The effect of radiation therapy in the treatment of adult soft tissue sarcomas of the extremities: a long‐term community‐based cancer center experience

Abstract

The aim of the study was to determine the effect of external beam radiotherapy (RT) in the treatment of extremity soft tissue sarcoma (STS) before or after limb‐sparing surgery (LSS) in a community‐based setting. Patients presenting to our institution from 1992 to 2010 and meeting eligibility criteria were stratified into low (G1) or high (G2, G3) pathologic grade and evaluated. Major complication events, including amputation, radiation‐induced sarcoma, and pathologic fracture, were assessed. Kaplan–Meier techniques and Cox proportional hazards regression models were used. One hundred and sixty‐two eligible patients underwent LSS for extremity STS (120 high grade, 42 low grade). Median time of follow‐up was 5.1 years (0.8–20.3 years). RT was administered to 111 patients. In unadjusted models, RT significantly decreased the risk of local recurrence (LR) in high‐grade STS patients (P = 0.005) and had a trend for improved recurrence‐free survival (RFS) (P = 0.069). In multivariable‐adjusted models, RT significantly improved time to LR (P = 0.001), RFS (P = 0.003), and overall survival (OS) (P = 0.003). Analysis of all patients showed those who underwent RT had a major complication rate (MCR) of 16.2%, compared to 3.9% in the no RT group (P = 0.037); however, the difference in MCR did not differ significantly when the analysis was restricted to high‐grade sarcomas. In our large experience of patients with extremity STS undergoing limb sparing surgery (LSS), RT significantly improved local recurrence (LR), RFS, and OS, in patients with high‐grade tumors. Efficacy benefits of RT should be weighed against potential complications. External beam RT should be considered in patients with resected high‐grade sarcomas.

The Role of Radiotherapy in Soft Tissue Sarcoma on Extremities With Lymph Nodes Metastasis: An IPTW Propensity Score Analysis of the SEER Database

“…The significant treatment effect of adjuvant radiotherapy in the original cohort was also noted in the adjusted groups based on IPTW. There have been some studies concerning the treatment of STSE in which adjuvant radiotherapy has a protective effect on the prognosis in high-risk patients (13,(28)(29)(30)(31)(32). In the field of STSE-RLNM, studies are rare.…”

Adjuvant Radiation Therapy for Thoracic Soft Tissue Sarcomas: A Population-Based Analysis

“…24 Similarly, single institutional reports and studies using large datasets from 2 different cancer registries (Surveillance, Epidemiology, and End Results database and NCDB) have shown significant survival benefits of adjuvant RT for patients with head and neck sarcomas and extremity STSs, particularly in cases with high-grade tumors. 13,14,[25][26][27][28] Furthermore, a recent meta-analysis also concluded that RT is associated with lower long-term mortality in patients with surgically resected STSs when the results of high-quality studies (reporting adjusted HRs) are pooled. 29 For thoracic STSs, however, only a limited number of studies have reported single institution-based experiences regarding survival outcomes after adjuvant RT.…”

Impact of Acridine Orange in Patients With Soft Tissue Sarcoma Treated With Marginal Resection

“…Conversely, if resection is conducted in the area where the tumor is in contact with the tissue, the recurrence rate increases. In such cases, radiation therapy is one of adjuvant therapies; it may be effective in reducing local recurrence rate without serious dysfunction (1,2). However, adjuvant radiotherapy can also cause various conditions that could lead to dysfunction, such as fibrosis, edema, and other pathological fractures (1,3).…”