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Title: Patterns of Local Recurrence and Dose Fractionation of Adjuvant Radiation Therapy in 462 Patients With Soft Tissue Sarcoma of Extremity and Trunk Wall

Purpose: To study the impact of dose fractionation of adjuvant radiation therapy (RT) on local recurrence (LR) and the relation of LR to radiation fields. Methods and Materials: LR rates were analyzed in 462 adult patients with soft tissue sarcoma who underwent surgical excision and adjuvant RT at five Scandinavian sarcoma centers from 1998 to 2009. Medical records were reviewed for dose fractionation parameters and to determine the location of the LR relative to the radiation portals. Results: Fifty-five of 462 patients developed a LR (11.9%). Negative prognostic factors included intralesional surgical margin (hazard ratio [HR]: 7.83, 95% confidence interval [CI]: 3.08-20.0), high malignancy grade (HR: 5.82, 95% CI: 1.31-25.8), age at diagnosis (HR per 10 years: 1.27, 95% CI: 1.03-1.56), and malignant peripheral nerve sheath tumor histological subtype (HR: 6.66, 95% CI: 2.56-17.3). RT dose was tailored to margin status. No correlation between RT dose and LR rate was found in multiple Cox regression analysis. The majority (65%) of LRs occurred within the primary RT volume. Conclusions: No significant dose–response effect of adjuvant RT was demonstrated. Interestingly, patients given 45-Gy accelerated RT (1.8 Gy twice daily/2.5 weeks) had the best local outcome. A total dose of 50 Gy inmore » 25 fractions seemed adequate following wide margin surgery. The risk of LR was associated with histopathologic subtype, which should be included in the treatment algorithm of adjuvant RT in soft tissue sarcoma.« less
Authors:
 [1] ;  [2] ;  [3] ;  [4] ;  [5] ;  [6] ;  [7] ;  [8] ;  [9] ;  [2] ;  [1] ;  [2] ;  [10] ;  [2]
  1. Department of Clinical Medicine, Faculty of Medicine and Dentistry, University of Bergen, Bergen (Norway)
  2. (Norway)
  3. Department of Oncology, Skåne University Hospital, Lund (Sweden)
  4. Department of Oncology, Sahlgrenska University Hospital, Gothenburg (Sweden)
  5. Department of Molecular Medicine and Surgery, Section for Orthopaedics and Sports Medicine, Karolinska University Hospital, Karolinska Institute, Stockholm (Sweden)
  6. Department of Oncology, Haukeland University Hospital, Bergen (Norway)
  7. Department of Physics and Technology, University of Bergen, Bergen (Norway)
  8. (Denmark)
  9. Centre for Clinical Research, Haukeland University Hospital, Bergen (Norway)
  10. Department of Oncology, The Norwegian Radium Hospital, Oslo University Hospital, Oslo (Norway)
Publication Date:
OSTI Identifier:
22267841
Resource Type:
Journal Article
Resource Relation:
Journal Name: International Journal of Radiation Oncology, Biology and Physics; Journal Volume: 86; Journal Issue: 5; Other Information: Copyright (c) 2013 Elsevier Science B.V., Amsterdam, The 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; ALGORITHMS; ANIMAL TISSUES; DIAGNOSIS; FRACTIONATED IRRADIATION; HEALTH HAZARDS; MEDICAL RECORDS; PATIENTS; RADIATION DOSES; RADIOTHERAPY; REGRESSION ANALYSIS; SARCOMAS; SURGERY