Does adjuvant radiation therapy increase loco-regional control after optimal resection of soft-tissue sarcoma of the extremities?

Khanfir, K.; Alzieu, Laure; Terrier, Philippe; Péchoux, C. Le; Bonvalot, Sylvie; Vanel, D.; Cesne, Axel Le

doi:10.1016/s0959-8049(03)00426-x

Cited by 73 publications

(63 citation statements)

References 47 publications

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“…The data regarding the prognostic implication of undergoing a re-resection are somewhat conflicting, in particular with regard to local control. 2,5,12,14 Lewis et al 12 found that patients who undergo a re-resection have improved disease-specific and metastasesfree survival compared with those patients who are treated with a single definitive surgery. Re-resection, however, did not significantly decrease the rate of LR in that study.…”

Section: Discussionmentioning

confidence: 99%

“…13,[19][20][21] Khanfir et al 5 studied the role of adjuvant RT in 133 patients treated with wide excision and a negative microscopic margin. They showed that adjuvant RT improved local control exclusively in patients with a minimal resection (margin <1 cm).…”

Section: Discussionmentioning

confidence: 99%

“…It is estimated that at the time of re-resection 40% to 75% of patients will not have evidence of residual sarcoma on pathologic assessment. 5,12,13 It is generally assumed that such patients have a low rate of local recurrence (LR) and may constitute a subset of patients who do not require adjuvant radiation; however, the data supporting this are scant. 14,15 The purpose of this study was to determine the feasibility of omitting adjuvant radiation in a group of patients with primary extremity STS treated with limb-sparing surgery who were found to have a pathologically negative re-resection specimen.…”

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confidence: 99%

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Long‐term outcomes in extremity soft tissue sarcoma after a pathologically negative re‐resection and without radiotherapy

Cahlon

Spierer

Brennan

et al. 2008

Cancer

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BACKGROUND.The purpose was to define the rate of local recurrence (LR) and identify prognostic factors for LR in patients with extremity soft‐tissue sarcoma (STS) treated with limb‐sparing surgery and a pathologically negative re‐resection specimen without radiotherapy (RT).METHODS.A review of the prospective sarcoma database identified 200 patients with primary, nonmetastatic, extremity STS treated with limb‐sparing surgery between June 1982 and December 2002 who had a pathologically confirmed negative re‐resection. None of the patients had adjuvant RT. Univariate and multivariate analyses were performed to determine clinicopathologic factors associated with LR.RESULTS.With a median follow‐up of 82 months the 5‐year actuarial LR rate was 9%. Factors associated with higher LR rates on univariate and multivariate analysis were older age, stage III presentation, and histology. The 5‐year LR rate was 5% for those <50 compared with 15% for those ≥50 (P = .001). For patients with stage III the LR rate was 26% versus 7% for those with stage I/II (P < .001). On multivariate analysis only age ≥50 (relative risk [RR] 3.3; P = .02) and stage III disease (RR 3.4; P = .01) remained significant predictors for LR. When the cohort of patients was divided into 3 groups based on the number of risk factors present, the 5‐year LRs were as follows: no risk factors (stage I/II and <50 years old) 4%, 1 risk factor (stage III or ≥50) 12%, and 2 risk factors (stage III and ≥50) 31% (P < .01).CONCLUSIONS.Patients with a pathologically negative re‐excision represent a heterogeneous group. Whereas the overall rate of local recurrence at 5 years was 9% for the entire cohort, patients with older age and/or stage III disease had a higher rate of LR. Therefore, treatment decisions especially with regard to adjuvant RT should be individualized and not be based solely on the finding of a negative re‐resection. Cancer 2008. © 2008 American Cancer Society.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Long‐term outcomes in extremity soft tissue sarcoma after a pathologically negative re‐resection and without radiotherapy

Cahlon

Spierer

Brennan

et al. 2008

Cancer

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“…The addition of radiation to the wide resection of sarcomas improves local recurrence rates from 19% to 30% in certain studies, even in patients with microscopically positive margins [3,12,16,27,30,52,53,60,62]. Because patients with Stage III tumors receive adjuvant therapies, in addition to wide resection, to treat microscopically positive margins and/or satellite lesions, it is believed this would also treat any potential tumor cells in the core needle tract.…”

Section: Introductionmentioning

confidence: 99%

Adult Soft Tissue Sarcoma Local Recurrence After Adjuvant Treatment Without Resection of Core Needle Biopsy Tract

Binitie

Tejiram

Conway

et al. 2013

Clinical Orthopaedics &Amp; Related Research

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Background Core needle biopsies of sarcomas allow a diagnosis in a high percentage of patients with few complications. However, it is unclear whether the tract needs to be excised to prevent recurrences. Questions/purposes We therefore determined the rates of recurrence and metastases in patients with Stage III extremity sarcomas, who underwent wide local resection without excision of the needle tract and also received adjuvant treatment.

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“…3 Several nonrandomized series have reported LR rates\15 % for LSS alone without RT, but others have shown unacceptably high rates of LR with this approach. [4][5][6][7][8] Given the conflicting results for surgery alone from nonrandomized reports, and the clear local control advantage with RT demonstrated by randomized trials, the standard of care for most high-grade ESTS is LSS plus RT.…”

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confidence: 99%

Radiation Therapy for Extremity Soft Tissue Sarcoma: In the Absence of a Clear Survival Benefit, Why Do We Give It?

Baldini

Raut

2014

Ann Surg Oncol

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Due in large part to several sentinel contributions from the National Cancer Institute (NCI), the local management of extremity soft tissue sarcoma (ESTS) today typically results in excellent local control and very good limb function. In 1982, Rosenberg et al. 1 showed equivalent 5-year survival rates for limb-sparing surgery (LSS) plus radiation therapy (RT) compared with amputation and an acceptable 15 % local recurrence (LR) rate for LSS plus RT. Following publication of this landmark trial, amputation rates appropriately plummeted. In 1998, Yang et al. reported results from a second NCI randomized trial that compared LSS plus RT with LSS alone and showed a clear significant local control benefit for RT for both high-and low-grade ESTS. A randomized trial from Memorial Sloan-Kettering Cancer Center (MSKCC) in 1996 affirmed the local control advantage for RT (in the form of brachytherapy) in addition to LSS.3 Several nonrandomized series have reported LR rates\15 % for LSS alone without RT, but others have shown unacceptably high rates of LR with this approach. [4][5][6][7][8] Given the conflicting results for surgery alone from nonrandomized reports, and the clear local control advantage with RT demonstrated by randomized trials, the standard of care for most high-grade ESTS is LSS plus RT.The main and undisputed benefit of adjuvant RT is improved local control, and local control rates for LSS plus RT are \15 % in modern series.9-12 However, the effect of RT on overall survival is ambiguous. The aforementioned randomized trials as well as the 20-year update of the NCI trial reported by Beane et al. that accompanies this editorial, fail to show a statistically significant difference in survival with the addition of RT. 1-3,13Since RT has its own treatment-related toxicities and is not associated with an improvement in overall survival, should we stop using RT in conjunction with LSS? The report by Beane et al. shows a trend toward higher 20-year survival rates for LSS plus RT compared with LSS alone (71 vs. 64 %, p = 0.22). As the authors point out, this study was only powered to detect a 21 % survival difference. On the other hand, a review of 6,960 patients with high-grade ESTS showed a statistically significant improved 3-year survival rate of 73 % for LSS plus RT compared with 63 % for LSS alone (p \ 0.001).14 It is quite possible that adjuvant RT for ESTS does in fact confer a statistically significant survival advantage, but due to small patient numbers in most series, such a benefit has not been reliably demonstrated. This was the case for breast cancer. Most individual trials failed to show a significant association between local control and survival. 15,16 Nevertheless, patients with breast cancer were still treated with RT because of the local control advantage it conferred. Ultimately, a meta-analysis of 42,000 patients demonstrated a clear link between improved local control and superior survival. 17Another potential benefit of adjuvant RT relates to the consequences of a LR. The development of a L...

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Does adjuvant radiation therapy increase loco-regional control after optimal resection of soft-tissue sarcoma of the extremities?

Cited by 73 publications

References 47 publications

Long‐term outcomes in extremity soft tissue sarcoma after a pathologically negative re‐resection and without radiotherapy

Long‐term outcomes in extremity soft tissue sarcoma after a pathologically negative re‐resection and without radiotherapy

Adult Soft Tissue Sarcoma Local Recurrence After Adjuvant Treatment Without Resection of Core Needle Biopsy Tract

Radiation Therapy for Extremity Soft Tissue Sarcoma: In the Absence of a Clear Survival Benefit, Why Do We Give It?

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