title: Does a radiation dose-response relation exist concerning survival of patients who have soft-tissue sarcomas of the extremities? Radiation dose-response relation for soft-tissue sarcomas.
abstract: This study analyzes a single-institution experience by evaluating the impact on survival of increasing total dose of adjunctive irradiation in patients who had extremity soft-tissue sarcoma (ESTS). A retrospective review of the tumor registry at a university medical center from January 1984 through December 1992 yielded a total of 59 surgical patients of ESTS. With follow-up ranging from 30 to 135 months (median, 65 months), the 2-, 5-, and 8-year overall and disease-free survival for all patients was 86%, 71%, 58% and 76%, 70%, 56%, respectively. Multivariate analyses using the Cox proportional hazards model revealed that total radiation dose (p = 0.02), American Joint Committee on Cancer stage (p = 0.04), and tumor size (p = 0.006) were all significant prognostic factors of overall survival; however, only tumor size was predictive of disease-free survival (p = 0.02). When the effect of tumor size and disease stage were controlled in the Cox model, a dose-response curve between increasing total radiation dose and improved overall patient survival was indicated. This study demonstrates the significance of tumor size on predicting both overall and disease-free survival in patients who have soft-tissue sarcomas of the extremity. It also suggests, however, that a radiation dose-response relation may exist for overall survival. Future investigations should consider evaluating the minimal total radiation dose needed to optimize patient survival after limb-sparing surgery.
authors.affiliation: Department of Radiation Oncology, Sylvester Comprehensive Cancer Center, Miami, Florida, USA.
authors.forename: A H
authors.initials: AH
authors.lastname: Wolfson
authors.forename: P W
authors.initials: PW
authors.lastname: Benedetto
authors.forename: W
authors.initials: W
authors.lastname: Mnaymneh
authors.forename: F L
authors.initials: FL
authors.lastname: Moffat
authors.forename: D S
authors.initials: DS
authors.lastname: Robinson
authors.forename: C
authors.initials: C
authors.lastname: Boyer
authors.forename: W A
authors.initials: WA
authors.lastname: Raub
authors.forename: R C
authors.initials: RC
authors.lastname: Duncan
authors.forename: A M
authors.initials: AM
authors.lastname: Markoe
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000671:Amputation, Surgical; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D004307:Dose-Response Relationship, Radiation; D005121:Extremities; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D012042:Registries; D012189:Retrospective Studies; D012509:Sarcoma / Q000188:drug therapy / Q000401:mortality / Q000532:radiotherapy* / Q000601:surgery; D016019:Survival Analysis