845 10 years experience of adjuvant radiation therapy for localised adult soft tissue sarcomas

Abstract

Between January 1984 and December 1993, 119 adult patients (68 males and 51 females, median age 42.5 years) were treated at our institute for localised sarcoma of extravisceral soft tissue, by maximal conservative surgery followed by adjuvant radiation therapy. 30% had previously undergone surgery and relapsed. Sites affected were the extremities (63.5%), trunk wall (13%), retroperitoneum (9%) and head and neck (4%). Predominant histologies were MFH (27%) and Synovialosarcoma (19%). 85% of tumors were grade 2 or 3. Thirty-seven patients (31%) received chemotherapy. In 75% of the cases, radiation therapy was performed using standard techniques and doses of at least 45 Gy. Bifractionated radiotherapy (dose 45 Gy) was used for patients treated between 1989 and 1992 (25%). Treatment evaluation was performed on 1st March, 1995. Median follow-up is 66 months. 24% of the patients relapsed locally, and 47% developed metastatic disease. Median intervals between surgery and local or metastatic relapse were respectively 14 and 13 months. Overall actuarial survival and disease-free survival at 2 years are respectively 77 and 47%. Grade, tumor size, tumor depth, bony or neurovascular involvement as well as quality of surgery show significant effects on DFS. Considering prognosis, hyperfractionated radiotherapy did not seem to be superior to standard techniques. Long term side-effects, although usually mild, occurred in 35% of the patients. Dose of therapy, but not size of treatment fields, positively influenced them. Between January 1984 and December 1993, 119 adult patients (68 males and 51 females, median age 42.5 years) were treated at our institute for localised sarcoma of extravisceral soft tissue, by maximal conservative surgery followed by adjuvant radiation therapy. 30% had previously undergone surgery and relapsed. Sites affected were the extremities (63.5%), trunk wall (13%), retroperitoneum (9%) and head and neck (4%). Predominant histologies were MFH (27%) and Synovialosarcoma (19%). 85% of tumors were grade 2 or 3. Thirty-seven patients (31%) received chemotherapy. In 75% of the cases, radiation therapy was performed using standard techniques and doses of at least 45 Gy. Bifractionated radiotherapy (dose 45 Gy) was used for patients treated between 1989 and 1992 (25%). Treatment evaluation was performed on 1st March, 1995. Median follow-up is 66 months. 24% of the patients relapsed locally, and 47% developed metastatic disease. Median intervals between surgery and local or metastatic relapse were respectively 14 and 13 months. Overall actuarial survival and disease-free survival at 2 years are respectively 77 and 47%. Grade, tumor size, tumor depth, bony or neurovascular involvement as well as quality of surgery show significant effects on DFS. Considering prognosis, hyperfractionated radiotherapy did not seem to be superior to standard techniques. Long term side-effects, although usually mild, occurred in 35% of the patients. Dose of therapy, but not size of treatment fields, positively influenced them.