Combining limb-sparing surgery with radiation therapy in high-grade soft tissue sarcoma of extremities - Is it effective?

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• 作者：D.A. Mü ; ller^a ; ^{daniel.mueller@balgrist.ch" class="auth_mail" title="E-mail the corresponding author} ; G. Beltrami^b ; ^{giovannibeltrami@virgilio.it" class="auth_mail" title="E-mail the corresponding author} ; G. Scoccianti^b ; ^{guido.scoccianti@alice.it" class="auth_mail" title="E-mail the corresponding author} ; F. Frenos^b ; ^{frenosfilippo@gmail.com" class="auth_mail" title="E-mail the corresponding author} ; R. Capanna^b ; ^{capannar@aou-careggi.toscana.it" class="auth_mail" title="E-mail the corresponding author}
• 关键词：High-grade ; Soft tissue sarcoma ; Radiation therapy ; Limb-sparing surgery ; Local recurrence ; Distant metastasis
• 刊名：European Journal of Surgical Oncology (EJSO)
• 出版年：2016
• 出版时间：July 2016
• 年：2016
• 卷：42
• 期：7
• 页码：1057-1063
• 全文大小：505 K

文摘

Limb-sparing surgery in combination with radiation therapy is a well-established treatment for high-grade soft tissue sarcomas of the extremities. But selection of cases and optimal sequence of irradiation and surgery still remain controversial.

Methods

769 patients with a high-grade soft tissue sarcoma of the extremities, who underwent a limb-sparing surgery, were retrospectively reviewed. Group 1 (N = 89) was treated with neo-adjuvant radiation therapy, group 2 (N = 315) with adjuvant irradiation and group 3 (N = 365) with surgery alone.

Results

After a mean follow up of 45 months 95 local recurrences occurred resulting in a local recurrence-free survival of 83.2% after 5 years and 75.9% after 10 years. Contaminated surgical margins (Odds ratio: 2.42) and previous inadequate surgeries (Odds ratio: 1.89) were identified as risk factors for failed local control. Neo-adjuvant radiation therapy provides the best local recurrence-free rate for 5 years (90.0%), whereas after 10 years (78.3%) adjuvant irradiation showed better local control. The metastatic-free rate was independent from achieved surgical margins (p = 0.179). Group 1 showed the highest rate of revision surgery (9.0%), followed by group 3 (5.5%) and group 2 (4.4%) (p = 0.085). However, the rate of irradiation-correlated side effects was higher in group 2 (15.2%) than in group 1 (11.2%) (p = 0.221).

Conclusion

Surgery has to be effective for successful local control and remains the mainstay of the treatment in combination with neo-adjuvant as well as adjuvant irradiation. In really wide or even radical resections the benefit of radiation therapy can be discussed as the irradiation induced side effects are not negligible.