Outcome of surgery and radiotherapy for dermatofibrosarcoma protuberans: 5-year experience from two tertiary centers of eastern India

Abstract

Dermatofibrosarcoma protuberans (DFSP) is a relatively rare cutaneous soft tissue tumor that is locally aggressive, characterized by high rates of local recurrence, but low risk of metastasis. Wide radical excision is the preferred treatment for DFSP, but local recurrence rates of up to 60% after surgery alone have been documented in cases of close or compromised margin. Adjuvant radiotherapy has been used to reduce such recurrences. A retrospective audit of patients of DFSP in two tertiary care hospitals of eastern India treated radically by surgery with or without adjuvant radiotherapy was undertaken. A cohort of 16 patients receiving treatment between January 2010 and December 2015 was evaluated for presentation, diagnosis, treatment, local control, toxicity, and disease-free survival. The mean age of presentation was 46 years with the range from 17 to 71 years, with 9 out of 16 being females. All patients underwent wide local excision except in two cases, with 8 patients undergoing re-resections after initial excision biopsy. A total of 12 out of 16 patients had less than 2-cm margin, and six had close deep resection margin. Of 16 patients, 10 received adjuvant radiotherapy. With the median follow-up of 39 months, four patients have developed recurrence, three in the surgical cohort and one in the radiotherapy cohort. Two patients in the surgical cohort who have developed recurrence had excision with close margin, and use of postoperative radiotherapy in them was withheld in view of increased risk of toxicity. Combined modality therapy with surgery and radiotherapy for cases of close or inadequate margin results in good local control with acceptable toxicity, in cases where re-surgery is not possible or not contemplated.