title: Prognostic factors in adult soft tissue sarcoma treated with surgery combined with radiotherapy: a retrospective single-center study on 164 patients.
abstract: The aim of the present study is to assess the disease profile, outcome and prognostic factors in patients treated with surgery combined with radiotherapy (RT), with or without chemotherapy (CXT), for soft-tissue sarcoma (STS) in a multidisciplinary setting. One hundred and sixty-four patients with STS treated between 1980 and 2010 at the Centre Hospitalier Universitaire Vaudois were enrolled in this retrospective study. Seventy-six percent of patients underwent postoperative RT with (24%), or without (52%) CXT, 15% preoperative RT with (5%), or without (10%) CXT, surgery alone (7%), or RT alone (2%) with or without CXT. The median follow-up was 60 months (range 6-292). Local failure was observed in 18%, and distant failure in 21% of the patients. Overall survival (OS), diseasefree survival (DFS), local control (LC) and distant metastases-free survival (DMFS) were 88%, 68%, 83%, and 79% at 5 years, and 80%, 56%, 76%, and 69% at 10 years, respectively. In univariate analyses, favorable prognostic factors for OS, DFS, and DMFS were tumor size 6 cm or less, World Health Organization (WHO)/Zubrod score 0, and stage 2 or less. Age and superficial tumors were favorable only for OS and DMFS respectively. STS involving the extremities had a better outcome regarding DFS and LC. Histological grade 2 or less was favorable for DFS, DMFS, and LC. Radical surgery was associated with better LC and DMFS. RT dose more than 60 Gy was favorable for OS, DFS, and LC. In multivariate analyses, independent factors were age for OS; tumor size for OS, DFS and DMFS; WHO/Zubrod score for OS, DFS and LC; hemoglobin level for DFS; site for DFS and LC; tumor depth for DMFS; histological grade for DFS and LC; surgical procedure for LC and DMFS; and RT dose for OS. This study confirms that in a multidisciplinary setting, STS have a fairly good prognosis. A number of prognostic and predictive factors, including the role of surgery combined with RT, were identified. Regarding RT, a dose of more than 60 Gy was associated with a better outcome, at the price of a higher toxicity. We could not demonstrate a superiority of preoperative RT over postoperative RT.
authors.affiliation: Departments of Radiation Oncology, Vaud University Hospital Center , Lausanne, Switzerland.
authors.forename: Ling
authors.initials: L
authors.lastname: Cai
authors.affiliation: Departments of Radiation Oncology, Vaud University Hospital Center , Lausanne, Switzerland.
authors.forename: René-Olivier
authors.initials: RO
authors.lastname: Mirimanoff
authors.affiliation: Departments of Orthopedic Surgery, Vaud University Hospital Center , Lausanne, Switzerland.
authors.forename: Elyazid
authors.initials: E
authors.lastname: Mouhsine
authors.affiliation: Departments of Pathology, Vaud University Hospital Center , Lausanne, Switzerland.
authors.forename: Louis
authors.initials: L
authors.lastname: Guillou
authors.affiliation: Departments of Orthopedic Surgery, Vaud University Hospital Center , Lausanne, Switzerland.
authors.forename: Pierre-Francois
authors.initials: PF
authors.lastname: Leyvraz
authors.affiliation: Departments of Medical Oncology, Vaud University Hospital Center , Lausanne, Switzerland.
authors.forename: Serge
authors.initials: S
authors.lastname: Leyvraz
authors.affiliation: Departments of Medical Oncology, Vaud University Hospital Center , Lausanne, Switzerland.
authors.forename: Beatrice
authors.initials: B
authors.lastname: Gay
authors.affiliation: Departments of Radiation Oncology, Vaud University Hospital Center , Lausanne, Switzerland.
authors.forename: Oscar
authors.initials: O
authors.lastname: Matzinger
authors.affiliation: Departments of Radiation Oncology, Vaud University Hospital Center , Lausanne, Switzerland.
authors.forename: Mahmut
authors.initials: M
authors.lastname: Ozsahin
authors.affiliation: Departments of Radiation Oncology, Vaud University Hospital Center , Lausanne, Switzerland.
authors.forename: Abderrahim
authors.initials: A
authors.lastname: Zouhair
keywords: complications; postoperative; preoperative; prognostic factors; radiotherapy; soft-tissue sarcoma