Sequencing radiotherapy for soft tissue sarcoma when re-resection is planned

Gunar K. Zagars, Matthew Ballo

Research output: Contribution to journalArticle

18 Citations (Scopus)

Abstract

Purpose: To evaluate whether disease outcome for localized soft-tissue sarcoma (STS) excised before referral to a specialist center and there re-resected was influenced by the timing of radiation therapy (XRT) - before or after re-resection. Methods and Materials: Two hundred ninety-five consecutive patients with localized grossly excised STS were retrospectively evaluated for local control, freedom from metastasis, disease-free survival, and disease-specific survival, according to whether they had XRT before (121) or after (174) re-resection of their tumor bed. Univariate and multivariate statistical techniques were employed. Results: At re-resection, residual STS was found in 159 patients (54%), including gross tumor in 73 (25%). The incidence of residual disease was lower in those receiving preoperative XRT (median dose 50 Gy) (36%) than in those having postoperative RT (median dose 60 Gy) (54%) (p = 0.024). With a median follow-up of 9.1 years, the local control rates for all patients at 5, 10, and 15 years were 86%, 84%, and 81%, respectively, and there were no differences between the two XRT sequences. In multivariate regression, there was no evidence that XRT sequence influenced local control, metastatic control, disease-free survival, or disease-specific survival. There was a trend toward fewer XRT-related late complications with preoperative XRT, but this was not significant, and the incidence of complications was low (5% at 15 years). Conclusions: Patients who present after total but oncologically inadequate excision of STS can receive approximately 50 Gy before re-resection or approximately 60 Gy after re-resection, with approximately equivalent, satisfactory local control and overall disease outcome. Decisions as to the most appropriate treatment sequence for any individual patient can be made regardless of considerations as to the effectiveness of one sequence compared with the other.

Original languageEnglish (US)
Pages (from-to)21-27
Number of pages7
JournalInternational Journal of Radiation Oncology Biology Physics
Volume56
Issue number1
DOIs
StatePublished - May 1 2003

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sequencing
Sarcoma
radiation therapy
Radiotherapy
cancer
Disease-Free Survival
Survival
tumors
Incidence
incidence
dosage
Neoplasms
Referral and Consultation
metastasis
Neoplasm Metastasis
beds
regression analysis
time measurement
trends

All Science Journal Classification (ASJC) codes

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

Cite this

Sequencing radiotherapy for soft tissue sarcoma when re-resection is planned. / Zagars, Gunar K.; Ballo, Matthew.

In: International Journal of Radiation Oncology Biology Physics, Vol. 56, No. 1, 01.05.2003, p. 21-27.

Research output: Contribution to journalArticle

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abstract = "Purpose: To evaluate whether disease outcome for localized soft-tissue sarcoma (STS) excised before referral to a specialist center and there re-resected was influenced by the timing of radiation therapy (XRT) - before or after re-resection. Methods and Materials: Two hundred ninety-five consecutive patients with localized grossly excised STS were retrospectively evaluated for local control, freedom from metastasis, disease-free survival, and disease-specific survival, according to whether they had XRT before (121) or after (174) re-resection of their tumor bed. Univariate and multivariate statistical techniques were employed. Results: At re-resection, residual STS was found in 159 patients (54{\%}), including gross tumor in 73 (25{\%}). The incidence of residual disease was lower in those receiving preoperative XRT (median dose 50 Gy) (36{\%}) than in those having postoperative RT (median dose 60 Gy) (54{\%}) (p = 0.024). With a median follow-up of 9.1 years, the local control rates for all patients at 5, 10, and 15 years were 86{\%}, 84{\%}, and 81{\%}, respectively, and there were no differences between the two XRT sequences. In multivariate regression, there was no evidence that XRT sequence influenced local control, metastatic control, disease-free survival, or disease-specific survival. There was a trend toward fewer XRT-related late complications with preoperative XRT, but this was not significant, and the incidence of complications was low (5{\%} at 15 years). Conclusions: Patients who present after total but oncologically inadequate excision of STS can receive approximately 50 Gy before re-resection or approximately 60 Gy after re-resection, with approximately equivalent, satisfactory local control and overall disease outcome. Decisions as to the most appropriate treatment sequence for any individual patient can be made regardless of considerations as to the effectiveness of one sequence compared with the other.",
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