title: Comparison of local recurrence with conventional and intensity-modulated radiation therapy for primary soft-tissue sarcomas of the extremity.
abstract: OBJECTIVE
  The use of intensity-modulated radiation therapy (IMRT) in the treatment of soft tissue sarcoma (STS) of the extremity is increasing, but no large-scale direct comparison has been reported between conventional external-beam radiation therapy (EBRT) and IMRT.
  
  
  METHODS
  Between January 1996 and December 2010, 319 consecutive adult patients with primary nonmetastatic extremity STS were treated with limb-sparing surgery and adjuvant radiotherapy (RT) at a single institution. Conventional EBRT was used in 154 patients and IMRT in 165 with similar dosing schedules. Median follow-up time for the cohort was 58 months.
  
  
  RESULTS
  Treatment groups were comparable in terms of tumor location, histology, tumor size, depth, and use of chemotherapy. Patients treated with IMRT were older (P = .08), had more high-grade lesions (P = .05), close (< 1 mm) or positive margins (P = .04), preoperative radiation (P < .001), and nerve manipulation (P = .04). Median follow-up was 90 months for patients treated with conventional EBRT and 42 months for patients treated with IMRT. On multivariable analysis adjusting for patient age and tumor size, IMRT retained significance as an independent predictor of reduced LR (hazard ratio = 0.46; 95% CI, 0.24 to 0.89; P = .02).
  
  
  CONCLUSIONS
  Despite a preponderance of higher-risk features (especially close/positive margin) in the IMRT group, IMRT was associated with significantly reduced local recurrence compared with conventional EBRT for primary STS of the extremity.
authors.affiliation: Memorial Sloan Kettering Cancer Center, New York, NY.
authors.forename: Michael R
authors.initials: MR
authors.lastname: Folkert
authors.affiliation: Memorial Sloan Kettering Cancer Center, New York, NY.
authors.forename: Samuel
authors.initials: S
authors.lastname: Singer
authors.affiliation: Memorial Sloan Kettering Cancer Center, New York, NY.
authors.forename: Murray F
authors.initials: MF
authors.lastname: Brennan
authors.affiliation: Memorial Sloan Kettering Cancer Center, New York, NY.
authors.forename: Deborah
authors.initials: D
authors.lastname: Kuk
authors.affiliation: Memorial Sloan Kettering Cancer Center, New York, NY.
authors.forename: Li-Xuan
authors.initials: LX
authors.lastname: Qin
authors.affiliation: Memorial Sloan Kettering Cancer Center, New York, NY.
authors.forename: Wendy K
authors.initials: WK
authors.lastname: Kobayashi
authors.affiliation: Memorial Sloan Kettering Cancer Center, New York, NY.
authors.forename: Aimee M
authors.initials: AM
authors.lastname: Crago
authors.affiliation: Memorial Sloan Kettering Cancer Center, New York, NY. alektiak@mskcc.org.
authors.forename: Kaled M
authors.initials: KM
authors.lastname: Alektiar
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003131:Combined Modality Therapy; D005121:Extremities; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D059351:Organ Sparing Treatments / Q000379:methods*; D011446:Prospective Studies; D050397:Radiotherapy, Intensity-Modulated; D012307:Risk Factors; D012509:Sarcoma / Q000188:drug therapy / Q000532:radiotherapy* / Q000601:surgery