title: Management of locally recurrent soft-tissue sarcoma after prior surgery and radiation therapy.
abstract: OBJECTIVE
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Division of Radiation Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, TX 77030, USA.
authors.forename: Mylin A
authors.initials: MA
authors.lastname: Torres
authors.forename: Matthew T
authors.initials: MT
authors.lastname: Ballo
authors.forename: Charles E
authors.initials: CE
authors.lastname: Butler
authors.forename: Barry W
authors.initials: BW
authors.lastname: Feig
authors.forename: Janice N
authors.initials: JN
authors.lastname: Cormier
authors.forename: Valerae O
authors.initials: VO
authors.lastname: Lewis
authors.forename: Raphael E
authors.initials: RE
authors.lastname: Pollock
authors.forename: Peter W
authors.initials: PW
authors.lastname: Pisters
authors.forename: Gunar K
authors.initials: GK
authors.lastname: Zagars
mesh_terms: D000368:Aged; D001918:Brachytherapy / Q000379:methods; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000532:radiotherapy* / Q000601:surgery; D019233:Retreatment; D012189:Retrospective Studies; D016879:Salvage Therapy / Q000379:methods*; D012509:Sarcoma / Q000401:mortality / Q000532:radiotherapy* / Q000601:surgery; D015996:Survival Rate