Role of radiation therapy in the conservative management of sarcoma within an irradiated field.
OBJECTIVE
To report on clinical outcome and toxicity profile after combined treatment that included radiation therapy (RT) in patients with localized sarcoma within an irradiated field.


METHODS
Individual clinical data from all consecutive patients diagnosed and treated for a localized SIF between January 2000 and October 2011 at the Institut Claudius Regaud, Toulouse, France, were retrospectively reviewed. Outcomes of patients with SIF who underwent adjuvant or definitive radiotherapy were compared with patients who did not receive further RT.


RESULTS
Of the 27 patients eligible for this study: surgery alone (S), surgery followed by RT (S + RT) or definitive RT (RT) was performed in 16, 8 and 2 cases respectively. The rate of unresectable, gross or microscopically positive margin disease among the 10 re-irradiated patients was significantly higher than the non re-irradiated group (90% vs. 12% p < 0.001). After a median follow-up of 3.8 years, there was a trend toward longer survival and better local control in the subgroup of patients who received adjuvant or definitive RT compared to the rest of the cohort with an acceptable toxicity profile. The 4-year relapse free survival rates of patients treated with and without RT were 53% and 27% respectively (p = 0.09).


CONCLUSIONS
SIF complete surgical resection is often difficult to achieve, enhancing the risk of relapse. RT should be discussed in case of unresectable tumor or after suboptimal surgery as part of intensified local management that has a curative intent.
Institut Claudius Regaud, Department of Radiation Oncology, 20-24, rue du Pont Saint-Pierre, 31000 Toulouse, France. Electronic address: modesto.anouchka@claudiusregaud.fr.
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Modesto
Institut Claudius Regaud, Department of Biostatistics, 20-24, rue du Pont Saint-Pierre, 31000 Toulouse, France.
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Filleron
Institut Claudius Regaud, Department of Medical Oncology, 20-24, rue du Pont Saint-Pierre, 31000 Toulouse, France.
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Chevreau
Institut Gustave Roussy, Department of Radiation Oncology, 114 rue Édouard-Vaillant, 94805 Villejuif, France.
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Le Pechoux
Institut Claudius Regaud, Department of Pathology, 20-24, rue du Pont Saint-Pierre, 31000 Toulouse, France.
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Rochaix
Institut Claudius Regaud, Department of Pathology, 20-24, rue du Pont Saint-Pierre, 31000 Toulouse, France.
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Le Guellec
Institut Claudius Regaud, Department of Radiation Oncology, 20-24, rue du Pont Saint-Pierre, 31000 Toulouse, France.
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Ducassou
Institut Claudius Regaud, Department of Surgery, 20-24, rue du Pont Saint-Pierre, 31000 Toulouse, France.
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Gangloff
Institut Claudius Regaud, Department of Surgery, 20-24, rue du Pont Saint-Pierre, 31000 Toulouse, France.
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Ferron
Institut Claudius Regaud, Department of Radiation Oncology, 20-24, rue du Pont Saint-Pierre, 31000 Toulouse, France.
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Delannes
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001943:Breast Neoplasms / Q000188:drug therapy / Q000532:radiotherapy* / Q000601:surgery; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D005260:Female; D006258:Head and Neck Neoplasms / Q000188:drug therapy / Q000532:radiotherapy* / Q000601:surgery; D006394:Hemangiosarcoma / Q000188:drug therapy / Q000532:radiotherapy / Q000601:surgery; D006801:Humans; D007890:Leiomyosarcoma / Q000188:drug therapy / Q000532:radiotherapy / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009381:Neoplasms, Radiation-Induced / Q000188:drug therapy / Q000532:radiotherapy* / Q000601:surgery; D010386:Pelvic Neoplasms / Q000188:drug therapy / Q000532:radiotherapy* / Q000601:surgery; D018714:Radiotherapy, Adjuvant; D012189:Retrospective Studies; D012208:Rhabdomyosarcoma / Q000188:drug therapy / Q000532:radiotherapy / Q000601:surgery; D012509:Sarcoma / Q000188:drug therapy / Q000532:radiotherapy* / Q000601:surgery; D016896:Treatment Outcome; D055815:Young Adult
Functional outcome; Radiation therapy; Radio-induced sarcoma; Reirradiation; Sarcoma