title: Positive surgical margins in soft tissue sarcoma treated with preoperative radiation: is a postoperative boost necessary?
abstract: OBJECTIVE
  For patients with an extremity soft tissue sarcoma (STS) treated with preoperative radiotherapy and surgically excised with positive margins, we retrospectively reviewed whether a postoperative radiation boost reduced the risk of local recurrence (LR).
  
  
  METHODS
  A total of 216 patients with positive margins after resection of an extremity STS treated between 1986 and 2003 were identified from our institution's prospectively collected database. Patient demographics, radiation therapy parameters including timing and dose, classification of positive margin status, reasons for not administering a postoperative boost, and oncologic outcome were collected and evaluated.
  
  
  RESULTS
  Of the 216 patients with a positive surgical margin, 52 patients were treated with preoperative radiation therapy alone (50 Gy), whereas 41 received preoperative radiation therapy plus a postoperative boost (80% received 16 Gy postoperatively for a total of 66 Gy). There was no difference in baseline tumor characteristics between the two groups. Six of 52 patients in the group receiving preoperative radiation alone developed a LR compared with 9 of 41 in the boost group. Five-year estimated LR-free survivals were 90.4% and 73.8%, respectively (p = 0.13).
  
  
  CONCLUSIONS
  We found that including the postoperative radiation boost after preoperative radiation and a margin-positive excision did not provide an advantage in preventing LR for patients treated with external beam radiotherapy. Given that higher radiation doses placed patients at greater risk for late complications such as fracture, fibrosis, edema, and joint stiffness, judicious avoidance of the postoperative boost while maintaining an equivalent rate of local control can reduce the risk of these difficult-to-treat morbidities.
authors.affiliation: Orthopaedic Surgery, University Musculoskeletal Oncology Unit, Mount Sinai Hospital, Toronto, ON, Canada.
authors.forename: Ali
authors.initials: A
authors.lastname: Al Yami
authors.forename: Anthony M
authors.initials: AM
authors.lastname: Griffin
authors.forename: Peter C
authors.initials: PC
authors.lastname: Ferguson
authors.forename: Charles N
authors.initials: CN
authors.lastname: Catton
authors.forename: Peter W M
authors.initials: PW
authors.lastname: Chung
authors.forename: Robert S
authors.initials: RS
authors.lastname: Bell
authors.forename: Jay S
authors.initials: JS
authors.lastname: Wunder
authors.forename: Brian
authors.initials: B
authors.lastname: O'Sullivan
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000671:Amputation, Surgical; D005260:Female; D018219:Histiocytoma, Benign Fibrous / Q000473:pathology / Q000517:prevention & control / Q000532:radiotherapy / Q000601:surgery; D006801:Humans; D007890:Leiomyosarcoma / Q000473:pathology / Q000517:prevention & control / Q000532:radiotherapy / Q000601:surgery; D023821:Limb Salvage; D008080:Liposarcoma / Q000473:pathology / Q000517:prevention & control / Q000532:radiotherapy / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000517:prevention & control; D018365:Neoplasm, Residual; D011182:Postoperative Care; D011879:Radiotherapy Dosage; D019233:Retreatment; D012509:Sarcoma / Q000473:pathology / Q000517:prevention & control / Q000532:radiotherapy* / Q000601:surgery; D055815:Young Adult