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

Journal Article · Sun Apr 01 00:00:00 EDT 2007 · International Journal of Radiation Oncology, Biology and Physics

DOI:https://doi.org/10.1016/j.ijrobp.2006.11.035· OSTI ID:20951592

DeLaney, Thomas F ^[1]; Kepka, Lucyna ^[2]; Goldberg, Saveli I ^[1]; Hornicek, Francis J ^[3]; Gebhardt, Mark C ^[4]; Yoon, Sam S ^[5]; Springfield, Dempsey S ^[3]; Raskin, Kevin A ^[3]; Harmon, David C ^[6]; Kirsch, David G ^[1]; Mankin, Henry J ^[3]; Rosenberg, Andrew E ^[7]; Nielsen, G Petur ^[7]; Suit, Herman D ^[1]

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1. Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA (United States)
2. Department of Radiation Oncology, M. Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Warsaw (Poland)
3. Department of Orthopaedic Oncology, Department of Orthopaedics, Massachusetts General Hospital, Boston, MA (United States)
4. Department of Orthopaedics, Beth Israel Deaconess Medical Center, Boston, MA (United States)
5. Department of Surgical Oncology, Department of Surgery, Massachusetts General Hospital, Boston, MA (United States)
6. Department of Hematology Oncology, Department of Medicine, Massachusetts General Hospital, Boston, MA (United States)
7. Department of Pathology, Massachusetts General Hospital, Boston, MA (United States)

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.

• OSTI ID: 20951592
• Journal Information: International Journal of Radiation Oncology, Biology and Physics, Vol. 67, 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); ISSN 0360-3016
• Country of Publication: United States
• Language: English

Related Subjects

62 RADIOLOGY AND NUCLEAR MEDICINE
FAILURES
MULTIVARIATE ANALYSIS
PATIENTS
RADIATION DOSES
RADIOTHERAPY
REVIEWS
SARCOMAS
SURGERY