title: The efficacy of adjuvant radiotherapy in dermatofibrosarcoma protuberans: a systemic review and meta-analysis.
abstract: BACKGROUND
  Dermatofibrosarcoma protuberans (DFSP) is a rare and locally aggressive tumour, with a high recurrence rate, even after complete surgical excision. Adjuvant radiotherapy (RT) has been suggested to reduce the risk of local recurrence after inadequate surgical resection in patients with narrow or positive surgical margins. However, the overall efficacy of adjuvant RT has not been well studied because of the rarity of DFSP and lack of an appropriate comparison group.
  
  
  OBJECTIVE
  We sought to evaluate the efficacy of adjuvant RT for DFSP by conducting a systemic review and meta-analysis to provide a more evidence-based measure of its effectiveness.
  
  
  METHODS
  We conducted a systemic review of articles published before 31 June 2015. Due to the rarity of the disease, we included all studies that reported DFSP patients who received adjuvant RT (postoperatively). The pooled recurrence rates were analysed from these extracted data.
  
  
  RESULTS
  Twelve studies met the inclusion criteria. The pooled estimate of the recurrence rate for all adjuvant radiotherapy was 11.74% (95% CI 7.4-17.38; n = 167). Patients with positive/close had a pooled recurrence rate of 14.23% (95% CI 8.13-22.49; n = 92), whereas there was no recurrence in patients with negative margins. The pooled estimate of the recurrence rate between surgery alone and surgery combined with adjuvant radiotherapy showed no significant difference (odds ratio 0.31, P = 0.07), although there was a trend that adjuvant RT had a lower recurrence rate than surgery alone.
  
  
  CONCLUSIONS
  Adjuvant RT might be considered for all patients undergoing surgical excision, even if a negative surgical margin has been achieved. Furthermore, for patients with large or recurrent tumours, especially when wide excision with negative margin would result in a significant functional or cosmetic deficit, postoperative radiotherapy is highly recommended in order to achieve a lower recurrence rate.
authors.affiliation: Department of Dermatology, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan.|School of Public Health, College of Public Health and Nutrition, Taipei Medical University, Taipei, Taiwan.
authors.forename: Y-T
authors.initials: YT
authors.lastname: Chen
authors.affiliation: Department of Dermatology, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan.
authors.forename: W-T
authors.initials: WT
authors.lastname: Tu
authors.affiliation: Department of Dermatology, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan.|Department of Dermatology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
authors.forename: W-R
authors.initials: WR
authors.lastname: Lee
authors.affiliation: Department of Dermatology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.|Department of Dermatology, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan.
authors.forename: Y-C
authors.initials: YC
authors.lastname: Huang
mesh_terms: D003131:Combined Modality Therapy; D018223:Dermatofibrosarcoma / Q000532:radiotherapy* / Q000601:surgery; D006801:Humans; D018714:Radiotherapy, Adjuvant