Improved Survival With Radiation Therapy in High-Grade Soft Tissue Sarcomas of the Extremities: A SEER Analysis

Abstract

Purpose The benefit of radiation therapy in extremity soft tissue sarcomas remains controversial. The purpose of this study was determine the effect of radiation therapy on overall survival among patients with primary soft tissue sarcomas of the extremity who underwent limb sparing surgery. Patients and Methods A retrospective study from the Surveillance, Epidemiology, and End Results (SEER) database that included data from January 1, 1988, to December 31st, 2005. A total of 6,960 patients comprised the study population. Overall survival curves were constructed using Kaplan-Meir Method and for patients with low and high grade tumors. Hazard ratios were calculated based on multivariable Cox proportional hazards models. Results Of the cohort, 47% received radiation therapy. There was no significant difference in overall survival among patients with low grade tumors by radiation therapy. In high grade tumors, the 3 year overall survival was 73% in patients who received radiation therapy vs. 63% for those who did not receive radiation therapy (p < 0.001). On multivariate analysis, patients with high grade tumors who received radiation therapy had an improved overall survival (HR 0.67, 95% CI 0.57-0.79). In patients receiving radiation therapy, 13.5% received it in a neo-adjuvant setting. The incidence of patients receiving neo-adjuvant radiation did not change significantly between 1988 and 2005. Conclusions This is the largest population based study reported in patients undergoing limb sparing surgery for soft tissue sarcomas of the extremities and reports that radiation was associated with improved survival in patients with high grade tumors.

Sinonasal fibrosarcoma: analysis of the Surveillance, Epidemiology, and End Results database

“…Previous analysis has demonstrated that adjuvant radiotherapy can improve the survival rate significantly. 4,18 As such, it is likely that the patients who were treated with combination surgery and radiotherapy in our analysis and displayed a lower survival than patient treated with surgery alone would have had an even worse prognosis (due to larger tumor sizes or potential positive surgical margins) if they had not undergone radiotherapy. Although margin status is not included in the SEER database and was not analyzed in this study, a greater proportion of patients with regional or distant metastasis underwent combination surgery with radiotherapy or radiotherapy alone ( Table 3).…”

Neoadjuvant Treatment with Preoperative Radiotherapy for Extremity Soft Tissue Sarcomas: Long-Term Results from a Single Institution in Turkey

“…Randomized trials have showed that, limb-sparing surgery with adjuvant radiotherapy yields equivalent local control rates with improved functional and psychological outcome compared to amputation alone (Rosenberg et al, 1982 ;Yang et al, 1998). Recent SEER database demonstrated a survival benefit for the addition of radiotherapy to surgery in large, high-grade tumors (Koshy et al, 2010 A considerable proportion of the patients are presenting with locally advanced tumors not safely amenable to a limb salvage procedure due to the bulk and extent of the tumor or proximity to critical tissues. Preoperative radiotherapy combined with or without chemotherapy is preferred for these patients.…”

The Benefit of Adjuvant Radiotherapy in High-grade Nonmetastatic Retroperitoneal Soft Tissue Sarcoma

“…20 In two SEER analyses of patients with STS of the extremities, adjuvant RT is associated with an improved OS in those with high-grade disease, but not in those with low-grade disease. 21,22 However, no studies exist analyzing the effect of RT for patients specifically with high-grade RPS. Consequently, we postulated that patients with highgrade RPS might be a population in which adjuvant RT could increase local tumor control, and furthermore that this could translate into an increase in OS.…”