title: The effect of radiation therapy in the treatment of adult soft tissue sarcomas of the extremities: a long-term community-based cancer center experience.
abstract: The aim of the study was to determine the effect of external beam radiotherapy (RT) in the treatment of extremity soft tissue sarcoma (STS) before or after limb-sparing surgery (LSS) in a community-based setting. Patients presenting to our institution from 1992 to 2010 and meeting eligibility criteria were stratified into low (G1) or high (G2, G3) pathologic grade and evaluated. Major complication events, including amputation, radiation-induced sarcoma, and pathologic fracture, were assessed. Kaplan-Meier techniques and Cox proportional hazards regression models were used. One hundred and sixty-two eligible patients underwent LSS for extremity STS (120 high grade, 42 low grade). Median time of follow-up was 5.1 years (0.8-20.3 years). RT was administered to 111 patients. In unadjusted models, RT significantly decreased the risk of local recurrence (LR) in high-grade STS patients (P = 0.005) and had a trend for improved recurrence-free survival (RFS) (P = 0.069). In multivariable-adjusted models, RT significantly improved time to LR (P = 0.001), RFS (P = 0.003), and overall survival (OS) (P = 0.003). Analysis of all patients showed those who underwent RT had a major complication rate (MCR) of 16.2%, compared to 3.9% in the no RT group (P = 0.037); however, the difference in MCR did not differ significantly when the analysis was restricted to high-grade sarcomas. In our large experience of patients with extremity STS undergoing limb sparing surgery (LSS), RT significantly improved local recurrence (LR), RFS, and OS, in patients with high-grade tumors. Efficacy benefits of RT should be weighed against potential complications. External beam RT should be considered in patients with resected high-grade sarcomas.
authors.affiliation: Department of Orthopedic Oncology, Levine Cancer Institute, Carolinas HealthCare System, Charlotte, North Carolina.
authors.forename: Jeffrey S
authors.initials: JS
authors.lastname: Kneisl
authors.affiliation: Department of Orthopedic Oncology, Levine Cancer Institute, Carolinas HealthCare System, Charlotte, North Carolina.
authors.forename: Chad
authors.initials: C
authors.lastname: Ferguson
authors.affiliation: Department of Cancer Biostatistics, Levine Cancer Institute, Carolinas HealthCare System, Charlotte, North Carolina.
authors.forename: Myra
authors.initials: M
authors.lastname: Robinson
authors.affiliation: Department of Radiation Oncology, Levine Cancer Institute, Carolinas HealthCare System, Charlotte, North Carolina.
authors.forename: Anthony
authors.initials: A
authors.lastname: Crimaldi
authors.affiliation: Department of Pathology, Carolinas Pathology Group, Charlotte, North Carolina.
authors.forename: Will
authors.initials: W
authors.lastname: Ahrens
authors.affiliation: Department of Cancer Biostatistics, Levine Cancer Institute, Carolinas HealthCare System, Charlotte, North Carolina.
authors.forename: James
authors.initials: J
authors.lastname: Symanowski
authors.affiliation: Department of Orthopedic Oncology, Levine Cancer Institute, Carolinas HealthCare System, Charlotte, North Carolina.
authors.forename: Michael
authors.initials: M
authors.lastname: Bates
authors.affiliation: Department of Solid Tumor Oncology and Investigational Therapeutics, Levine Cancer Institute, Carolinas HealthCare System, Charlotte, North Carolina.
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Ersek
authors.affiliation: Department of Solid Tumor Oncology and Investigational Therapeutics, Levine Cancer Institute, Carolinas HealthCare System, Charlotte, North Carolina.
authors.forename: Michael
authors.initials: M
authors.lastname: Livingston
authors.affiliation: Department of Orthopedic Oncology, Levine Cancer Institute, Carolinas HealthCare System, Charlotte, North Carolina.
authors.forename: Joshua
authors.initials: J
authors.lastname: Patt
authors.affiliation: Department of Solid Tumor Oncology and Investigational Therapeutics, Levine Cancer Institute, Carolinas HealthCare System, Charlotte, North Carolina.
authors.forename: Edward S
authors.initials: ES
authors.lastname: Kim
mesh_terms: D018572:Disease-Free Survival; D005121:Extremities / Q000473:pathology*; D005260:Female; D006801:Humans; D008297:Male; D020360:Neoadjuvant Therapy; D059351:Organ Sparing Treatments / Q000379:methods*; D016016:Proportional Hazards Models; D018714:Radiotherapy, Adjuvant; D012189:Retrospective Studies; D012509:Sarcoma / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D016019:Survival Analysis; D016896:Treatment Outcome
keywords: Adult; complications; extremities; radiotherapy; sarcoma; survival