Radiation Therapy for Control of Soft-Tissue Sarcomas Resected With Positive Margins

Thomas F. DeLaney, Lucyna Kepka, Saveli I. Goldberg, Francis J. Hornicek, Mark C. Gebhardt, Sam S. Yoon, Dempsey S. Springfield, Kevin A. Raskin, David C. Harmon, David G. Kirsch, Henry J. Mankin, Andrew Rosenberg, G. Petur Nielsen, Herman D. Suit

Research output: Contribution to journalArticle

108 Citations (Scopus)

Abstract

Purpose: Positive margins (PM) remain after surgery in some soft-tissue sarcoma (STS) patients. We investigated the efficacy of radiation therapy (RT) in STS patients with PM. Methods and Materials: A retrospective chart review was performed on 154 patients with STS at various anatomic sites with PM, defined as tumor on ink, who underwent RT with curative intent between 1970 and 2001. Local control (LC), disease-free survival (DFS), and overall survival (OS) rates were evaluated by univariate (log-rank) and multivariate analysis of prognostic and treatment factors. Results: At 5 years, actuarial LC, DFS, and OS rates were: 76%, 46.7%, and 65.2%, respectively. LC was highest with extremity lesions (p < 0.01), radiation dose >64 Gy (p < 0.05), microscopically (vs. grossly visible) positive margin (p = 0.03), and superficial lesions (p = 0.05). Patients receiving >64 Gy had higher 5-year LC, DFS, and OS rates of 85%, 52.1%, and 67.8% vs. 66.1%, 41.8%, and 62.9% if ≤64 Gy, p < 0.04. OS was worse in patients with G2/G3 tumors with local failure (LF), p < 0.001. Other known prognostic factors, including grade, stage, size, and age (>50), also significantly influenced OS. By multivariate analysis, the best predictors of LC were site (extremity vs. other), p < 0.01 and dose (>64 vs. ≤64 Gy), p < 0.05; the best predictors for OS were size, p < 0.001, gross vs. microscopic PM, p < 0.05, and LF, p < 0.01. Conclusion: Local control is achieved in most PM STS patients undergoing RT. Doses >64 Gy, superficial location, and extremity site are associated with improved LC. OS is worse in patients with tumors with lesions >5 cm, grossly positive margins, and after local failure.

Original languageEnglish
Pages (from-to)1460-1469
Number of pages10
JournalInternational Journal of Radiation Oncology Biology Physics
Volume67
Issue number5
DOIs
StatePublished - Apr 1 2007
Externally publishedYes

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Sarcoma
radiation therapy
margins
Radiotherapy
cancer
Disease-Free Survival
Survival Rate
Extremities
Multivariate Analysis
Ink
Survival
lesions
Neoplasms
tumors
inks
charts
surgery
Therapeutics
predictions

Keywords

  • Positive margins
  • Radiotherapy
  • Soft-tissue sarcoma

ASJC Scopus subject areas

  • Oncology
  • Radiology Nuclear Medicine and imaging
  • Radiation

Cite this

DeLaney, T. F., Kepka, L., Goldberg, S. I., Hornicek, F. J., Gebhardt, M. C., Yoon, S. S., ... Suit, H. D. (2007). Radiation Therapy for Control of Soft-Tissue Sarcomas Resected With Positive Margins. International Journal of Radiation Oncology Biology Physics, 67(5), 1460-1469. https://doi.org/10.1016/j.ijrobp.2006.11.035

Radiation Therapy for Control of Soft-Tissue Sarcomas Resected With Positive Margins. / DeLaney, Thomas F.; Kepka, Lucyna; Goldberg, Saveli I.; Hornicek, Francis J.; Gebhardt, Mark C.; Yoon, Sam S.; Springfield, Dempsey S.; Raskin, Kevin A.; Harmon, David C.; Kirsch, David G.; Mankin, Henry J.; Rosenberg, Andrew; Nielsen, G. Petur; Suit, Herman D.

In: International Journal of Radiation Oncology Biology Physics, Vol. 67, No. 5, 01.04.2007, p. 1460-1469.

Research output: Contribution to journalArticle

DeLaney, TF, Kepka, L, Goldberg, SI, Hornicek, FJ, Gebhardt, MC, Yoon, SS, Springfield, DS, Raskin, KA, Harmon, DC, Kirsch, DG, Mankin, HJ, Rosenberg, A, Nielsen, GP & Suit, HD 2007, 'Radiation Therapy for Control of Soft-Tissue Sarcomas Resected With Positive Margins', International Journal of Radiation Oncology Biology Physics, vol. 67, no. 5, pp. 1460-1469. https://doi.org/10.1016/j.ijrobp.2006.11.035
DeLaney, Thomas F. ; Kepka, Lucyna ; Goldberg, Saveli I. ; Hornicek, Francis J. ; Gebhardt, Mark C. ; Yoon, Sam S. ; Springfield, Dempsey S. ; Raskin, Kevin A. ; Harmon, David C. ; Kirsch, David G. ; Mankin, Henry J. ; Rosenberg, Andrew ; Nielsen, G. Petur ; Suit, Herman D. / Radiation Therapy for Control of Soft-Tissue Sarcomas Resected With Positive Margins. In: International Journal of Radiation Oncology Biology Physics. 2007 ; Vol. 67, No. 5. pp. 1460-1469.
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abstract = "Purpose: Positive margins (PM) remain after surgery in some soft-tissue sarcoma (STS) patients. We investigated the efficacy of radiation therapy (RT) in STS patients with PM. Methods and Materials: A retrospective chart review was performed on 154 patients with STS at various anatomic sites with PM, defined as tumor on ink, who underwent RT with curative intent between 1970 and 2001. Local control (LC), disease-free survival (DFS), and overall survival (OS) rates were evaluated by univariate (log-rank) and multivariate analysis of prognostic and treatment factors. Results: At 5 years, actuarial LC, DFS, and OS rates were: 76{\%}, 46.7{\%}, and 65.2{\%}, respectively. LC was highest with extremity lesions (p < 0.01), radiation dose >64 Gy (p < 0.05), microscopically (vs. grossly visible) positive margin (p = 0.03), and superficial lesions (p = 0.05). Patients receiving >64 Gy had higher 5-year LC, DFS, and OS rates of 85{\%}, 52.1{\%}, and 67.8{\%} vs. 66.1{\%}, 41.8{\%}, and 62.9{\%} if ≤64 Gy, p < 0.04. OS was worse in patients with G2/G3 tumors with local failure (LF), p < 0.001. Other known prognostic factors, including grade, stage, size, and age (>50), also significantly influenced OS. By multivariate analysis, the best predictors of LC were site (extremity vs. other), p < 0.01 and dose (>64 vs. ≤64 Gy), p < 0.05; the best predictors for OS were size, p < 0.001, gross vs. microscopic PM, p < 0.05, and LF, p < 0.01. Conclusion: Local control is achieved in most PM STS patients undergoing RT. Doses >64 Gy, superficial location, and extremity site are associated with improved LC. OS is worse in patients with tumors with lesions >5 cm, grossly positive margins, and after local failure.",
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AU - DeLaney, Thomas F.

AU - Kepka, Lucyna

AU - Goldberg, Saveli I.

AU - Hornicek, Francis J.

AU - Gebhardt, Mark C.

AU - Yoon, Sam S.

AU - Springfield, Dempsey S.

AU - Raskin, Kevin A.

AU - Harmon, David C.

AU - Kirsch, David G.

AU - Mankin, Henry J.

AU - Rosenberg, Andrew

AU - Nielsen, G. Petur

AU - Suit, Herman D.

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N2 - Purpose: Positive margins (PM) remain after surgery in some soft-tissue sarcoma (STS) patients. We investigated the efficacy of radiation therapy (RT) in STS patients with PM. Methods and Materials: A retrospective chart review was performed on 154 patients with STS at various anatomic sites with PM, defined as tumor on ink, who underwent RT with curative intent between 1970 and 2001. Local control (LC), disease-free survival (DFS), and overall survival (OS) rates were evaluated by univariate (log-rank) and multivariate analysis of prognostic and treatment factors. Results: At 5 years, actuarial LC, DFS, and OS rates were: 76%, 46.7%, and 65.2%, respectively. LC was highest with extremity lesions (p < 0.01), radiation dose >64 Gy (p < 0.05), microscopically (vs. grossly visible) positive margin (p = 0.03), and superficial lesions (p = 0.05). Patients receiving >64 Gy had higher 5-year LC, DFS, and OS rates of 85%, 52.1%, and 67.8% vs. 66.1%, 41.8%, and 62.9% if ≤64 Gy, p < 0.04. OS was worse in patients with G2/G3 tumors with local failure (LF), p < 0.001. Other known prognostic factors, including grade, stage, size, and age (>50), also significantly influenced OS. By multivariate analysis, the best predictors of LC were site (extremity vs. other), p < 0.01 and dose (>64 vs. ≤64 Gy), p < 0.05; the best predictors for OS were size, p < 0.001, gross vs. microscopic PM, p < 0.05, and LF, p < 0.01. Conclusion: Local control is achieved in most PM STS patients undergoing RT. Doses >64 Gy, superficial location, and extremity site are associated with improved LC. OS is worse in patients with tumors with lesions >5 cm, grossly positive margins, and after local failure.

AB - Purpose: Positive margins (PM) remain after surgery in some soft-tissue sarcoma (STS) patients. We investigated the efficacy of radiation therapy (RT) in STS patients with PM. Methods and Materials: A retrospective chart review was performed on 154 patients with STS at various anatomic sites with PM, defined as tumor on ink, who underwent RT with curative intent between 1970 and 2001. Local control (LC), disease-free survival (DFS), and overall survival (OS) rates were evaluated by univariate (log-rank) and multivariate analysis of prognostic and treatment factors. Results: At 5 years, actuarial LC, DFS, and OS rates were: 76%, 46.7%, and 65.2%, respectively. LC was highest with extremity lesions (p < 0.01), radiation dose >64 Gy (p < 0.05), microscopically (vs. grossly visible) positive margin (p = 0.03), and superficial lesions (p = 0.05). Patients receiving >64 Gy had higher 5-year LC, DFS, and OS rates of 85%, 52.1%, and 67.8% vs. 66.1%, 41.8%, and 62.9% if ≤64 Gy, p < 0.04. OS was worse in patients with G2/G3 tumors with local failure (LF), p < 0.001. Other known prognostic factors, including grade, stage, size, and age (>50), also significantly influenced OS. By multivariate analysis, the best predictors of LC were site (extremity vs. other), p < 0.01 and dose (>64 vs. ≤64 Gy), p < 0.05; the best predictors for OS were size, p < 0.001, gross vs. microscopic PM, p < 0.05, and LF, p < 0.01. Conclusion: Local control is achieved in most PM STS patients undergoing RT. Doses >64 Gy, superficial location, and extremity site are associated with improved LC. OS is worse in patients with tumors with lesions >5 cm, grossly positive margins, and after local failure.

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