title: Impact of postoperative radiation on survival for high-grade soft tissue sarcoma of the extremities after limb sparing radical resection.
abstract: OBJECTIVE
  To use the Surveillance, Epidemiology, and End Results (SEER) Database to analyze the impact of postoperative radiation after limb sparing surgery for high-grade extremity soft tissue sarcomas (STS).
  
  
  METHODS
  We identified patients, aged 20 to 79, who were diagnosed between 1988 and 2006 with high-grade STS of the extremities and underwent radical limb sparing surgery with or without postoperative external beam radiation. Kaplan-Meier and Cox regression analyses were performed to evaluate the effect of postoperative external beam radiation therapy on overall survival (OS) and disease-specific survival (DSS).
  
  
  RESULTS
  A total of 983 patients met the selection criteria: 788 (80.2%) received postoperative radiation and 195 (19.8%) underwent surgery alone. For the whole cohort, there were no differences between the groups in OS (P=0.06) or DSS (P=0.20). On subgroup analysis, for tumors ≤5 cm there remained no significant differences in OS (P=0.8) or DSS (P=0.93). However, for tumors >5 cm the 3-year OS improved with the addition of postoperative radiation from 55.6% to 73.4% (P<0.001). Similarly, the 3-year DSS improved from 68.1% to 80.6% (P=0.005).
  
  
  CONCLUSIONS
  Because of the retrospective nature of this study and inherent limitations of the SEER database, a large prospective study is needed to further elucidate the relationship between postoperative radiation and survival. However, these data do support the use of adjuvant radiation for patients with high-grade extremity STS measuring >5 cm.
authors.affiliation: Department of Radiation Oncology, State University of New York Downstate Medical Center, Brooklyn Campus, NY 11209, USA. david.schreiber@downstate.edu
authors.forename: David
authors.initials: D
authors.lastname: Schreiber
authors.forename: Justin
authors.initials: J
authors.lastname: Rineer
authors.forename: Evangelia
authors.initials: E
authors.lastname: Katsoulakis
authors.forename: Rameses L
authors.initials: RL
authors.lastname: Sroufe
authors.forename: Christopher S
authors.initials: CS
authors.lastname: Lange
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Nwokedi
authors.forename: David
authors.initials: D
authors.lastname: Schwartz
authors.forename: Kwang
authors.initials: K
authors.lastname: Choi
authors.forename: Marvin
authors.initials: M
authors.lastname: Rotman
mesh_terms: D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D018572:Disease-Free Survival; D005121:Extremities / Q000473:pathology / Q000601:surgery; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D011184:Postoperative Period; D016016:Proportional Hazards Models; D018714:Radiotherapy, Adjuvant; D012189:Retrospective Studies; D018426:SEER Program; D012509:Sarcoma / Q000401:mortality* / Q000532:radiotherapy* / Q000601:surgery; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology