Long-Term Treatment Results in Soft Tissue Sarcomas of the Thoracic Wall Treated with Pre-or-Postoperative Radiotherapy - a Single Institution Experience

Abstract

Objective: To evaluate the long term results among patients with soft tissue sarcoma of the thoracic wall. Materials and Methods: Twenty-six patients who were treated with pre-or postoperative radiotherapy between December 1980-December 2007, with a diagnosis of soft tissue sarcoma of the thoracic wall were retrospectively evaluated. Results: The median age was 44 years (14-85 years) and 15 of them were male. A total of 50% of patients were grade 3. The most common histologic type of tumor was undifferentiated pleomorphic sarcoma (26.9%). Tumor size varied between 2-25 cm (median 6.5 cm). Seventeen of the cases had marginal and 9 had wide local resection. Four cases received preoperative radiotherapy and 22 postoperative radiotherapy. Six of the patients with large and high grade tumors received chemotherapy. Median follow-up time was 82 months (9-309 months). Local recurrence and metastasis was detected in 34.6% and 42.3% of patients, respectively. Fiveyear local control (LC), disease-free survival (DFS), overall survival (OS), and disease-specific survival (DSS) were 62%, 38%, 69%, and 76% respectively. On univariate analysis, the patients with positive surgical margins had a markedly lower 5-year LC rate than patients with negative surgical margin, but the difference was not significant (43% vs 78%, p=0.1). Five-year DFS (66% vs 17%) and DSS (92% vs 60%) rates were significantly worse for the patients who had high grade tumors (p=0.01, p=0.008 respectively). Conclusions: Tumor grade and surgical margin are essential parameters for determining the prognosis of thoracic wall soft tissue sarcoma both in our series and the literature.

Long-term outcomes of patients with soft tissue sarcoma of the chest wall: Analysis of the prognostic significance of microscopic margins

“…Tsukushi et al ( 5 ) performed a study on 44 patients with chest wall STS involving a high proportion of dermatofibrosarcoma protuberans (27.2 vs. 7.5% in the current study), which rarely metastasizes and, therefore, may have resulted in the high 5-year OS rate of 89%. The distribution of histological subtypes in the series of Oksuz et al ( 4 ) was comparable with that in the patient population of the present study, resulting in similar 5-year OS rates (69 vs. 66%). The study by Oksuz et al ( 4 ) is the only analysis on chest wall STS to date that determined the prognostic effects of surgical margins.…”

“…The remaining studies on chest wall STS by Oksuz et al ( 4 ) and Tsukushi et al ( 5 ) revealed age and histological grade to be significant prognostic factors of survival based on univariate analyses. Tsukushi et al ( 5 ) performed a study on 44 patients with chest wall STS involving a high proportion of dermatofibrosarcoma protuberans (27.2 vs. 7.5% in the current study), which rarely metastasizes and, therefore, may have resulted in the high 5-year OS rate of 89%.…”

Treatment outcome of chest wall soft tissue sarcomas: Analysis of prognostic factors

“…Several previous retrospective studies have also focused exclusively on patients with primary chest wall STS; however, these studies are difficult to compare because of heterogeneous patient selection criteria and variable frequencies of high‐grade sarcomas (Table ). Nevertheless, these studies have identified several prognostic factors that influence survival in chest wall STS patients, including tumor grade, tumor size, completeness of surgical margins, and age . For example, Gross et al and Harati et al noted that a tumor size of <5 cm was associated with improved OS.…”

Targeted photo-chemo therapy of malignancy on the chest wall while cardiopulmonary avoidance based on Fe3O4@ZnO nanocomposites

“…Generally, wide local excision can be adequate for small superficial lesions. But, when the recurrence of tumor on the chest wall occurs, advanced cutaneous neoplasm and lymphoma, patients are not amenable to wide local excision with negative margins due to the bulk and extent of the tumor [2]. Meanwhile, radiotherapy to the chest wall could carry the risks of radiation-related toxicity such as pneumonitis, lung fibrosis, and coronary heart disease because considerable volumes of heart and lung are likely to receive high doses [2].…”

“…But, when the recurrence of tumor on the chest wall occurs, advanced cutaneous neoplasm and lymphoma, patients are not amenable to wide local excision with negative margins due to the bulk and extent of the tumor [2]. Meanwhile, radiotherapy to the chest wall could carry the risks of radiation-related toxicity such as pneumonitis, lung fibrosis, and coronary heart disease because considerable volumes of heart and lung are likely to receive high doses [2]. Although modern radiation therapy techniques have been introduced to avoid high dose exposure to surrounding and underlying healthy tissue, their clinical benefit is still a matter of debate [1].…”