One hundred and thirty-six patients autografted for relapsed or refractory non-Hodgkin's lymphoma (NHL) were evaluated to assess long-term event-free survival and to identify important prognostic factors. High-dose therapy consisted primarily of carmustine (BCNU), etoposide, cytarabine, and cyclophosphamide (BEAC) followed by unpurged autologous stem cell rescue. The 5-year Kaplan-Meier event-free survival (EFS) for the entire cohort was 34% (95% confidence interval: 24-44%) with a median follow-up of approximately 3 years (range 0-7.5 years). For patients entering with minimal disease (defined as all areas < or = 2 cm), the 5-year EFS was 40 vs 26% for those entering with bulky disease (P = 0.0004). In the multivariate analysis, minimal disease on entry and administration of involved-field XRT post-transplant were significantly associated with improved EFS; the latter association was observed mainly in the cohort of patients with bulky disease. The overall 100-day treatment-related mortality rate was 4.4% (3% for the last 71 patients). New strategies are needed to reduce the high rate of relapse (50-60%) following auto-transplantation for relapsed or refractory NHL.

Seventy consecutive patients with refractory or relapsed Hodgkin's disease who received high-dose chemotherapy followed by autologous stem cell rescue were analyzed to identify clinically relevant predictors of long-term event-free survival. High-dose therapy consisted primarily of carmustine (BCNU), etoposide, cytarabine and cyclophosphamide (BEAC). The 5-year Kaplan-Meier event-free survival (EFS) for the entire cohort was 32% (95% confidence interval; 18-45%) with a median follow-up of 3.6 years (range 7 months-7.6 years). The most significant predictor of improved survival was the presence of minimal disease (defined as all areas < or =2 cm) at the time of transplant: the 5 years EFS was 46 vs 10% for patients with bulky disease (P = 0.0002). Other independent predictors identified by step-wise regression analysis included the presence of non-refractory disease and the administration of post-transplant involved-field radiotherapy (XRT). Treatment-related mortality occurred in 13 of 70 patients: nine patients (13%) died within the first 100 days, mainly from cardiopulmonary toxicity. However, only one of 24 patients (4%) transplanted during the last 4.5 years died from early treatment-related complications. While high-dose therapy followed by autotransplantation led to long-term EFS of 50% for patients with favorable prognostic factors, a substantial proportion of patients relapsed, indicating that new therapeutic strategies are needed.

Purpose/Objective(s): Angiosarcoma is a rare but aggressive malignant vascular tumor often associated with prior radiotherapy. This study aimed to define prognostic factors and to identify successful therapeutic approaches in the treatment of angiosarcoma with radiation therapy (RT). Materials/Methods: Between 1964 and 2009, 41 patients with nonmetastatic, histologically proven angiosarcoma were treated with RT at the University of Florida. The median age of the patients was 67 years (range, 21 to 87 years). Sixteen of the 41 angiosarcomas were considered radiation-induced. Twenty-two patients had angiosarcomas of the head and neck, including 9 of the scalp. Fourteen angiosarcomas were located on the breast or chest wall while 5 were located on the extremities, retroperitoneum, or deep soft tissues. Thirty-one patients were treated with both surgery and RT (12 with preoperative RT and 19 with postoperative RT), whereas 10 patients were treated with RT alone. The median RT dose was 60 Gy (range, 37.5 to 76 Gy). Sixteen patients were treated with RT once daily, 7 patients were treated twice daily, and 18 patients were treated three times daily. Two patients received adjuvant chemotherapy. The median follow-up was 44 months (range, 2 to 343 months). Results: The 5-year local control and overall survival rates were 64% and 54%, respectively. Of 23 patients who relapsed, 15 had a component of local failure: 11 had an isolated local recurrence and 4 occurred in conjunction with metastatic disease. The median time to a local failure was 1.5 years from RT and the longest time interval to a local failure was 10.2 years. Predictors of 5-year local control were non-scalp primary location (92% breast vs. 80% other vs. 60% non-scalp head and neck vs. 18% scalp; p\ 0.05), tumor size # 5 cm (76% vs. 26%; p \0.01), radiation-induced tumors versus de novo angiosarcoma (92% vs. 47%; p \ 0.01), and combined-modality local therapy (78% surgery + RT vs. 30% RT alone; p\0.01). Predictors of 5-year overall survival were non-scalp primary location (79% breast vs. 69% non-scalp head and neck vs. 20% other vs. 9% scalp; p \ 0.05) and tumor size # 5 cm (69% vs. 17%; p \ 0.05). With regard to both local control and overall survival, the most favorable cohort was comprised of patients who were treated with radiotherapy three times daily combined with surgery for angiosarcoma of the breast. Conclusions: For angiosarcomas treated with radiotherapy, outcome varies widely and is most impacted by site, size, and resectability. In amenable sites, aggressive treatment with surgical resection and hyperfractionated radiation therapy may offer the best prognosis.Purpose/Objective(s): Patients with pulmonary metastases (PM) from soft tissue sarcomas (STS) have historically been treated with surgery and/or chemotherapy; however, survival is limited. Since 2001 we have treated extracranial metastases from various primary malignancies with stereotactic body radiation therapy (SBRT) resulting in outstanding local control (LC), unexpectedly favorable overal...

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