Treatment outcome of conservative surgery plus postoperative radiotherapy for extremity soft tissue sarcoma
Identifieur interne : 002625 ( Pmc/Checkpoint ); précédent : 002624; suivant : 002626Treatment outcome of conservative surgery plus postoperative radiotherapy for extremity soft tissue sarcoma
Auteurs : Jieun Lee [Corée du Sud] ; Young Je Park [Corée du Sud] ; Dae Sik Yang [Corée du Sud] ; Won Sup Yoon [Corée du Sud] ; Jung Ae Lee [Corée du Sud] ; Chai Hong Rim [Corée du Sud] ; Chul Yong Kim [Corée du Sud]Source :
- Radiation Oncology Journal [ 2234-1900 ] ; 2012.
Abstract
To evaluate the treatment outcome and prognostic factor of postoperative radiotherapy for extremity soft tissue sarcoma (STS).
Forty three patients with extremity STS were treated with conservative surgery and postoperative radiotherapy from January 1981 to December 2010 at Korea University Medical Center. Median total 60 Gy (range, 50 to 74.4 Gy) of radiation was delivered and 7 patients were treated with chemotherapy.
The median follow-up period was 70 months (range, 5 to 302 months). Twelve patients (27.9%) sustained relapse of their disease. Local recurrence occurred in 3 patients (7.0%) and distant metastases developed in 10 patients (23.3%). The 5-year overall survival (OS) was 69.2% and disease free survival was 67.9%. The 5-year local relapse-free survival was 90.7% and distant relapse-free survival was 73.3%. On univariate analysis, no significant prognostic factors were associated with development of local recurrence. Histologic grade (p = 0.005) and stage (p = 0.02) influenced the development of distant metastases. Histologic grade was unique significant prognostic factor for the OS on univariate and multivariate analysis. Severe acute treatment-related complications, Common Terminology Criteria for Adverse Events (CTCAE) grade 3 or 4, developed in 6 patients (14.0%) and severe late complications in 2 patients (4.7%).
Conservative surgery with postoperative radiotherapy achieved a satisfactory rate of local control with acceptable complication rate in extremity STS. Most failures were distant metastases that correlate with tumor grade and stage. The majority of local recurrences developed within the field. Selective dose escalation of radiotherapy or development of effective systemic treatment might be considered.
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DOI: 10.3857/roj.2012.30.2.62
PubMed: 22984684
PubMed Central: 3429890
Affiliations:
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<series><title level="j">Radiation Oncology Journal</title>
<idno type="ISSN">2234-1900</idno>
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<front><div type="abstract" xml:lang="en"><sec><title>Purpose</title>
<p>To evaluate the treatment outcome and prognostic factor of postoperative radiotherapy for extremity soft tissue sarcoma (STS).</p>
</sec>
<sec><title>Materials and Methods</title>
<p>Forty three patients with extremity STS were treated with conservative surgery and postoperative radiotherapy from January 1981 to December 2010 at Korea University Medical Center. Median total 60 Gy (range, 50 to 74.4 Gy) of radiation was delivered and 7 patients were treated with chemotherapy.</p>
</sec>
<sec><title>Results</title>
<p>The median follow-up period was 70 months (range, 5 to 302 months). Twelve patients (27.9%) sustained relapse of their disease. Local recurrence occurred in 3 patients (7.0%) and distant metastases developed in 10 patients (23.3%). The 5-year overall survival (OS) was 69.2% and disease free survival was 67.9%. The 5-year local relapse-free survival was 90.7% and distant relapse-free survival was 73.3%. On univariate analysis, no significant prognostic factors were associated with development of local recurrence. Histologic grade (p = 0.005) and stage (p = 0.02) influenced the development of distant metastases. Histologic grade was unique significant prognostic factor for the OS on univariate and multivariate analysis. Severe acute treatment-related complications, Common Terminology Criteria for Adverse Events (CTCAE) grade 3 or 4, developed in 6 patients (14.0%) and severe late complications in 2 patients (4.7%).</p>
</sec>
<sec><title>Conclusion</title>
<p>Conservative surgery with postoperative radiotherapy achieved a satisfactory rate of local control with acceptable complication rate in extremity STS. Most failures were distant metastases that correlate with tumor grade and stage. The majority of local recurrences developed within the field. Selective dose escalation of radiotherapy or development of effective systemic treatment might be considered.</p>
</sec>
</div>
</front>
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<front><journal-meta><journal-id journal-id-type="nlm-ta">Radiation Oncol J</journal-id>
<journal-id journal-id-type="iso-abbrev">Radiation Oncol J</journal-id>
<journal-id journal-id-type="publisher-id">ROJ</journal-id>
<journal-title-group><journal-title>Radiation Oncology Journal</journal-title>
</journal-title-group>
<issn pub-type="ppub">2234-1900</issn>
<issn pub-type="epub">2234-3164</issn>
<publisher><publisher-name>The Korean Society for Radiation Oncology</publisher-name>
</publisher>
</journal-meta>
<article-meta><article-id pub-id-type="pmid">22984684</article-id>
<article-id pub-id-type="pmc">3429890</article-id>
<article-id pub-id-type="doi">10.3857/roj.2012.30.2.62</article-id>
<article-categories><subj-group subj-group-type="heading"><subject>Original Article</subject>
<subj-group><subject>Clinical Investigation</subject>
</subj-group>
</subj-group>
</article-categories>
<title-group><article-title>Treatment outcome of conservative surgery plus postoperative radiotherapy for extremity soft tissue sarcoma</article-title>
</title-group>
<contrib-group><contrib contrib-type="author"><name><surname>Lee</surname>
<given-names>Jieun</given-names>
</name>
<degrees>MD</degrees>
<xref ref-type="aff" rid="A1"></xref>
</contrib>
<contrib contrib-type="author"><name><surname>Park</surname>
<given-names>Young Je</given-names>
</name>
<degrees>MD</degrees>
<xref ref-type="aff" rid="A1"></xref>
</contrib>
<contrib contrib-type="author"><name><surname>Yang</surname>
<given-names>Dae Sik</given-names>
</name>
<degrees>MD</degrees>
<xref ref-type="aff" rid="A1"></xref>
</contrib>
<contrib contrib-type="author"><name><surname>Yoon</surname>
<given-names>Won Sup</given-names>
</name>
<degrees>MD</degrees>
<xref ref-type="aff" rid="A1"></xref>
</contrib>
<contrib contrib-type="author"><name><surname>Lee</surname>
<given-names>Jung Ae</given-names>
</name>
<degrees>MD</degrees>
<xref ref-type="aff" rid="A1"></xref>
</contrib>
<contrib contrib-type="author"><name><surname>Rim</surname>
<given-names>Chai Hong</given-names>
</name>
<degrees>MD</degrees>
<xref ref-type="aff" rid="A1"></xref>
</contrib>
<contrib contrib-type="author" corresp="yes"><name><surname>Kim</surname>
<given-names>Chul Yong</given-names>
</name>
<degrees>MD</degrees>
<xref ref-type="aff" rid="A1"></xref>
</contrib>
</contrib-group>
<aff id="A1">Department of Radiation Oncology, Korea University Medical Center, Seoul, Korea.</aff>
<author-notes><corresp>Correspondence: Chul Yong Kim, MD, Department of Radiation Oncology, Korea University Medical Center, 73 Inchon-ro, Seongbuk-gu, Seoul 136-705, Korea. Tel: +82-2-920-5516, Fax: +82-2-927-1419, <email>kcyro@korea.ac.kr</email>
</corresp>
</author-notes>
<pub-date pub-type="ppub"><month>6</month>
<year>2012</year>
</pub-date>
<pub-date pub-type="epub"><day>30</day>
<month>6</month>
<year>2012</year>
</pub-date>
<volume>30</volume>
<issue>2</issue>
<fpage>62</fpage>
<lpage>69</lpage>
<history><date date-type="received"><day>18</day>
<month>4</month>
<year>2012</year>
</date>
<date date-type="rev-recd"><day>01</day>
<month>6</month>
<year>2012</year>
</date>
<date date-type="accepted"><day>14</day>
<month>6</month>
<year>2012</year>
</date>
</history>
<permissions><copyright-statement>Copyright © 2012. The Korean Society for Radiation Oncology</copyright-statement>
<copyright-year>2012</copyright-year>
<license license-type="open-access" xlink:href="http://creativecommons.org/licenses/by-nc/3.0"><license-p>This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (<ext-link ext-link-type="uri" xlink:href="http://creativecommons.org/licenses/by-nc/3.0/">http://creativecommons.org/licenses/by-nc/3.0/</ext-link>
) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.</license-p>
</license>
</permissions>
<abstract><sec><title>Purpose</title>
<p>To evaluate the treatment outcome and prognostic factor of postoperative radiotherapy for extremity soft tissue sarcoma (STS).</p>
</sec>
<sec><title>Materials and Methods</title>
<p>Forty three patients with extremity STS were treated with conservative surgery and postoperative radiotherapy from January 1981 to December 2010 at Korea University Medical Center. Median total 60 Gy (range, 50 to 74.4 Gy) of radiation was delivered and 7 patients were treated with chemotherapy.</p>
</sec>
<sec><title>Results</title>
<p>The median follow-up period was 70 months (range, 5 to 302 months). Twelve patients (27.9%) sustained relapse of their disease. Local recurrence occurred in 3 patients (7.0%) and distant metastases developed in 10 patients (23.3%). The 5-year overall survival (OS) was 69.2% and disease free survival was 67.9%. The 5-year local relapse-free survival was 90.7% and distant relapse-free survival was 73.3%. On univariate analysis, no significant prognostic factors were associated with development of local recurrence. Histologic grade (p = 0.005) and stage (p = 0.02) influenced the development of distant metastases. Histologic grade was unique significant prognostic factor for the OS on univariate and multivariate analysis. Severe acute treatment-related complications, Common Terminology Criteria for Adverse Events (CTCAE) grade 3 or 4, developed in 6 patients (14.0%) and severe late complications in 2 patients (4.7%).</p>
</sec>
<sec><title>Conclusion</title>
<p>Conservative surgery with postoperative radiotherapy achieved a satisfactory rate of local control with acceptable complication rate in extremity STS. Most failures were distant metastases that correlate with tumor grade and stage. The majority of local recurrences developed within the field. Selective dose escalation of radiotherapy or development of effective systemic treatment might be considered.</p>
</sec>
</abstract>
<kwd-group><kwd>Sarcoma</kwd>
<kwd>Extremity</kwd>
<kwd>Radiotherapy</kwd>
<kwd>Postoperative</kwd>
<kwd>Treatment outcome</kwd>
</kwd-group>
</article-meta>
</front>
<floats-group><fig id="F1" position="float"><label>Fig. 1</label>
<caption><p>Kaplan-Meier estimates of local relapse-free survival (LRFS). The 5-year LRFS was 90.7%.</p>
</caption>
<graphic xlink:href="roj-30-62-g001"></graphic>
</fig>
<fig id="F2" position="float"><label>Fig. 2</label>
<caption><p>Patterns of failure of all patients.</p>
</caption>
<graphic xlink:href="roj-30-62-g002"></graphic>
</fig>
<fig id="F3" position="float"><label>Fig. 3</label>
<caption><p>Kaplan-Meier estimates of overall survival (OS). The 5-year OS was 69.2%.</p>
</caption>
<graphic xlink:href="roj-30-62-g003"></graphic>
</fig>
<table-wrap id="T1" position="float"><label>Table 1</label>
<caption><p>Patient, tumor and treatment characteristics (n = 43)</p>
</caption>
<graphic xlink:href="roj-30-62-i001"></graphic>
<table-wrap-foot><fn><p>MFH, malignant fibrous histiocytoma; RT, radiotherapy; CCRT, concurrent chemo-radiotherapy; CT, chemotherapy.</p>
</fn>
</table-wrap-foot>
</table-wrap>
<table-wrap id="T2" position="float"><label>Table 2</label>
<caption><p>Characteristics of patients with local recurrence</p>
</caption>
<graphic xlink:href="roj-30-62-i002"></graphic>
<table-wrap-foot><fn><p>RM, resection margin; RT, radiotherapy; LR, local recurrence; LRFS, local relapse-free survival; MFH, malignant fibrous histiocytoma; (-), negative; DID, dead of intercurrent disease; NED, no evidence of disease; (+), positive; DOD, dead of disease.</p>
</fn>
</table-wrap-foot>
</table-wrap>
<table-wrap id="T3" position="float"><label>Table 3</label>
<caption><p>Univariate analysis of prognostic factors</p>
</caption>
<graphic xlink:href="roj-30-62-i003"></graphic>
<table-wrap-foot><fn><p>LRFS, local relapse-free survival; DRFS, distant relapse-free survival; OS, overall survival; DSS, disease-specific survival; NS, non-significant; NA, not applicable; RM, resection margin; (-), negative; (+), positive.</p>
</fn>
</table-wrap-foot>
</table-wrap>
<table-wrap id="T4" position="float"><label>Table 4</label>
<caption><p>Multivariate analysis of prognostic factors</p>
</caption>
<graphic xlink:href="roj-30-62-i004"></graphic>
<table-wrap-foot><fn><p>HR, hazard ratio; CI, confidence interval; DRFS, distant relapse-free survival; NS, non-significant; RM, resection margin; (-), negative; (+), positive; OS, overall survival; DSS, disease specific survival.</p>
</fn>
</table-wrap-foot>
</table-wrap>
<table-wrap id="T5" position="float"><label>Table 5</label>
<caption><p>Treatment related complications (n = 43)</p>
</caption>
<graphic xlink:href="roj-30-62-i005"></graphic>
</table-wrap>
</floats-group>
</pmc>
<affiliations><list><country><li>Corée du Sud</li>
</country>
<region><li>Région capitale de Séoul</li>
</region>
<settlement><li>Séoul</li>
</settlement>
</list>
<tree><country name="Corée du Sud"><region name="Région capitale de Séoul"><name sortKey="Lee, Jieun" sort="Lee, Jieun" uniqKey="Lee J" first="Jieun" last="Lee">Jieun Lee</name>
</region>
<name sortKey="Kim, Chul Yong" sort="Kim, Chul Yong" uniqKey="Kim C" first="Chul Yong" last="Kim">Chul Yong Kim</name>
<name sortKey="Lee, Jung Ae" sort="Lee, Jung Ae" uniqKey="Lee J" first="Jung Ae" last="Lee">Jung Ae Lee</name>
<name sortKey="Park, Young Je" sort="Park, Young Je" uniqKey="Park Y" first="Young Je" last="Park">Young Je Park</name>
<name sortKey="Rim, Chai Hong" sort="Rim, Chai Hong" uniqKey="Rim C" first="Chai Hong" last="Rim">Chai Hong Rim</name>
<name sortKey="Yang, Dae Sik" sort="Yang, Dae Sik" uniqKey="Yang D" first="Dae Sik" last="Yang">Dae Sik Yang</name>
<name sortKey="Yoon, Won Sup" sort="Yoon, Won Sup" uniqKey="Yoon W" first="Won Sup" last="Yoon">Won Sup Yoon</name>
</country>
</tree>
</affiliations>
</record>
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