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

Abstract

PurposeTo evaluate the treatment outcome and prognostic factor of postoperative radiotherapy for extremity soft tissue sarcoma (STS).Materials and MethodsForty 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.ResultsThe 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%).ConclusionConservative 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.

Does the Clinical Presentation of Secondary Osteosarcoma in Patients Who Survive Retinoblastoma Differ From That of Conventional Osteosarcoma and How Do We Detect Them?

“…Regarding the prognosis of secondary malignancy, contrary to previous reports showing that the prognosis of osteosarcoma as an secondary malignancy was poorer than that of primary osteosarcoma [1,20,28], our results showed that its prognosis may not be inferior. Lee et al [21] reported that the 2-year overall survival and eventfree survival rates of patients with osteosarcoma as a secondary malignancy were 56% and 33%, respectively.…”

Excellent Local Control With IOERT and Postoperative EBRT in High-Grade Extremity Sarcoma: Results From a Subgroup Analysis of a Prospective Trial

“…This might be at least partly attributable to the use of neoadjuvant chemotherapy, although major responses according to RECIST criteria were rare. Further on, local control seemed to be at least slightly improved compared to recent series using EBRT alone (pre-or postoperatively), which reported consistently 5-year-LC rates of 83-93% [6,[19][20][21][22][23][24][25][26] with mainly comparable R1-resection rates (0-25%) as in our trial. This might be attributable to the increased biological effect of the high single dose which was guided directly to the high risk region under visual control via IOERT, but given the limited number of patients in our study and the lack of a control arm, it cannot be ruled out that this difference has occurred by selection bias or randomly.…”

MET Gene Copy Number Alterations and Expression of MET and Hepatocyte Growth Factor Are Potential Biomarkers in Angiosarcomas and Undifferentiated Pleomorphic Sarcomas

“…However, these treatments often have adverse effects or are ineffective, e.g., for retroperitoneal sarcomas the 5-year local control rate is only 40–71% and the 5-year survival rate is low with 51–60% [ 5 ]. Sarcomas of the extremities have a high local recurrence rate of 30–50% and half the patients die from their disease [ 6 ].…”