Management of extremity soft tissue sarcomas with limbsparing surgery and postoperative irradiation: Do total dose, overall treatment time, and the surgery-radiotherapy interval impact on local control?

Fein, Douglas A.; Lee, William R.; Lanciano, Rachelle; Corn, Benjamin W.; Herbert, Scott H.; Hanlon, Alexandra L.; Hoffman, John P.; Eisenberg, Burton L.; Coia, Lawrence R.

doi:10.1016/0360-3016(95)00105-8

Cited by 122 publications

(52 citation statements)

References 38 publications

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“…Only two patients in the entire series received an EBRT component total dose higher than 50 Gy, which is an EBRT value lower than recommended in the radical management of STS [5]. IOERT boost does shorten the overall treatment time, with the additional potential advantage of facilitating the integration of chemo-radiation segments in the initial part of the multidisciplinary treatment.…”

Section: Discussionmentioning

confidence: 95%

Intraoperative radiotherapy electron boost followed by moderate doses of external beam radiotherapy in resected soft-tissue sarcoma of the extremities

Azinovic¹,

Monge²,

Aristu³

et al. 2003

Radiotherapy and Oncology

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Purpose: To analyze the patterns offailure and the toxicity profile of intraoperative electron beam radiotherapy (IOERT) after resection of soft tissue sarcomas of the extremities (STS). Patients and methods: Forty-five patients with extremity STS were treated with IOERT and moderate-dose postoperative radiotherapy (45-50 Gy). Twenty-six patients were treated for primary disease (PD) and 19 patients for an isolated recurrence (ILR). Tumor size was > 5 cm (maximum diameter) in 36 patients (80%), and high-grade histology in PD patients was present in 14 patients (54%). In nine patients, IOERT was used alone, due to previous irradiation or patient refusal. Chemotherapy (neoadjuvant and/or adjuvant) was mainly given to high-grade tumors. Results: Nine patients relapsed in the extremity (20%), and 12 patients in distant sites (28%). Actuarial local control at 5 years was 88% for patients with negative/close margins and 57% for patients presenting positive margins (P = 0.04). Five patients (11%) developed neuropathy associated with the treatment. Extremity preservation was achieved in 40 patients (88%). With a median follow-up of 93 months (range: 27-143 months) for the patients at risk, 25 patients remain alive (a 7-year actuarial survival rate of 75% for PD and 47% for ILR; P = 0.01). Conclusions: IOERT combined with moderate doses of external beam irradiation yields high local control and extremity preservation rates in resected extremity STS. Peripheral nerves in the IOERT field are dose-limiting structures requiring a dose compromise in the IOERT component to avoid severe neurological damage.

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Section: Discussionmentioning

confidence: 95%

Intraoperative radiotherapy electron boost followed by moderate doses of external beam radiotherapy in resected soft-tissue sarcoma of the extremities

Azinovic¹,

Monge²,

Aristu³

et al. 2003

Radiotherapy and Oncology

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“…However, as it turned out, there were no significant differences in outcome by any of the overall treatment parameters. The potential influence of factors such as reexcision of tumor beds, 29 the utility of preoperative XRT versus postoperative XRT, 30 and the significance of XRT dose [31][32][33] will be reported separately. It should be reiterated that this series included relatively few patients with STS arising in the deep trunk, particularly in the retroperitoneum, because it was not general policy to offer adjuvant XRT to patients with such disease.…”

Section: Discussionmentioning

confidence: 99%

Prognostic factors for patients with localized soft‐tissue sarcoma treated with conservation surgery and radiation therapy

Zagars

Ballo

Pisters

et al. 2003

Cancer

591

474

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BACKGROUNDPrognostic factors for patients with soft‐tissue sarcoma who are treated with conservative surgery and radiation are documented poorly.METHODSThe clinicopathologic features and disease outcome for 1225 patients with localized sarcoma who were treated with conservative surgery and radiation were reviewed retrospectively. Actuarial univariate and multivariate statistical methods were used to determine significant prognostic factors for local control, metastatic recurrence, and disease specific survival.RESULTSThe median follow‐up of surviving patients was 9.5 years. The respective local control rates at 5 years, 10 years, and 15 years were 83%, 80%, and 79%. Factors predictive of local recurrence were positive or uncertain resection margins; tumors located in the head and neck and the deep trunk; presentation with local recurrence; patient age > 64 years; malignant fibrous histiocytoma, neurogenic sarcoma. or epithelioid sarcoma histopathology; tumor measuring > 10 cm in greatest dimension; and high pathologic grade. Freedom from metastasis at 5 years, 10 years, and 15 years was 71%, 68%, and 66%, respectively. Factors that were predictive of metastatic recurrence were high tumor grade; large tumor size (> 5 cm); and leiomyosarcoma, rhabdomyosarcoma, synovial sarcoma, or epithelioid sarcoma. The respective disease specific survival rates at 5 years, 10 years, and 15 years were 73%, 68%, and 65%. Adverse factors for disease specific survival were high tumor grade; large tumor size (> 5 cm); tumors located in the head and neck and deep trunk; rhabdomyosarcoma, epithelioid sarcoma, or clear cell sarcoma; patient age > 64 years; and positive or uncertain resection margins.CONCLUSIONSSoft‐tissue sarcoma comprises a heterogeneous group of diseases. Prognostic factors for local recurrence, metastatic recurrence, lymph node recurrence, disease free survival, and disease specific survival are different, and optimal treatment strategies need to take this complexity into account. Cancer 2003;10:2530–43. © 2003 American Cancer Society.DOI 10.1002/cncr.11365

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“…Combined modality treatment of this nature can achieve 5-year local control rates of 85-90% [1][2][3][4][5][6][7] and 5-year overall survival rates in excess of 70%. [1][2][3]5,7,8 In terms of local control and survival this compares favourably with the results achieved by radical surgery or amputation.…”

Section: Introductionmentioning

confidence: 99%

Pattern of Local Recurrence After Conservative Surgery and Radiotherapy for Soft Tissue Sarcoma

Cleator

Cottrill

Harmer

2000

Sarcoma

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Purpose: Over the past three decades our centre has adopted a policy of conservative surgery followed by adjuvant radicaldose radiotherapy for medium-and high-grade soft tissue sarcomas. For all cases of local recurrence following this treatment we aimed to define the spatial relationship between sites of recurrence and the positions of the phase 1 and 2 radiotherapy volumes. Patients: We identified 25 cases of local recurrence recorded on our soft tissue sarcoma database between 1986 and 1999 inclusive. We excluded patients with macroscopic residual disease following surgery. Most patients were treated with a phase I volume corresponding to the entire muscle compartment (50 Gy in 25 fractions over 5 weeks) and a phase II volume corresponding to the tumour bed (10 Gy in five fractions). Six of the patients were treated according to a hyperfractionated regimen. Methods: For each case we reviewed the diagnostic imaging, planning radiographs and prescription sheets. We audited whether treatment had been given according to protocol and defined whether recurrence had arisen in the phase 1 volume, phase 2 volume or 'out of field'. Results: Four (16%) patients recurred within the phase I volume, 17 (68%) recurred within the phase II volume and four (16%) outside the irradiated volume including one marginal recurrence. In six patients there had been deviation from our radiotherapy protocol (usually unavoidable) including all three true out of field recurrences. Discussion: The majority of recurrences occur in the phase 2 volume. Prospective multi-centre data collection and, ideally, a prospective randomised trial are required to formulate an improved treatment policy with respect to radiotherapy margins and dose.

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Management of extremity soft tissue sarcomas with limbsparing surgery and postoperative irradiation: Do total dose, overall treatment time, and the surgery-radiotherapy interval impact on local control?

Cited by 122 publications

References 38 publications

Intraoperative radiotherapy electron boost followed by moderate doses of external beam radiotherapy in resected soft-tissue sarcoma of the extremities

Intraoperative radiotherapy electron boost followed by moderate doses of external beam radiotherapy in resected soft-tissue sarcoma of the extremities

Prognostic factors for patients with localized soft‐tissue sarcoma treated with conservation surgery and radiation therapy

Pattern of Local Recurrence After Conservative Surgery and Radiotherapy for Soft Tissue Sarcoma

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