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

Abstract

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.more » 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.« less

Authors:
 [1];  [2];  [3];  [4];  [4];  [4];  [4];  [4];  [1]
  1. Division of Radiation Oncology, University of Texas M. D. Anderson Cancer Center, Houston, TX (United States)
  2. Division of Radiation Oncology, University of Texas M. D. Anderson Cancer Center, Houston, TX (United States). E-mail: mballo@mdanderson.org
  3. Department of Plastic Surgery, University of Texas M. D. Anderson Cancer Center, Houston, TX (United States)
  4. Department of Surgical Oncology, University of Texas M. D. Anderson Cancer Center, Houston, TX (United States)
Publication Date:
OSTI Identifier:
20944771
Resource Type:
Journal Article
Resource Relation:
Journal Name: International Journal of Radiation Oncology, Biology and Physics; Journal Volume: 67; Journal Issue: 4; Other Information: DOI: 10.1016/j.ijrobp.2006.10.036; PII: S0360-3016(06)03375-X; Copyright (c) 2007 Elsevier Science B.V., Amsterdam, Netherlands, All rights reserved; Country of input: International Atomic Energy Agency (IAEA)
Country of Publication:
United States
Language:
English
Subject:
62 RADIOLOGY AND NUCLEAR MEDICINE; BRACHYTHERAPY; IRRADIATION; METASTASES; MULTIVARIATE ANALYSIS; PATIENTS; RADIATION SOURCE IMPLANTS; SARCOMAS; SURGERY; TOXICITY

Citation Formats

Torres, Mylin A., Ballo, Matthew T., Butler, Charles E., Feig, Barry W., Cormier, Janice N., Lewis, Valerae O., Pollock, Raphael E., Pisters, Peter W., and Zagars, Gunar K. Management of locally recurrent soft-tissue sarcoma after prior surgery and radiation therapy. United States: N. p., 2007. Web. doi:10.1016/j.ijrobp.2006.10.036.
Torres, Mylin A., Ballo, Matthew T., Butler, Charles E., Feig, Barry W., Cormier, Janice N., Lewis, Valerae O., Pollock, Raphael E., Pisters, Peter W., & Zagars, Gunar K. Management of locally recurrent soft-tissue sarcoma after prior surgery and radiation therapy. United States. doi:10.1016/j.ijrobp.2006.10.036.
Torres, Mylin A., Ballo, Matthew T., Butler, Charles E., Feig, Barry W., Cormier, Janice N., Lewis, Valerae O., Pollock, Raphael E., Pisters, Peter W., and Zagars, Gunar K. Thu . "Management of locally recurrent soft-tissue sarcoma after prior surgery and radiation therapy". United States. doi:10.1016/j.ijrobp.2006.10.036.
@article{osti_20944771,
title = {Management of locally recurrent soft-tissue sarcoma after prior surgery and radiation therapy},
author = {Torres, Mylin A. and Ballo, Matthew T. and Butler, Charles E. and Feig, Barry W. and Cormier, Janice N. and Lewis, Valerae O. and Pollock, Raphael E. and Pisters, Peter W. and Zagars, Gunar K.},
abstractNote = {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.},
doi = {10.1016/j.ijrobp.2006.10.036},
journal = {International Journal of Radiation Oncology, Biology and Physics},
number = 4,
volume = 67,
place = {United States},
year = {Thu Mar 15 00:00:00 EDT 2007},
month = {Thu Mar 15 00:00:00 EDT 2007}
}