Management of locally recurrent soft-tissue sarcoma after prior surgery and radiation therapy

Mylin A. Torres, Matthew Ballo, Charles E. Butler, Barry W. Feig, Janice N. Cormier, Valerae O. Lewis, Raphael E. Pollock, Peter W. Pisters, Gunar K. Zagars

Research output: Contribution to journalArticle

44 Citations (Scopus)

Abstract

Purpose: The aim of this study was to evaluate outcome and treatment toxicity after wide local re-excision (WLE), with or without additional radiation therapy, for patients with isolated first local recurrence of soft-tissue sarcoma arising within a previously irradiated field. Methods: A retrospective review was performed of 62 consecutive patients. All patients underwent prior resection and external beam radiation. For recurrent disease, 25 patients were treated with WLE alone, and 37 patients were treated with WLE and additional radiation (45- 64 Gy). In 33 patients, the radiation was delivered via an afterloaded brachytherapy, single-plane implant. Results: The 5-year disease specific and distant metastasis-free survival rates were 65% and 73%, respectively. Local control (LC) at 5 years was 51%, and on multivariate analysis, a positive surgical resection margin (p< 0.001) was associated with a lower rate of LC. Reirradiation was not associated with improved LC; however complications requiring outpatient or surgical management were more common in patients who had undergone reirradiation (80% vs. 17%, p < 0.001). Amputation was also more common in the subgroup of patients who underwent extremity reirradiation (35% with radiation vs. 11% without, p = 0.05), although only one amputation was performed to resolve a treatment complication. Conclusion: Conservative surgery alone results in LC in a minority of patients who have failed locally after previous excision and external beam radiation. Although selection biases and small patient numbers confound the analysis, local treatment intensification with additional radiation does not clearly improve outcome after surgical excision alone, and is associated with an increase in complications.

Original languageEnglish (US)
Pages (from-to)1124-1129
Number of pages6
JournalInternational Journal of Radiation Oncology Biology Physics
Volume67
Issue number4
DOIs
StatePublished - Mar 15 2007
Externally publishedYes

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surgery
Sarcoma
radiation therapy
therapy
Radiotherapy
cancer
Radiation
radiation
Amputation
Selection Bias
Brachytherapy
metastasis
minorities
subgroups
toxicity
margins
Outpatients
Multivariate Analysis
Survival Rate
Extremities

All Science Journal Classification (ASJC) codes

  • Oncology
  • Radiology Nuclear Medicine and imaging
  • Radiation

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Management of locally recurrent soft-tissue sarcoma after prior surgery and radiation therapy. / Torres, Mylin A.; Ballo, Matthew; Butler, Charles E.; Feig, Barry W.; Cormier, Janice N.; Lewis, Valerae O.; Pollock, Raphael E.; Pisters, Peter W.; Zagars, Gunar K.

In: International Journal of Radiation Oncology Biology Physics, Vol. 67, No. 4, 15.03.2007, p. 1124-1129.

Research output: Contribution to journalArticle

Torres, MA, Ballo, M, Butler, CE, Feig, BW, Cormier, JN, Lewis, VO, Pollock, RE, Pisters, PW & Zagars, GK 2007, 'Management of locally recurrent soft-tissue sarcoma after prior surgery and radiation therapy', International Journal of Radiation Oncology Biology Physics, vol. 67, no. 4, pp. 1124-1129. https://doi.org/10.1016/j.ijrobp.2006.10.036
Torres, Mylin A. ; Ballo, Matthew ; Butler, Charles E. ; Feig, Barry W. ; Cormier, Janice N. ; Lewis, Valerae O. ; Pollock, Raphael E. ; Pisters, Peter W. ; Zagars, Gunar K. / Management of locally recurrent soft-tissue sarcoma after prior surgery and radiation therapy. In: International Journal of Radiation Oncology Biology Physics. 2007 ; Vol. 67, No. 4. pp. 1124-1129.
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AU - Torres, Mylin A.

AU - Ballo, Matthew

AU - Butler, Charles E.

AU - Feig, Barry W.

AU - Cormier, Janice N.

AU - Lewis, Valerae O.

AU - Pollock, Raphael E.

AU - Pisters, Peter W.

AU - Zagars, Gunar K.

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N2 - Purpose: The aim of this study was to evaluate outcome and treatment toxicity after wide local re-excision (WLE), with or without additional radiation therapy, for patients with isolated first local recurrence of soft-tissue sarcoma arising within a previously irradiated field. Methods: A retrospective review was performed of 62 consecutive patients. All patients underwent prior resection and external beam radiation. For recurrent disease, 25 patients were treated with WLE alone, and 37 patients were treated with WLE and additional radiation (45- 64 Gy). In 33 patients, the radiation was delivered via an afterloaded brachytherapy, single-plane implant. Results: The 5-year disease specific and distant metastasis-free survival rates were 65% and 73%, respectively. Local control (LC) at 5 years was 51%, and on multivariate analysis, a positive surgical resection margin (p< 0.001) was associated with a lower rate of LC. Reirradiation was not associated with improved LC; however complications requiring outpatient or surgical management were more common in patients who had undergone reirradiation (80% vs. 17%, p < 0.001). Amputation was also more common in the subgroup of patients who underwent extremity reirradiation (35% with radiation vs. 11% without, p = 0.05), although only one amputation was performed to resolve a treatment complication. Conclusion: Conservative surgery alone results in LC in a minority of patients who have failed locally after previous excision and external beam radiation. Although selection biases and small patient numbers confound the analysis, local treatment intensification with additional radiation does not clearly improve outcome after surgical excision alone, and is associated with an increase in complications.

AB - Purpose: The aim of this study was to evaluate outcome and treatment toxicity after wide local re-excision (WLE), with or without additional radiation therapy, for patients with isolated first local recurrence of soft-tissue sarcoma arising within a previously irradiated field. Methods: A retrospective review was performed of 62 consecutive patients. All patients underwent prior resection and external beam radiation. For recurrent disease, 25 patients were treated with WLE alone, and 37 patients were treated with WLE and additional radiation (45- 64 Gy). In 33 patients, the radiation was delivered via an afterloaded brachytherapy, single-plane implant. Results: The 5-year disease specific and distant metastasis-free survival rates were 65% and 73%, respectively. Local control (LC) at 5 years was 51%, and on multivariate analysis, a positive surgical resection margin (p< 0.001) was associated with a lower rate of LC. Reirradiation was not associated with improved LC; however complications requiring outpatient or surgical management were more common in patients who had undergone reirradiation (80% vs. 17%, p < 0.001). Amputation was also more common in the subgroup of patients who underwent extremity reirradiation (35% with radiation vs. 11% without, p = 0.05), although only one amputation was performed to resolve a treatment complication. Conclusion: Conservative surgery alone results in LC in a minority of patients who have failed locally after previous excision and external beam radiation. Although selection biases and small patient numbers confound the analysis, local treatment intensification with additional radiation does not clearly improve outcome after surgical excision alone, and is associated with an increase in complications.

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