Prognostic factors for disease-specific survival after first relapse of soft-tissue sarcoma: Analysis of 402 patients with disease relapse after initial conservative surgery and radiotherapy

Gunar K. Zagars, Matthew Ballo, Peter W.T. Pisters, Raphael E. Pollock, Shreyaskumar R. Patel, Robert S. Benjamin

Research output: Contribution to journalArticle

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Abstract

Purpose: To document the prognostic factors for survival of patients with soft-tissue sarcoma sustaining a first relapse after definitive treatment. Methods and Materials: The clinicopathologic features, relapse patterns, and disease-specific survival rates for 402 consecutive patients sustaining a first relapse of sarcoma after combined surgery and radiotherapy were retrospectively reviewed. Factors affecting disease-specific survival after relapse were evaluated with univariate and multivariate techniques. Results: The median follow-up after relapse was 6.8 years. The overall disease-specific survival rate was 25%, 19%, and 16% at 5, 10, and 15 years, respectively, after the first relapse. The median survival duration was 21 months. Patients with an isolated local recurrence had a 5- and 10-year disease-specific survival rate of 48% and 46%, respectively, and those with an initial metastatic relapse had a disease-specific survival rate of 16% and 10%, respectively (p < 0.001). For isolated local recurrences, the independent determinants of survival were (favorable feature first) the primary tumor site (extremity and superficial trunk vs. head and neck and deep trunk); tumor grade (low and intermediate vs. high); time to recurrence (>12 vs. ≤12 months); and initial tumor size (≤5 vs. >5 cm). Although the development of subsequent metastasis was the major cause of death, a significant fraction of patients died of uncontrolled primary tumor. For patients presenting with metastasis as the first relapse, the time to metastasis was the major determinant of survival (>12 vs. ≤12 months). Long-term salvage was largely confined to patients who could and did undergo resection of relapsed disease, either local or metastatic. Conclusion: On the whole, patients whose sarcoma relapses fare poorly. However, select subgroups are potentially salvageable. Patients with an isolated local recurrence at sites other than the head and neck and deep trunk have a reasonable prospect for satisfactory outcome. Surgical resection of recurrences and metastases appears to play a major role in potential salvage.

Original languageEnglish (US)
Pages (from-to)739-747
Number of pages9
JournalInternational Journal of Radiation Oncology Biology Physics
Volume57
Issue number3
DOIs
StatePublished - Nov 1 2003
Externally publishedYes

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surgery
Sarcoma
radiation therapy
Radiotherapy
cancer
Recurrence
Survival
metastasis
sustaining
Survival Rate
Neoplasm Metastasis
tumors
subgroups
death
determinants
causes
Cause of Death
Neoplasms
Neck
Head

All Science Journal Classification (ASJC) codes

  • Radiation
  • Oncology
  • Radiology Nuclear Medicine and imaging
  • Cancer Research

Cite this

Prognostic factors for disease-specific survival after first relapse of soft-tissue sarcoma : Analysis of 402 patients with disease relapse after initial conservative surgery and radiotherapy. / Zagars, Gunar K.; Ballo, Matthew; Pisters, Peter W.T.; Pollock, Raphael E.; Patel, Shreyaskumar R.; Benjamin, Robert S.

In: International Journal of Radiation Oncology Biology Physics, Vol. 57, No. 3, 01.11.2003, p. 739-747.

Research output: Contribution to journalArticle

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abstract = "Purpose: To document the prognostic factors for survival of patients with soft-tissue sarcoma sustaining a first relapse after definitive treatment. Methods and Materials: The clinicopathologic features, relapse patterns, and disease-specific survival rates for 402 consecutive patients sustaining a first relapse of sarcoma after combined surgery and radiotherapy were retrospectively reviewed. Factors affecting disease-specific survival after relapse were evaluated with univariate and multivariate techniques. Results: The median follow-up after relapse was 6.8 years. The overall disease-specific survival rate was 25{\%}, 19{\%}, and 16{\%} at 5, 10, and 15 years, respectively, after the first relapse. The median survival duration was 21 months. Patients with an isolated local recurrence had a 5- and 10-year disease-specific survival rate of 48{\%} and 46{\%}, respectively, and those with an initial metastatic relapse had a disease-specific survival rate of 16{\%} and 10{\%}, respectively (p < 0.001). For isolated local recurrences, the independent determinants of survival were (favorable feature first) the primary tumor site (extremity and superficial trunk vs. head and neck and deep trunk); tumor grade (low and intermediate vs. high); time to recurrence (>12 vs. ≤12 months); and initial tumor size (≤5 vs. >5 cm). Although the development of subsequent metastasis was the major cause of death, a significant fraction of patients died of uncontrolled primary tumor. For patients presenting with metastasis as the first relapse, the time to metastasis was the major determinant of survival (>12 vs. ≤12 months). Long-term salvage was largely confined to patients who could and did undergo resection of relapsed disease, either local or metastatic. Conclusion: On the whole, patients whose sarcoma relapses fare poorly. However, select subgroups are potentially salvageable. Patients with an isolated local recurrence at sites other than the head and neck and deep trunk have a reasonable prospect for satisfactory outcome. Surgical resection of recurrences and metastases appears to play a major role in potential salvage.",
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T1 - Prognostic factors for disease-specific survival after first relapse of soft-tissue sarcoma

T2 - Analysis of 402 patients with disease relapse after initial conservative surgery and radiotherapy

AU - Zagars, Gunar K.

AU - Ballo, Matthew

AU - Pisters, Peter W.T.

AU - Pollock, Raphael E.

AU - Patel, Shreyaskumar R.

AU - Benjamin, Robert S.

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N2 - Purpose: To document the prognostic factors for survival of patients with soft-tissue sarcoma sustaining a first relapse after definitive treatment. Methods and Materials: The clinicopathologic features, relapse patterns, and disease-specific survival rates for 402 consecutive patients sustaining a first relapse of sarcoma after combined surgery and radiotherapy were retrospectively reviewed. Factors affecting disease-specific survival after relapse were evaluated with univariate and multivariate techniques. Results: The median follow-up after relapse was 6.8 years. The overall disease-specific survival rate was 25%, 19%, and 16% at 5, 10, and 15 years, respectively, after the first relapse. The median survival duration was 21 months. Patients with an isolated local recurrence had a 5- and 10-year disease-specific survival rate of 48% and 46%, respectively, and those with an initial metastatic relapse had a disease-specific survival rate of 16% and 10%, respectively (p < 0.001). For isolated local recurrences, the independent determinants of survival were (favorable feature first) the primary tumor site (extremity and superficial trunk vs. head and neck and deep trunk); tumor grade (low and intermediate vs. high); time to recurrence (>12 vs. ≤12 months); and initial tumor size (≤5 vs. >5 cm). Although the development of subsequent metastasis was the major cause of death, a significant fraction of patients died of uncontrolled primary tumor. For patients presenting with metastasis as the first relapse, the time to metastasis was the major determinant of survival (>12 vs. ≤12 months). Long-term salvage was largely confined to patients who could and did undergo resection of relapsed disease, either local or metastatic. Conclusion: On the whole, patients whose sarcoma relapses fare poorly. However, select subgroups are potentially salvageable. Patients with an isolated local recurrence at sites other than the head and neck and deep trunk have a reasonable prospect for satisfactory outcome. Surgical resection of recurrences and metastases appears to play a major role in potential salvage.

AB - Purpose: To document the prognostic factors for survival of patients with soft-tissue sarcoma sustaining a first relapse after definitive treatment. Methods and Materials: The clinicopathologic features, relapse patterns, and disease-specific survival rates for 402 consecutive patients sustaining a first relapse of sarcoma after combined surgery and radiotherapy were retrospectively reviewed. Factors affecting disease-specific survival after relapse were evaluated with univariate and multivariate techniques. Results: The median follow-up after relapse was 6.8 years. The overall disease-specific survival rate was 25%, 19%, and 16% at 5, 10, and 15 years, respectively, after the first relapse. The median survival duration was 21 months. Patients with an isolated local recurrence had a 5- and 10-year disease-specific survival rate of 48% and 46%, respectively, and those with an initial metastatic relapse had a disease-specific survival rate of 16% and 10%, respectively (p < 0.001). For isolated local recurrences, the independent determinants of survival were (favorable feature first) the primary tumor site (extremity and superficial trunk vs. head and neck and deep trunk); tumor grade (low and intermediate vs. high); time to recurrence (>12 vs. ≤12 months); and initial tumor size (≤5 vs. >5 cm). Although the development of subsequent metastasis was the major cause of death, a significant fraction of patients died of uncontrolled primary tumor. For patients presenting with metastasis as the first relapse, the time to metastasis was the major determinant of survival (>12 vs. ≤12 months). Long-term salvage was largely confined to patients who could and did undergo resection of relapsed disease, either local or metastatic. Conclusion: On the whole, patients whose sarcoma relapses fare poorly. However, select subgroups are potentially salvageable. Patients with an isolated local recurrence at sites other than the head and neck and deep trunk have a reasonable prospect for satisfactory outcome. Surgical resection of recurrences and metastases appears to play a major role in potential salvage.

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