy Number Alterations and Expression of MET and Hepatocyte Growth Factor Are Potential Biomarkers in Angiosarcomas and Undifferentiated Pleomorphic Sarcomas vol.10, pp.4, 2012, https://doi.org/10.1371/journal.pone.0120079
  4. Intraoperative radiation therapy (IORT) in soft-tissue sarcoma vol.12, pp.None, 2012, https://doi.org/10.1186/s13014-016-0751-2
  5. Intraoperative Electron Radiation Therapy Combined with External Beam Radiation Therapy after Gross Total Resection in Extremity Soft Tissue Sarcoma: A European Pooled Analysis vol.25, pp.13, 2018, https://doi.org/10.1245/s10434-018-6787-9
  6. Intraoperative radiation therapy (IORT) for soft tissue sarcoma – ESTRO IORT Task Force/ACROP recommendations vol.150, pp.None, 2012, https://doi.org/10.1016/j.radonc.2020.07.019