Management of locally recurrent soft-tissue sarcoma after prior surgery and radiation therapy

Journal Article · Thu Mar 15 04:00:00 EDT 2007 · International Journal of Radiation Oncology, Biology and Physics

DOI:https://doi.org/10.1016/j.ijrobp.2006.10.036· OSTI ID:20944771

Torres, Mylin A ^[1]; Ballo, Matthew T ^[1]; Butler, Charles E ^[2]; Feig, Barry W ^[3]; Cormier, Janice N ^[3]; Lewis, Valerae O ^[3]; Pollock, Raphael E ^[3]; Pisters, Peter W ^[3]; Zagars, Gunar K ^[1]

---

1. Division of Radiation Oncology, University of Texas M. D. Anderson Cancer Center, Houston, TX (United States)
2. Department of Plastic Surgery, University of Texas M. D. Anderson Cancer Center, Houston, TX (United States)
3. Department of Surgical Oncology, University of Texas M. D. Anderson Cancer Center, Houston, TX (United States)

Purpose: The aim of this study was to evaluate outcome and treatment toxicity after wide local re-excision (WLE), with or without additional radiation therapy, for patients with isolated first local recurrence of soft-tissue sarcoma arising within a previously irradiated field. Methods: A retrospective review was performed of 62 consecutive patients. All patients underwent prior resection and external beam radiation. For recurrent disease, 25 patients were treated with WLE alone, and 37 patients were treated with WLE and additional radiation (45- 64 Gy). In 33 patients, the radiation was delivered via an afterloaded brachytherapy, single-plane implant. Results: The 5-year disease specific and distant metastasis-free survival rates were 65% and 73%, respectively. Local control (LC) at 5 years was 51%, and on multivariate analysis, a positive surgical resection margin (p< 0.001) was associated with a lower rate of LC. Reirradiation was not associated with improved LC; however complications requiring outpatient or surgical management were more common in patients who had undergone reirradiation (80% vs. 17%, p < 0.001). Amputation was also more common in the subgroup of patients who underwent extremity reirradiation (35% with radiation vs. 11% without, p = 0.05), although only one amputation was performed to resolve a treatment complication. Conclusion: Conservative surgery alone results in LC in a minority of patients who have failed locally after previous excision and external beam radiation. Although selection biases and small patient numbers confound the analysis, local treatment intensification with additional radiation does not clearly improve outcome after surgical excision alone, and is associated with an increase in complications.

• OSTI ID: 20944771
• Journal Information: International Journal of Radiation Oncology, Biology and Physics, Journal Name: International Journal of Radiation Oncology, Biology and Physics Journal Issue: 4 Vol. 67; ISSN IOBPD3; ISSN 0360-3016
• Country of Publication: United States
• Language: English

Related Subjects

62 RADIOLOGY AND NUCLEAR MEDICINE
BRACHYTHERAPY
IRRADIATION
METASTASES
MULTIVARIATE ANALYSIS
PATIENTS
RADIATION SOURCE IMPLANTS
SARCOMAS
SURGERY
TOXICITY