Local control results in extremity soft tissue sarcomas

Year 2022, Volume: 5 Issue: 6, 1736 - 1740, 25.10.2022

Gülçin Ertaş , Muzaffer Bedri Altundağ , Ebru Atasever Akkaş , Hayati Abanuz , Esra Kekilli , Fatih Göksel

https://doi.org/10.32322/jhsm.1175942

Cited By: 1

Abstract

Aim: The aim of this study is to investigate local control results and effective predictive factors in local control of extremity soft tissue sarcomas, retrospectively.
Material and Method: 51 patients underwent postoperative adjuvant radiotherapy (RT) in Dr. Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital between October 2008-January 2022. Patients who underwent post-operative adjuvant RT were treated with 60-68 Gy in 2 phases from 2 Gy /day using conformal radiotherapy technique. IMA chemotherapy protocol was applied to 31.4% of the patients after radiotherapy.
Results: The median follow up time was 46 months range (1-135). Recurrence was detected in 5 of the patients and the mean time of recurrence was 11.6 months (min: 3-max: 27). 10 patients developed metastasis at follow-up, the mean time until metastasis was 27 months (min: 18- max: 46). The mean overall survival (OS) was 103 (min:4-max:139) months and the OS of 2, 5 and 10 years were 93%, 65% and 60%, respectively. Disease-free survival (DFS) was 97 (min:4-max:139) months; 2, 5 and 10 years of DFS were 77%, 65% and 60%, respectively. The OS in patients aged ≥65 years old was significantly lower than in patients <65 years old (p=0.02). Overall and disease-free survival was significantly lower in patients undergoing chemotherapy (p=0.037 for overall survival, p=0.013 for disease-free survival). The occurrence of recurrence, metastasis or death within 3 years after the operation was significantly higher than after 3 years (p<0.001). Local failure was significantly higher in grade 3 tumors (p=0.05). All patients who recurred had grade 3 tumors. Metastasis and excitus were significantly higher in the follow-up of patients who underwent chemotherapy at one point during their treatment (p=0.027 for metastasis, p=0.042).
Conclusion: While favorable local control results are obtained with adjuvant high dose-conformal radiotherapy in extremity sarcomas, close follow up is important for distant metastasis and local recurrence, especially in the first 3 years.

Keywords

Extremity, sarcoma, survival, age, grade, radiotherapy

References

• NCCN (National Comprehensive Cancer Network) Guidelines Version 2.2022 Soft Tissue Sarcoma. Available Online: https://www.nccn.org/professionals/physician_gls/pdf/sarcoma.pdf
• Yang JC, Chang AE, Baker AR, et al. Randomized prospective study of the benefit of adjuvant radiation therapy in the treatment of soft tissue sarcomas of the extremity. J Clin Oncol 1998; 16: 197-203.
• Biau DJ, Ferguson PC, Chung P, et al. Local recurrence of localized soft tissue sarcoma: a new look at old predictors. Cancer 2012; 118: 5867-77.
• Sampo M, Tarkkanen M, Huuhtanen R, Tukiainen E, Bohling T, Blomqvist C. Impact of the smallest surgical margin on local control in soft tissue sarcoma. Br J Surg 2008; 95: 237-43.
• Potter BK, Hwang PF, Forsberg JA, et al. Impact of margin status and local recurrence on soft-tissue sarcoma outcomes. J Bone Joint Surg Am 2013; 95: e151.
• Sugiura H, Nishida Y, Nakashima H, Yamada Y, Tsukushi S, Yamada K. Surgical procedures and prognostic factors for local recurrence of soft tissue sarcomas. J Orthop Sci 2014; 19: 141-9.
• Casali PG, Abecassis N, Aro HT, et al. Soft tissue and visceral sarcomas: ESMO-EURACAN Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 2018; 29: 51-67.
• Beane JD, Yang JC, White D, Steinberg SM, Rosenberg SA, Rudloff U. Efficacy of adjuvant radiation therapy in the treatment of soft tissue sarcoma of the extremity: 20-year follow-up of a randomized prospective trial. Ann Surg Oncol 2014; 21: 2484-9.
• DeLaney TF, Trofimov AV, Engelsman M, Suit HD. Advanced-technology radiation therapy in the management of bone and soft tissue sarcomas. Cancer Control 2005; 12: 27–35.
• Alektiar KM, Brennan MF, Healey JH, Singer S. Impact of intensity-modulated radiation therapy on local control in primary soft-tissue sarcoma of the extremity. J Clin Oncol 2008; 26: 3440-4.
• Hoefkens F, Dehandschutter C, Gestel DV, et al. Soft tissue sarcoma of the extremities; pending questions on surgery and radiotherapy. Radiat Oncol 2016; 11: 136.
• Pisters PW, Harrison LB, Leung DH, Woodruff JM, Casper ES, Brennan MF. Long-term results of a prospective randomized trial of adjuvant brachytherapy in soft tissue sarcoma. J Clin Oncol 1996; 14: 859-68.
• Gronchi A, Lo Vullo S, Colombo C, et al. Extremity soft tissue sarcoma in a series of patients treated at a single institution: local control directly impacts survival. Ann Surg 2010; 251: 506-11.
• Look Hong NJ, Hornicek FJ, Harmon DC, et al. Neoadjuvant chemoradiotherapy for patients with high-risk extremity and truncal sarcomas: a 10-year single institutionretrospective study. Eur J Cancer 2013; 49: 875-83.
• Pervaiz N, Colterjohn N, Farrokhyar F, Tozer R, Figueredo A, Ghert M. A systematic meta-analysis of randomized controlled trials of adjuvant chemotherapy for localized resectable soft-tissue sarcoma. Cancer 2008; 113: 573-81.
• Woll PJ, Reichardt P, Le Cesne A, et al. Adjuvant chemotherapy with doxorubicin, ifosfamide, and lenograstim for resected soft-tissue sarcoma (EORTC 62931): a multicentre randomised controlled trial. Lancet Oncol 2012; 13: 1045-54.
• Stone P, Rees E, Hardy JR. A randomised phase II study on neo-adjuvant chemotherapy for “high-risk” adult soft-tissue sarcoma. Eur J Cancer 2001; 37: 1096-103.
• Falk AT, Moureau-Zabotto L, Ouali M, et al. Effect on survival of local ablative treatment of metastases from sarcomas: a study of the french sarcoma group. Clin Oncol 2015; 27: 48-55.
• Cammelli S, Cotesi A, Buwenge M, et al. The role of Radiotherapy in adult soft tissues sarcoma of the extremities. Eur J Orthop Surg Traumatol 2021; 31: 1583-96.
• Lindsay AD, Haupt EE, Chan CM, et al. Treatment of sarcoma lung metastases with stereotactic body radiotherapy. Sarcoma 2018; 2018: 9132359.