title: Treatment and outcome of radiation-induced soft-tissue sarcomas at a specialist institution.
abstract: BACKGROUND
  Radiation-induced sarcoma (RIS) is a rare late complication of therapeutic irradiation with a reputation for aggressive pathology and poor outcome.
  
  
  METHODS
  We retrospectively reviewed histopathological features, surgery and outcome in 67 patients with RIS treated between 1990 and 2005 at a single tertiary referral center.
  
  
  RESULTS
  Previous breast cancer was the most common indication for radiotherapy. The median interval from irradiation to development of RIS of was 11 years (3-36 years). Median tumour size was 7 cm with 56% classified as high grade, 31% intermediate grade and 13% low grade. The commonest histology was leiomyosarcoma. The only relationship for histology with site was for angiosarcoma (n=9), all of which developed on the chest wall/breast after irradiation for breast cancer. Of 67 patients, 34 underwent potentially curative surgery, and microscopically clear margins were achieved in 75% of cases. Pedicled or free tissue transfer was required in 12 patients and abdominal or chest wall mesh reconstructions were required in 8 patients. No patient received adjuvant radiotherapy but 7 received adjuvant/neoadjuvant chemotherapy. Median follow up is 53 months. Median sarcoma specific survival was 54 months (2- & 5-year survival: 75% & 45%). The local relapse rate was 65%. Negative histopathological margins were a significant predictor of sarcoma specific survival (HR 3.0 95% CI 1.1-8.6 p=0.04). Grade and size of tumour approached, but did not attain significance.
  
  
  CONCLUSIONS
  RIS is a biologically aggressive tumour with high rates of local relapse despite aggressive attempts at curative surgery.
authors.affiliation: Sarcoma and Melanoma Unit, Department of Academic Surgery, Royal Marsden Hospital, Chelsea, London, UK.
authors.forename: S J
authors.initials: SJ
authors.lastname: Neuhaus
authors.forename: N
authors.initials: N
authors.lastname: Pinnock
authors.forename: V
authors.initials: V
authors.lastname: Giblin
authors.forename: C
authors.initials: C
authors.lastname: Fisher
authors.forename: K
authors.initials: K
authors.lastname: Thway
authors.forename: J M
authors.initials: JM
authors.lastname: Thomas
authors.forename: A J
authors.initials: AJ
authors.lastname: Hayes
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003131:Combined Modality Therapy; D006801:Humans; D008875:Middle Aged; D009381:Neoplasms, Radiation-Induced / Q000628:therapy*; D012189:Retrospective Studies; D012509:Sarcoma / Q000628:therapy*; D016896:Treatment Outcome