title: Improved survival with radiation therapy in high-grade soft tissue sarcomas of the extremities: a SEER analysis.
abstract: 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.
authors.affiliation: Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, MD 21201, USA. mkoshy@umm.edu
authors.forename: Matthew
authors.initials: M
authors.lastname: Koshy
authors.forename: Shayna E
authors.initials: SE
authors.lastname: Rich
authors.forename: Majid M
authors.initials: MM
authors.lastname: Mohiuddin
mesh_terms: 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
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