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Limb salvage surgery in combination with brachytherapy and external beam radiation for high-grade soft tissue sarcomas


Beltrami, G; Rüdiger, H A; Mela, M M; Scoccianti, G; Livi, L; Franchi, A; Campanacci, D A; Capanna, R (2008). Limb salvage surgery in combination with brachytherapy and external beam radiation for high-grade soft tissue sarcomas. European Journal of Surgical Oncology, 34(7):811-816.

Abstract

While combined treatment of high-grade soft tissue sarcoma with resection and radiotherapy has become an accepted standard, outlines of treatment algorithms remain a matter of debate. Our institutional practice foresees wide surgical resection with adjuvant brachytherapy and external beam radiation. It was the purpose of this study to determine long-term outcome, prognostic factors for local and systemic recurrence and morbidity in patients with high-grade soft tissue sarcomas of the extremities, who were subjected to this regimen. One hundred and twelve patients met the inclusion criteria (56 male, 56 female; median age, 50 years). Median follow-up was 75 months (min. 11 months). Overall survival rate was 77.5% and 71.1% at 5 and 7 years, respectively. Disease-free survival rate was 63.3% and 58.4% at 5 and 10 years, respectively. Local control was achieved in 91.5% and 87.0% at 5 and 10 years, respectively. Wide surgical margins were associated with a significantly better local control rate compared to marginal or intralesional margins. Tumor size did correlate with systemic but not local recurrence. Tumor site and histotype did not appear to have an impact on outcome. Chemotherapy did not show to have an impact on local or systemic control. Fourteen patients (12.5%) had local complications attributed to radiotherapy. Eleven patients developed wound-healing problems, which needed further surgery. Using our treatment algorithm for high-grade soft tissue sarcoma of the extremities, good local and systemic control can be achieved with a low complication rate.

Abstract

While combined treatment of high-grade soft tissue sarcoma with resection and radiotherapy has become an accepted standard, outlines of treatment algorithms remain a matter of debate. Our institutional practice foresees wide surgical resection with adjuvant brachytherapy and external beam radiation. It was the purpose of this study to determine long-term outcome, prognostic factors for local and systemic recurrence and morbidity in patients with high-grade soft tissue sarcomas of the extremities, who were subjected to this regimen. One hundred and twelve patients met the inclusion criteria (56 male, 56 female; median age, 50 years). Median follow-up was 75 months (min. 11 months). Overall survival rate was 77.5% and 71.1% at 5 and 7 years, respectively. Disease-free survival rate was 63.3% and 58.4% at 5 and 10 years, respectively. Local control was achieved in 91.5% and 87.0% at 5 and 10 years, respectively. Wide surgical margins were associated with a significantly better local control rate compared to marginal or intralesional margins. Tumor size did correlate with systemic but not local recurrence. Tumor site and histotype did not appear to have an impact on outcome. Chemotherapy did not show to have an impact on local or systemic control. Fourteen patients (12.5%) had local complications attributed to radiotherapy. Eleven patients developed wound-healing problems, which needed further surgery. Using our treatment algorithm for high-grade soft tissue sarcoma of the extremities, good local and systemic control can be achieved with a low complication rate.

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12 citations in Web of Science®
15 citations in Scopus®
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Additional indexing

Item Type:Journal Article, refereed, original work
Communities & Collections:04 Faculty of Medicine > Balgrist University Hospital, Swiss Spinal Cord Injury Center
Dewey Decimal Classification:610 Medicine & health
Language:English
Date:2008
Deposited On:23 Jan 2009 12:32
Last Modified:05 Apr 2016 12:53
Publisher:Elsevier
ISSN:0748-7983
Publisher DOI:https://doi.org/10.1016/j.ejso.2007.08.011
PubMed ID:17981427

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