Long‐term outcomes in extremity soft tissue sarcoma after a pathologically negative re‐resection and without radiotherapy

Abstract

BACKGROUND.The purpose was to define the rate of local recurrence (LR) and identify prognostic factors for LR in patients with extremity soft‐tissue sarcoma (STS) treated with limb‐sparing surgery and a pathologically negative re‐resection specimen without radiotherapy (RT).METHODS.A review of the prospective sarcoma database identified 200 patients with primary, nonmetastatic, extremity STS treated with limb‐sparing surgery between June 1982 and December 2002 who had a pathologically confirmed negative re‐resection. None of the patients had adjuvant RT. Univariate and multivariate analyses were performed to determine clinicopathologic factors associated with LR.RESULTS.With a median follow‐up of 82 months the 5‐year actuarial LR rate was 9%. Factors associated with higher LR rates on univariate and multivariate analysis were older age, stage III presentation, and histology. The 5‐year LR rate was 5% for those <50 compared with 15% for those ≥50 (P = .001). For patients with stage III the LR rate was 26% versus 7% for those with stage I/II (P < .001). On multivariate analysis only age ≥50 (relative risk [RR] 3.3; P = .02) and stage III disease (RR 3.4; P = .01) remained significant predictors for LR. When the cohort of patients was divided into 3 groups based on the number of risk factors present, the 5‐year LRs were as follows: no risk factors (stage I/II and <50 years old) 4%, 1 risk factor (stage III or ≥50) 12%, and 2 risk factors (stage III and ≥50) 31% (P < .01).CONCLUSIONS.Patients with a pathologically negative re‐excision represent a heterogeneous group. Whereas the overall rate of local recurrence at 5 years was 9% for the entire cohort, patients with older age and/or stage III disease had a higher rate of LR. Therefore, treatment decisions especially with regard to adjuvant RT should be individualized and not be based solely on the finding of a negative re‐resection. Cancer 2008. © 2008 American Cancer Society.

Hypofractionated adjuvant radiation therapy of soft-tissue sarcoma achieves excellent results in elderly patients

“…Old age and stage 3 disease were identified as factors associated with a higher rate of local recurrence [8].…”

Surgery alone is sufficient therapy for children and adolescents with low-risk synovial sarcoma: A joint analysis from the European paediatric soft tissue sarcoma Study Group and the Children's Oncology Group

“…Several retrospective analyses in adults with soft tissue sarcomas indicate that adjuvant radiotherapy is not necessary for patients whose tumour can be adequately excised, even when the tumour is high grade or >5 cm in maximal diameter [14,15,21]. An analysis of paediatric SS patients treated on three prospective European studies showed that a significant proportion could be cured without radiotherapy when a strategy of omitting radiotherapy for those with a complete response to surgery and chemotherapy was utilized [5].…”

“…Both studies identified a group of low-risk SS cases to be treated with surgery alone. This treatment strategy was based on retrospective analyses suggesting that adjuvant chemotherapy and radiotherapy might be omitted in low-risk SS [13–15], but no prospective series have confirmed the safety of this approach.…”

Preliminary Results From a Prospective Study Using Limited Margin Radiotherapy in Pediatric and Young Adult Patients With High-Grade Nonrhabdomyosarcoma Soft-Tissue Sarcoma

“…In the 12 patients undergoing a wide local excision achieving clear surgical margins, six had tumor less than 5.0 cm in the greatest dimension. Based on retrospective data in adults, this group of pediatric patients who have undergone a wide resection may be candidates for observation alone in the context of a clinical trial (as is being done in Children’s Oncology Group trial ARST0332) (27–30). Patients with primary disease involving the trunk or head and neck did not experience an adverse local outcome despite the historic adverse prognosis that these features would predict (24, 25).…”