title: Radiotherapy for spermatic cord sarcoma.
abstract: OBJECTIVE
  Spermatic cord sarcomas are rare paratesticular tumors affecting older men. Current management is based on small series, case reports, and literature reviews, with surgery still the mainstay of treatment. Local-regional recurrence is common after definitive surgery (~50%), but patients treated with adjuvant radiotherapy may have improved outcomes.
  
  
  METHODS
  We reviewed the outcomes of 15 patients with intermediate-grade to high-grade spermatic cord sarcomas treated with radiation at our institution from 1974 to 2009. Patients were treated to 40 to 60 Gy using conformal opposed anterior-posterior/posterior-anterior ports to the scrotum, inguinal canal, and lower pelvic wall with various beam energies. Some patients were managed with surgical exploration and resection, followed by radiotherapy and/or definitive surgery. More recently treated patients had an initial biopsy, followed by preoperative radiation or planned resection with postoperative radiation therapy.
  
  
  RESULTS
  No patient experienced a local recurrence. Two patients had regional nodal recurrences and 1 had distant metastases. All recurrences were in patients who had initial "exploration" with unexpected findings of sarcoma during surgery versus planned, definitive resection with planned adjuvant radiotherapy. At 5 years, overall survival was 53%, but cause-specific survival was 80%. Complications were minimal, with only 4 grade 2 or 3 toxicities and no grade 4 toxicities.
  
  
  CONCLUSIONS
  Although most patients die from causes other than disease progression, this sarcoma carries grave morbidity. Optimizing the primary management is of utmost importance. Unplanned treatments complicate definitive therapy and increase the risk of local-regional contamination and recurrence. Proactive management is therefore consistent with sarcomas of other primary sites, ideally with preoperative radiotherapy and definitive resection.
authors: Departments of Radiation Oncology, University of Florida College of Medicine, Gainesville, FL, USA.
authors: Ronica
authors: R
authors: Hazariwala
authors: Christopher G
authors: CG
authors: Morris
authors: Scott
authors: S
authors: Gilbert
authors: Chester
authors: C
authors: Algood
authors: Robert A
authors: RA
authors: Zlotecki
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D015331:Cohort Studies; D018572:Disease-Free Survival; D005500:Follow-Up Studies; D005834:Genital Neoplasms, Male / Q000401:mortality* / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness / Q000473:pathology; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000473:pathology*; D009367:Neoplasm Staging; D011879:Radiotherapy Dosage; D018714:Radiotherapy, Adjuvant; D035583:Rare Diseases; D012189:Retrospective Studies; D018570:Risk Assessment; D012509:Sarcoma / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D013085:Spermatic Cord / Q000473:pathology* / Q000528:radiation effects; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult