Is there no influence of local control on the rate of metastases in high-grade soft tissue sarcoma?

PURPOSE This trial was performed to evaluate the impact of adjuvant brachytherapy on local and systemic recurrence rates in patients with soft tissue sarcoma. PATIENTS AND METHODS In a single-institution prospective randomized trial, 164 patients were randomized intraoperatively to receive either adjuvant brachytherapy (BRT) or no further therapy (no BRT) after complete resection of soft tissue sarcomas of the extremity or superficial trunk. The adjuvant radiation was administered by iridium-192 implant, which delivered 42 to 45 Gy over 4 to 6 days. The two study groups had comparable distributions of patient and tumor factors, including age, sex, tumor site, tumor size, and histologic type and grade. RESULTS With a median follow-up time of 76 months, the 5-year actuarial local control rates were 82% and 69% in the BRT and no BRT groups (P = .04), respectively. Patients with high-grade lesions had local control rates of 89% (BRT) and 66% (no BRT) (P = .0025). BRT had no impact on local control in patients with low-grade lesions (P = .49). The 5-year freedom-from-distant-recurrence rates were 83% and 76% in the BRT and no BRT groups (P = .60), respectively. Analysis by histologic grade did not demonstrate an impact of BRT on the development of distant metastasis, despite the improvement in local control noted in patients with high-grade lesions. The 5-year disease-specific survival rates for the BRT and no BRT groups were 84% and 81% (P = .65), respectively, with no impact of BRT regardless of tumor grade. CONCLUSION Adjuvant brachytherapy improves local control after complete resection of soft tissue sarcomas. This improvement in local control is limited to patients with high-grade histopathology. The reduction in local recurrence in patients with high-grade lesions is not associated with a significant reduction in distant metastasis or improvement in disease-specific survival.

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Resection of high-grade large soft tissue sarcoma with adequate wide margin can lead to good local control without adjuvant radiotherapy

Annals of Oncology ◽

10.1093/annonc/mdz283.062 ◽

2019 ◽

Vol 30 ◽

pp. v707

Author(s):

T. Kunisada ◽

E. Nakata ◽

J. Hasei ◽

T. Ozaki

Keyword(s):

Soft Tissue ◽

Soft Tissue Sarcoma ◽

Local Control ◽

Adjuvant Radiotherapy ◽

High Grade ◽

Wide Margin ◽

Good Local Control

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A review of adult head and neck soft tissue sarcoma in a tertiary centre: malaysia experience

Bangladesh Journal of Medical Science ◽

10.3329/bjms.v16i1.31136 ◽

2017 ◽

Vol 16 (1) ◽

pp. 69-76 ◽

Cited By ~ 1

Author(s):

Salman Amiruddin ◽

Mohd Razif Muhamad Yunus ◽

Marina Mat Baki

Keyword(s):

Soft Tissue ◽

Soft Tissue Sarcoma ◽

Head And Neck ◽

Local Control ◽

Adjuvant Radiotherapy ◽

Soft Tissue Sarcomas ◽

Optimal Treatment ◽

High Morbidity ◽

High Grade ◽

Adult Head

Background: Head and neck tissue sarcoma are rare with potential high morbidity and mortality. The purpose of the present study was to present these cases and determine the optimal treatment for adult patients with head and neck soft tissue sarcomas.Methods: It is a retrospective study of adult head and neck soft tissue sarcoma conducted in the Department of Otorhinolaryngology at Universiti Kebangsaan Malaysia Medical Centre (UKMMC) which is one of the national referral center within the period of 16 years from 1998 till 2014.Results: Fourteen cases were reviewed in which7 histopathological variations of soft tissue sarcomas were identified. Local control after surgery alone or combined with radiotherapy was obtained in 50 % of the patients which is influenced by histologic grade, tumor size, and surgical margins. Patients with high-grade tumors or positive margins have improved local control if adjuvant radiotherapy is used. Distant metastases occurred in 14.2 % of patients and the 5-year survival rate was 50 %.Conclusions: The optimal treatment for adult head and neck soft tissue sarcomas is surgery. Adjuvant radiotherapy improves outcomes for those with high-grade tumors or positive margins.Bangladesh Journal of Medical Science Vol.16(1) 2017 p.69-76

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Adjuvant Radiation for Stage II-B Soft Tissue Sarcoma of the Extremity

Journal of Clinical Oncology ◽

10.1200/jco.2002.20.6.1643 ◽

2002 ◽

Vol 20 (6) ◽

pp. 1643-1650 ◽

Cited By ~ 25

Author(s):

Kaled M. Alektiar ◽

Dennis Leung ◽

Michael J. Zelefsky ◽

Murray F. Brennan

Keyword(s):

Soft Tissue ◽

Soft Tissue Sarcoma ◽

Local Control ◽

Tumor Location ◽

Stage Ii ◽

External Beam Radiation ◽

Adjuvant Radiation ◽

High Grade ◽

Unplanned Excision ◽

Significant Difference

PURPOSE: Adjuvant radiation therapy (RT) has been shown to improve local control in patients with high-grade soft tissue sarcoma (STS) of the extremity. This study sought to define the optimal management in patients with stage II-B (high-grade, size ≤ 5 cm) tumors. PATIENTS AND METHODS: Between July 1982 and December 1998, 204 adult patients with primary stage II-B STS underwent limb-sparing surgery with negative microscopic margins. Eighty-eight patients (43%) received RT; 116 (57%) did not. The RT and no-RT groups were balanced with regard to age, site (upper v lower extremity), whether patients had prior unplanned excision, and location (central, ie, shoulder/groin v noncentral). The RT group had more deep tumors (P = .03). Adjuvant RT was delivered with brachytherapy in 60% and external-beam radiation in 40% of patients. RESULTS: With a median follow-up of 67 months, the 5-year local control, distant relapse-free survival, and disease-specific survival rates were 82%, 80%, and 88%, respectively. There was no significant difference in local control between the RT and no-RT groups (84% v 80%, respectively, P = .3). Tumor depth, site, and prior unplanned excision did not correlate with local control. The only independent predictors of poor local control were central tumor location (relative risk [RR] = 3; 95% confidence interval [CI], 2 to 7; P = .005) and age more than 50 years (RR = 6; 95% CI, 2 to 13; P = .001). CONCLUSION: In this retrospective study, adjuvant RT did not significantly improve local control in patients with stage II-B STS of the extremity. The outcome of patients with central tumor location was poor, and efforts to identify the optimal local treatment approach for such patients are warranted.

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Radiochemotherapy with gemcitabine as radiosensitizer in patients with soft tissue sarcoma.

Journal of Clinical Oncology ◽

10.1200/jco.2020.38.15_suppl.e23559 ◽

2020 ◽

Vol 38 (15_suppl) ◽

pp. e23559-e23559

Author(s):

Marinela Augustin ◽

Martin Wilhelm ◽

Bert Reichert ◽

Gabriele Margareta Siegler ◽

Juergen Dreier ◽

...

Keyword(s):

Radiation Therapy ◽

Soft Tissue ◽

Soft Tissue Sarcoma ◽

Local Control ◽

Systemic Treatment ◽

Tumor Regression ◽

External Beam Radiation ◽

High Grade ◽

Beam Radiation ◽

Palliative Setting

e23559 Background: Radiation therapy is an essential backbone of the management of patients (pts.) with soft tissue sarcoma (STS) as part of a multimodal curative or palliative treatment. Concurrent external-beam radiation therapy (EBRT) and chemotherapy with doxorubicin (doxo) and ifosfamide (ifo) may be indicated as well, but is associated with relevant toxicity. Gemcitabine (gem) is a known radiosensitizer and has shown activity in STS. The purpose of this study was to evaluate the efficacy and toxicity of concurrent EBRT and gemcitabine. Methods: A single center, retrospective analysis of 12 patients (pts) with STS treated with concurrent EBRT and gemcitabine from Nov 2017 to Dez 2019 in a neoadjuvant (6 pts) or palliative setting (6 pts). Gemcitabine (gem) was administered with 150-300mg/m2 once weekly for the duration of the EBRT (50 Gy in 25 fractions over 5 weeks). In the neoadjuvant treated group, 4 pts had undifferentiated pleomorphic sarcoma (UPS) G3, 1 leiomyosarcoma (LMS) G2 and 1 retroperitoneal G1 liposarcoma (LPS). The pts. were either not eligible for a neoadjuvant systemic treatment with doxo/ifo or received the EBRT/gem treatment in addition to it. Results: 5/6 pts. with neoadjuvant EBRT/gem had R0 resection and 1/6pt. R1. The IUCC stage was IIIB in 5/6 pts and IB in 1/6 pt. The tumor regression grade (TRG) was > 99% in 3/4 pts. with UPS G3 (75%) and 80% in 1/4 pt. with UPS G3. The TRG for the G2 LMS and for the G1 LPS was 20%. All pts treated in palliative setting had high grade sarcoma and responded to the treatment with partial remission, the 6 months’ local control rate was 83% (5/6 pts) for symptomatic fast growing lesions, 1/6 pt. being in PR at 4 months follow up. The combination treatment was well tolerated with reversible skin toxicity CTCAE grade I. As expected transient thrombocytopenia was observed without limiting effect on the planned EBRT. Conclusions: The combination therapy of EBRT and gemcitabine as sensitizer in pts. with STS is feasible und well tolerated. The treatment is an option for patients not eligible for neoadjuvant systemic treatment with doxo/ifo and in the palliative setting as well. It might be more potent than radiation only in achieving tumor regression and local control for high grade STS.

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