Effectiveness and morbidity of reirradiation in conservative salvage management of recurrent soft tissue sarcoma

Abstract

21507 Background: The management of isolated local recurrence of soft tissue sarcoma is therapeutically complex, and functional conservative management would be preferable to radical or amputative salvage surgery. This study reviews the University of Florida experience using conservative resection and reirradiation to manage isolated local recurrences of soft tissue sarcoma after primary treatment by resection and radiotherapy. Methods: From February 1976 to February 2005, 14 patients who had underwent primary conservative resection and irradiation for soft tissue sarcoma developed an isolated local recurrence and were managed with conservative salvage by combined resection and reirradiation. Three patients had tumors of the distal extremity, 8 of the proximal extremity, and 3 of the trunk. At the time of recurrence, 64% of tumors were greater than 5 cm and 79% were high grade. In combination with gross total resection, 13 of 14 patients received external beam radiotherapy with or without brachytherapy, and 1 patient was treated with brachytherapy alone. Two patients received chemotherapy. Results: The median follow-up was 30 months and no living patients were lost during follow-up. From retreatment, the 5-year actuarial overall survival, cause-specific survival, and local control rates were 40%, 40%, and 18%, respectively. There was a 50% incidence of serious complication requiring either reoperation or leading to permanent functional impairment. Of the 14 patients, only 1 remains disease free and without any significant complication. No treatment factors, including achieving wide surgical margins or delivering higher radiation dosages, seemed to confer an advantage in local control. Patients who were managed with planned preoperative external beam radiation therapy combined with perioperative brachytherapy demonstrated the greatest risks of complications. Conclusions: Salvage therapy for management of locally recurrent soft tissue sarcoma is challenging and the effects of reoperation and reirradiation can be severe. New management strategies are needed that improve the potential for disease control while minimizing the risk of complications. No significant financial relationships to disclose.