Improved survival with radiation therapy in high-grade soft tissue sarcomas of the extremities: a SEER analysis.
OBJECTIVE
The benefit of radiation therapy in extremity soft tissue sarcomas remains controversial. The purpose of this study was to determine the effect of radiation therapy on overall survival among patients with primary soft tissue sarcomas of the extremity who underwent limb-sparing surgery.


METHODS
A retrospective study from the Surveillance, Epidemiology, and End Results (SEER) database that included data from January 1, 1988, to December 31, 2005. A total of 6,960 patients constituted the study population. Overall survival curves were constructed using the Kaplan-Meir method and for patients with low- and high-grade tumors. Hazard ratios were calculated based on multivariable Cox proportional hazards models.


RESULTS
Of the cohort, 47% received radiation therapy. There was no significant difference in overall survival among patients with low-grade tumors by radiation therapy. In high-grade tumors, the 3-year overall survival was 73% in patients who received radiation therapy vs. 63% for those who did not receive radiation therapy (p < 0.001). On multivariate analysis, patients with high-grade tumors who received radiation therapy had an improved overall survival (hazard ratio 0.67, 95% confidence interval 0.57-0.79). In patients receiving radiation therapy, 13.5% received it in a neoadjuvant setting. The incidence of patients receiving neoadjuvant radiation did not change significantly between 1988 and 2005.


CONCLUSIONS
To our knowledge, this is the largest population-based study reported in patients undergoing limb-sparing surgery for soft tissue sarcomas of the extremities. It reports that radiation was associated with improved survival in patients with high-grade tumors.
Koshy
Matthew
M
Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, MD 21201, USA. mkoshy@umm.edu
Rich
Shayna E
SE
Mohiuddin
Majid M
MM
D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D005121:Extremities / Q000473:pathology / Q000601:surgery; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy / Q000379:methods; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018426:SEER Program; D012509:Sarcoma / Q000401:mortality* / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D012983:Soft Tissue Neoplasms / Q000401:mortality* / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D047368:Tumor Burden; D014481:United States; D055815:Young Adult
Br J Cancer. 1995 Aug;72(2):469-75
7640234
Aust N Z J Surg. 1999 May;69(5):336-43
10353547
Radiother Oncol. 2008 Sep;88(3):382-7
18584905
Int J Radiat Oncol Biol Phys. 1986 Apr;12(4):579-86
3009369
J Clin Oncol. 1998 Jan;16(1):197-203
9440743
Cancer. 1982 Sep 15;50(6):1076-83
7104949
Eur J Cancer. 1998 Dec;34(14 Spec No):2212-7
10070289
Cancer. 1981 May 15;47(10):2391-7
7272893
Int J Radiat Oncol Biol Phys. 2008 Jul 15;71(4):1196-203
18207661
J Clin Oncol. 2001 Mar 1;19(5):1238-47
11230464
J Clin Oncol. 1996 Mar;14(3):859-68
8622034
Lancet. 2002 Jun 29;359(9325):2235-41
12103287
Int J Radiat Oncol Biol Phys. 1995 Jul 15;32(4):969-76
7607971
CA Cancer J Clin. 2007 Jan-Feb;57(1):43-66
17237035
Acta Orthop Scand Suppl. 2001 Feb;72(300):1-31
11381580
Lancet. 2005 Dec 17;366(9503):2087-106
16360786
Ann Surg. 1982 Sep;196(3):305-15
7114936
Cochrane Database Syst Rev. 2000;(2):CD001419
10796873
Sarcoma. 2002;6(1):5-18
18521341
Radiother Oncol. 2005 Apr;75(1):48-53
15948265