title: Long-term results following postoperative radiotherapy for soft tissue sarcomas of the extremity.
abstract: OBJECTIVE
  To review long-term outcomes following postoperative radiotherapy (RT) for extremity soft tissue sarcoma (STS) and identify variables affecting the therapeutic ratio.
  
  
  METHODS
  Between 1970 and 2008, 173 patients with localized extremity STS were treated with postoperative radiation. No patients received prior irradiation. Sixteen percent of tumors had recurred after initial surgery alone; 89% of tumors were high grade. The median patient age was 57 years (range, 18-86 years). Sixty-one percent underwent >1 surgery before RT in an attempt to achieve wide negative margins. Final margin status was negative in 70% and marginal or microscopically positive in 30%. The median time between final surgery and start of RT was 40 days. The median RT dose was 65 Gy (range, 49-74 Gy). The median follow-up for all patients was 10.4 years and 13.2 years among survivors.
  
  
  RESULTS
  At 10 years, local control (LC), cause-specific survival (CSS), and overall survival (OS) rates were 87%, 80%, and 70%, respectively, with 89% of local failures occurring within 3 years after treatment. On multivariate analysis, age >55 years (82% vs 93%, P<.05) and recurrent presentation (67% vs 91%, P<.05) were associated with inferior 10-year LC. The LC according to final margin status was 90% for wide negative margins vs 79% for marginal/microscopically positive margins (P=.08). Age>55 years and local recurrence were associated with inferior CSS and OS on multivariate analysis. Twelve percent of patients experienced grade 3+ toxicity; 12 of these occurred in patients with tumors of the proximal lower extremity, with the most common toxicity of pathologic fracture occurring in 6.3%.
  
  
  CONCLUSIONS
  This large single-institution series confirms that postoperative RT for STS of the extremities provides good long-term disease control with acceptable toxicity. Our experience supports recurrent presentation and older age as adverse prognostic factors for LC.
authors.affiliation: Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, Florida, USA.
authors.forename: Lisa
authors.initials: L
authors.lastname: McGee
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Indelicato
authors.forename: Roi
authors.initials: R
authors.lastname: Dagan
authors.forename: Christopher G
authors.initials: CG
authors.lastname: Morris
authors.forename: Jacquelyn A
authors.initials: JA
authors.lastname: Knapik
authors.forename: John D
authors.initials: JD
authors.lastname: Reith
authors.forename: Mark T
authors.initials: MT
authors.lastname: Scarborough
authors.forename: C Parker
authors.initials: CP
authors.lastname: Gibbs
authors.forename: Robert B
authors.initials: RB
authors.lastname: Marcus
authors.forename: Robert A
authors.initials: RA
authors.lastname: Zlotecki
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D005121:Extremities; D005431:Florida; D006801:Humans; D008175:Lung Neoplasms / Q000556:secondary; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000532:radiotherapy; D011184:Postoperative Period; D011379:Prognosis; D011832:Radiation Injuries / Q000150:complications; D012189:Retrospective Studies; D012509:Sarcoma / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D015996:Survival Rate; D014495:Universities; D055815:Young Adult