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Title: Radiation Therapy for Control of Soft-Tissue Sarcomas Resected With Positive Margins

Abstract

Purpose: Positive margins (PM) remain after surgery in some soft-tissue sarcoma (STS) patients. We investigated the efficacy of radiation therapy (RT) in STS patients with PM. Methods and Materials: A retrospective chart review was performed on 154 patients with STS at various anatomic sites with PM, defined as tumor on ink, who underwent RT with curative intent between 1970 and 2001. Local control (LC), disease-free survival (DFS), and overall survival (OS) rates were evaluated by univariate (log-rank) and multivariate analysis of prognostic and treatment factors. Results: At 5 years, actuarial LC, DFS, and OS rates were: 76%, 46.7%, and 65.2%, respectively. LC was highest with extremity lesions (p < 0.01), radiation dose >64 Gy (p < 0.05), microscopically (vs. grossly visible) positive margin (p = 0.03), and superficial lesions (p = 0.05). Patients receiving >64 Gy had higher 5-year LC, DFS, and OS rates of 85%, 52.1%, and 67.8% vs. 66.1%, 41.8%, and 62.9% if {<=}64 Gy, p < 0.04. OS was worse in patients with G2/G3 tumors with local failure (LF), p < 0.001. Other known prognostic factors, including grade, stage, size, and age (>50), also significantly influenced OS. By multivariate analysis, the best predictors of LC were sitemore » (extremity vs. other), p < 0.01 and dose (>64 vs. {<=}64 Gy), p < 0.05; the best predictors for OS were size, p < 0.001, gross vs. microscopic PM, p < 0.05, and LF, p < 0.01. Conclusion: Local control is achieved in most PM STS patients undergoing RT. Doses >64 Gy, superficial location, and extremity site are associated with improved LC. OS is worse in patients with tumors with lesions >5 cm, grossly positive margins, and after local failure.« less

Authors:
 [1];  [2];  [3];  [4];  [5];  [6];  [4];  [4];  [7];  [3];  [4];  [8];  [8];  [3]
  1. Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA (United States). E-mail: tdelaney@partners.org
  2. Department of Radiation Oncology, M. Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Warsaw (Poland)
  3. Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA (United States)
  4. Department of Orthopaedic Oncology, Department of Orthopaedics, Massachusetts General Hospital, Boston, MA (United States)
  5. Department of Orthopaedics, Beth Israel Deaconess Medical Center, Boston, MA (United States)
  6. Department of Surgical Oncology, Department of Surgery, Massachusetts General Hospital, Boston, MA (United States)
  7. Department of Hematology Oncology, Department of Medicine, Massachusetts General Hospital, Boston, MA (United States)
  8. Department of Pathology, Massachusetts General Hospital, Boston, MA (United States)
Publication Date:
OSTI Identifier:
20951592
Resource Type:
Journal Article
Resource Relation:
Journal Name: International Journal of Radiation Oncology, Biology and Physics; Journal Volume: 67; Journal Issue: 5; Other Information: DOI: 10.1016/j.ijrobp.2006.11.035; PII: S0360-3016(06)03499-7; 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; FAILURES; MULTIVARIATE ANALYSIS; PATIENTS; RADIATION DOSES; RADIOTHERAPY; REVIEWS; SARCOMAS; SURGERY

Citation Formats

DeLaney, Thomas F., Kepka, Lucyna, Goldberg, Saveli I., Hornicek, Francis J., Gebhardt, Mark C., Yoon, Sam S., Springfield, Dempsey S., Raskin, Kevin A., Harmon, David C., Kirsch, David G., Mankin, Henry J., Rosenberg, Andrew E., Nielsen, G. Petur, and Suit, Herman D.. Radiation Therapy for Control of Soft-Tissue Sarcomas Resected With Positive Margins. United States: N. p., 2007. Web. doi:10.1016/j.ijrobp.2006.11.035.
DeLaney, Thomas F., Kepka, Lucyna, Goldberg, Saveli I., Hornicek, Francis J., Gebhardt, Mark C., Yoon, Sam S., Springfield, Dempsey S., Raskin, Kevin A., Harmon, David C., Kirsch, David G., Mankin, Henry J., Rosenberg, Andrew E., Nielsen, G. Petur, & Suit, Herman D.. Radiation Therapy for Control of Soft-Tissue Sarcomas Resected With Positive Margins. United States. doi:10.1016/j.ijrobp.2006.11.035.
DeLaney, Thomas F., Kepka, Lucyna, Goldberg, Saveli I., Hornicek, Francis J., Gebhardt, Mark C., Yoon, Sam S., Springfield, Dempsey S., Raskin, Kevin A., Harmon, David C., Kirsch, David G., Mankin, Henry J., Rosenberg, Andrew E., Nielsen, G. Petur, and Suit, Herman D.. Sun . "Radiation Therapy for Control of Soft-Tissue Sarcomas Resected With Positive Margins". United States. doi:10.1016/j.ijrobp.2006.11.035.
@article{osti_20951592,
title = {Radiation Therapy for Control of Soft-Tissue Sarcomas Resected With Positive Margins},
author = {DeLaney, Thomas F. and Kepka, Lucyna and Goldberg, Saveli I. and Hornicek, Francis J. and Gebhardt, Mark C. and Yoon, Sam S. and Springfield, Dempsey S. and Raskin, Kevin A. and Harmon, David C. and Kirsch, David G. and Mankin, Henry J. and Rosenberg, Andrew E. and Nielsen, G. Petur and Suit, Herman D.},
abstractNote = {Purpose: Positive margins (PM) remain after surgery in some soft-tissue sarcoma (STS) patients. We investigated the efficacy of radiation therapy (RT) in STS patients with PM. Methods and Materials: A retrospective chart review was performed on 154 patients with STS at various anatomic sites with PM, defined as tumor on ink, who underwent RT with curative intent between 1970 and 2001. Local control (LC), disease-free survival (DFS), and overall survival (OS) rates were evaluated by univariate (log-rank) and multivariate analysis of prognostic and treatment factors. Results: At 5 years, actuarial LC, DFS, and OS rates were: 76%, 46.7%, and 65.2%, respectively. LC was highest with extremity lesions (p < 0.01), radiation dose >64 Gy (p < 0.05), microscopically (vs. grossly visible) positive margin (p = 0.03), and superficial lesions (p = 0.05). Patients receiving >64 Gy had higher 5-year LC, DFS, and OS rates of 85%, 52.1%, and 67.8% vs. 66.1%, 41.8%, and 62.9% if {<=}64 Gy, p < 0.04. OS was worse in patients with G2/G3 tumors with local failure (LF), p < 0.001. Other known prognostic factors, including grade, stage, size, and age (>50), also significantly influenced OS. By multivariate analysis, the best predictors of LC were site (extremity vs. other), p < 0.01 and dose (>64 vs. {<=}64 Gy), p < 0.05; the best predictors for OS were size, p < 0.001, gross vs. microscopic PM, p < 0.05, and LF, p < 0.01. Conclusion: Local control is achieved in most PM STS patients undergoing RT. Doses >64 Gy, superficial location, and extremity site are associated with improved LC. OS is worse in patients with tumors with lesions >5 cm, grossly positive margins, and after local failure.},
doi = {10.1016/j.ijrobp.2006.11.035},
journal = {International Journal of Radiation Oncology, Biology and Physics},
number = 5,
volume = 67,
place = {United States},
year = {Sun Apr 01 00:00:00 EDT 2007},
month = {Sun Apr 01 00:00:00 EDT 2007}
}