This study revealed significant variation in the perception of negative and close margins among radiation oncologists in NA and Europe. Given these findings, a universal definition of negative margins and consistent recommendations for reexcision are needed.

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Purpose The benefit of radiation therapy in extremity soft tissue sarcomas remains controversial. The purpose of this study was determine the effect of radiation therapy on overall survival among patients with primary soft tissue sarcomas of the extremity who underwent limb sparing surgery. Patients and Methods A retrospective study from the Surveillance, Epidemiology, and End Results (SEER) database that included data from January 1, 1988, to December 31st, 2005. A total of 6,960 patients comprised the study population. Overall survival curves were constructed using Kaplan-Meir Method and for patients with low and high grade tumors. Hazard ratios were calculated based on multivariable Cox proportional hazards models. Results Of the cohort, 47% received radiation therapy. There was no significant difference in overall survival among patients with low grade tumors by radiation therapy. In high grade tumors, the 3 year overall survival was 73% in patients who received radiation therapy vs. 63% for those who did not receive radiation therapy (p < 0.001). On multivariate analysis, patients with high grade tumors who received radiation therapy had an improved overall survival (HR 0.67, 95% CI 0.57-0.79). In patients receiving radiation therapy, 13.5% received it in a neo-adjuvant setting. The incidence of patients receiving neo-adjuvant radiation did not change significantly between 1988 and 2005. Conclusions This is the largest population based study reported in patients undergoing limb sparing surgery for soft tissue sarcomas of the extremities and reports that radiation was associated with improved survival in patients with high grade tumors.

While the workshop was co-sponsored by the NCI and RSS, the comments in this report are strictly the opinions of the co-authors and does not constitute endorsement of these results and/or treatments by the NCI and RSS or consensus of all the co-authors on each of the points. This report is designed to stimulate further formal research and development to explore the future clinical application of these novel therapies and not for implementation into routine clinical practice.