skip to main content
OSTI.GOV title logo U.S. Department of Energy
Office of Scientific and Technical Information

Title: Positive Surgical Margins in Soft Tissue Sarcoma Treated With Preoperative Radiation: Is a Postoperative Boost Necessary?

Abstract

Purpose: For patients with an extremity soft tissue sarcoma (STS) treated with preoperative radiotherapy and surgically excised with positive margins, we retrospectively reviewed whether a postoperative radiation boost reduced the risk of local recurrence (LR). Methods and Materials: A total of 216 patients with positive margins after resection of an extremity STS treated between 1986 and 2003 were identified from our institution's prospectively collected database. Patient demographics, radiation therapy parameters including timing and dose, classification of positive margin status, reasons for not administering a postoperative boost, and oncologic outcome were collected and evaluated. Results: Of the 216 patients with a positive surgical margin, 52 patients were treated with preoperative radiation therapy alone (50 Gy), whereas 41 received preoperative radiation therapy plus a postoperative boost (80% received 16 Gy postoperatively for a total of 66 Gy). There was no difference in baseline tumor characteristics between the two groups. Six of 52 patients in the group receiving preoperative radiation alone developed a LR compared with 9 of 41 in the boost group. Five-year estimated LR-free survivals were 90.4% and 73.8%, respectively (p = 0.13). Conclusions: We found that including the postoperative radiation boost after preoperative radiation and a margin-positive excision did notmore » provide an advantage in preventing LR for patients treated with external beam radiotherapy. Given that higher radiation doses placed patients at greater risk for late complications such as fracture, fibrosis, edema, and joint stiffness, judicious avoidance of the postoperative boost while maintaining an equivalent rate of local control can reduce the risk of these difficult-to-treat morbidities.« less

Authors:
;  [1];  [2]; ;  [3]
  1. Orthopaedic Surgery, University Musculoskeletal Oncology Unit, Mount Sinai Hospital, Toronto, ON (Canada)
  2. Orthopaedic Surgery, University Musculoskeletal Oncology Unit, Mount Sinai Hospital and the University of Toronto, Toronto, ON (Canada)
  3. Department of Radiation Oncology, Princess Margaret Hospital and University of Toronto, Toronto, ON (Canada)
Publication Date:
OSTI Identifier:
21436092
Resource Type:
Journal Article
Resource Relation:
Journal Name: International Journal of Radiation Oncology, Biology and Physics; Journal Volume: 77; Journal Issue: 4; Other Information: DOI: 10.1016/j.ijrobp.2009.06.074; PII: S0360-3016(09)02771-0; Copyright (c) 2010 Elsevier Science B.V., Amsterdam, The Netherlands, All rights reserved.
Country of Publication:
United States
Language:
English
Subject:
62 RADIOLOGY AND NUCLEAR MEDICINE; EDEMA; FIBROSIS; RADIATION DOSES; RADIOTHERAPY; SARCOMAS; SURGERY; DISEASES; DOSES; MEDICINE; NEOPLASMS; NUCLEAR MEDICINE; PATHOLOGICAL CHANGES; RADIOLOGY; SYMPTOMS; THERAPY

Citation Formats

Al Yami, Ali, Griffin, Anthony M., Ferguson, Peter C., Catton, Charles N., and Chung, Peter W.M. Positive Surgical Margins in Soft Tissue Sarcoma Treated With Preoperative Radiation: Is a Postoperative Boost Necessary?. United States: N. p., 2010. Web. doi:10.1016/j.ijrobp.2009.06.074.
Al Yami, Ali, Griffin, Anthony M., Ferguson, Peter C., Catton, Charles N., & Chung, Peter W.M. Positive Surgical Margins in Soft Tissue Sarcoma Treated With Preoperative Radiation: Is a Postoperative Boost Necessary?. United States. doi:10.1016/j.ijrobp.2009.06.074.
Al Yami, Ali, Griffin, Anthony M., Ferguson, Peter C., Catton, Charles N., and Chung, Peter W.M. Thu . "Positive Surgical Margins in Soft Tissue Sarcoma Treated With Preoperative Radiation: Is a Postoperative Boost Necessary?". United States. doi:10.1016/j.ijrobp.2009.06.074.
@article{osti_21436092,
title = {Positive Surgical Margins in Soft Tissue Sarcoma Treated With Preoperative Radiation: Is a Postoperative Boost Necessary?},
author = {Al Yami, Ali and Griffin, Anthony M. and Ferguson, Peter C. and Catton, Charles N. and Chung, Peter W.M.},
abstractNote = {Purpose: For patients with an extremity soft tissue sarcoma (STS) treated with preoperative radiotherapy and surgically excised with positive margins, we retrospectively reviewed whether a postoperative radiation boost reduced the risk of local recurrence (LR). Methods and Materials: A total of 216 patients with positive margins after resection of an extremity STS treated between 1986 and 2003 were identified from our institution's prospectively collected database. Patient demographics, radiation therapy parameters including timing and dose, classification of positive margin status, reasons for not administering a postoperative boost, and oncologic outcome were collected and evaluated. Results: Of the 216 patients with a positive surgical margin, 52 patients were treated with preoperative radiation therapy alone (50 Gy), whereas 41 received preoperative radiation therapy plus a postoperative boost (80% received 16 Gy postoperatively for a total of 66 Gy). There was no difference in baseline tumor characteristics between the two groups. Six of 52 patients in the group receiving preoperative radiation alone developed a LR compared with 9 of 41 in the boost group. Five-year estimated LR-free survivals were 90.4% and 73.8%, respectively (p = 0.13). Conclusions: We found that including the postoperative radiation boost after preoperative radiation and a margin-positive excision did not provide an advantage in preventing LR for patients treated with external beam radiotherapy. Given that higher radiation doses placed patients at greater risk for late complications such as fracture, fibrosis, edema, and joint stiffness, judicious avoidance of the postoperative boost while maintaining an equivalent rate of local control can reduce the risk of these difficult-to-treat morbidities.},
doi = {10.1016/j.ijrobp.2009.06.074},
journal = {International Journal of Radiation Oncology, Biology and Physics},
number = 4,
volume = 77,
place = {United States},
year = {Thu Jul 15 00:00:00 EDT 2010},
month = {Thu Jul 15 00:00:00 EDT 2010}
}