Limb Soft Tissue Sarcoma Research Articles

Relationship of CUL4A gene underexpression and prognosis in localized high-risk soft tissue sarcoma (STS) patients of limbs or trunk wall.

10079 Background: Genes involved in cell cycle checkpoints and chromosome stability seem to be relevant in distant metastases appearance in STS. CUL4A is an E3 ubiquitin ligase that has been related to both p16 activation and maintenance of genomic stability. Expression of CUL4A has been scarcely described in some tumors with divergent outcome and there are no publications regarding its expression in STS patients. We previously showed that protein underexpression of CUL4A in metastatic STS was related to poor survival. Methods: The expression level of CUL4A was determined by quantitative qPCR and was retrospectively performed in a subset of 39 high-risk (grade 3, deep tumours and > than 5 cm) localized STS of limbs or trunk wall patients for which histological material and clinical data were available. Patients of this series were enrolled prospectively into a randomized clinical trial conducted by the Italian and Spanish sarcoma groups (ISG-GEIS 0101) comparing 3 vs 5 cycles of epirrubicin and ifosfamide. Differences in PFS, RFS, and OS were calculated using log-rank test Results: The median age was 51 years with a median follow-up of 52 months. The pathologic subtypes were undifferentiated pleomorphic sarcoma (35.3%), synovial sarcoma (23.5%) and mixed subtypes (41.2%). Location was distributed as inferior limbs (66.6%), upper limbs (25.5%) and trunk wall (7.9%). No relationship was seen between CUL4A expression and clinical variables (histologic types, location, size or response to neoadjuvant treatment). The expression level of CUL4A was significantly associated with events of progression, 65% vs 32%, p =0.037, for expression values under and over the median respectively. Regarding 4 y actuarial survival, there was a significant worse PFS and RFS for patients underexpressing CUL4A (p=0.041 and 0.009 respectively) and a trend towards worse OS (p=0.056). Conclusions: Expression of CUL4A gene shows a prognostic role in sarcomas within this high risk localized subset of STS patients. The outcome of this exploratory analysis is aligned with our hypothesis that genes implicated in cell cycle regulation and chromosome stability could play a relevant prognostic role in STS.

Intentional marginal excision of canine limb soft tissue sarcomas followed by radiotherapy

To evaluate the outcome in a group of dogs treated with postoperative radiotherapy following intentional marginal excision of soft tissue sarcomas from their limbs and to assess parameters for prognostic significance. Patients that had had intentional marginal excision of limb soft tissue sarcomas followed by radiotherapy were selected. A coarse fractionated protocol of four once weekly 8 to 9 Gy by 4 MV x-rays was used. The time to local recurrence was determined. Tumour grade, size, site, number of surgeries, surgeon and time from last surgery to radiotherapy were evaluated as potential prognostic indicators. Fifty-six cases were included. Minor surgical complications occurred in four patients (7%). Tumour recurred locally in 10 dogs (18%). Fourteen dogs died from tumour-related causes (25%). From Cox proportional hazard analysis time from surgery to radiotherapy was the only predictor of tumour recurrence (P=0·039); hazard ratio 8·63. Delaying radiotherapy beyond 4 weeks was associated with improved outcomes. Three dogs developed serious but non-life-threatening local complications; wound dehiscence, self-trauma and osteonecrosis of underlying bone. Intentional marginal excision followed by hypofractionated radiotherapy is a viable option for canine limb soft tissue sarcomas, providing good long-term clinical outcomes and low morbidity.

Postoperative hypofractionated radiotherapy for canine soft tissue sarcomas of limbs:a retrospective study of 14 cases

Postoperative hypofractionated radiotherapy for canine soft tissue sarcomas of limbs:a retrospective study of 14 cases

Intérêt de l’imagerie dans la surveillance des sarcomes des parties molles des membres

PurposeWe have studied the post-treatment follow-up of patients with history of limb soft tissue sarcoma including MR imaging to determine its added value compared to simple clinical follow-up and the impact of MR imaging findings on patient management. We have also studied the value of chest CT to detect metastases. Patients and methodsRetrospective study of 85 patients treated for limb soft tissue sarcoma with post-treatment MR imaging of the affected region. We have studied the percentage of local recurrences and the modality of detection of these recurrences. We have evaluated the impact on management of patients with abnormalities detected on MRI. For distant metastases, we have recorded their percentage and date of occurrence. ResultsThere were five cases of local recurrence, for a percentage of 6%, with 50% detected clinically. The percentage of metastases was 26%. Six biopsies were performed and complementary examinations were performed in 18 cases based on abnormalities detected on MR. ConclusionThese results are in keeping with recommendations from the Fédération nationale des centres de lutte contre le cancer. Imaging is necessary to detect lung metastases.

Histology and outcome in localized high-risk soft tissue sarcomas (STS) treated with preoperative chemotherapy (CHT) with or without radiation therapy (RT) within a phase III trial from the Italian Sarcoma Group (ISG) and the Spanish Sarcoma Group (GEIS).

10089 Background: We reported on a phase III trial comparing 3 versus 5 cycles of preoperative CHT in high-grade localized STS of the extremities and trunk wall. We explored to which extent histological subtype was prognostically relevant in such an adjuvant series. Methods: 311 pts were eligible. All received 3 cycles of preoperative Epirubicin + Ifosfamide, followed by surgery. Local RT was administered before or after surgery. 136 pts were randomized to receive 2 more cycles of adjuvant CHT. In 222 (71%) cases, centralized pathological review was performed. Histology was categorized into 4 groups: MFH/undifferentiated pleomorphic sarcoma and spindle cell sarcoma NOS (Group 1 = 125 pts), leiomyosarcoma (Group 2 = 41 pts), synovial sarcoma (Group 3 = 68 pts), other (Group 4 = 77 pts). The influence of histology OS and RFS was retrospectively assessed through a univariate Cox regression model. Besides, responses to the preoperative treatment according to RECIST (78% evaluated pts of those with measurable disease) and CHOI criteria (50% evaluated pts) were retrospectively recorded. Results: Group 1, Group 2 and Group 3 accounted for about 75% of cases. At a median follow-up of 60 months (range = 24-102), the OS probability was 0.76, 0.48, 0.64 and 0.73, and the RFS probability was 0.61, 0.48, 0.59 and 0.65, respectively, for Groups 1, 2, 3, 4. For both OS and RFS, a trend in favour of a better outcome was observed in Group 1. On the contrary, a diagnosis of leiomyosarcoma correlated with both a worse OS (Group 1 vs Group 2: HR 2.88, 95%CI 1.63 – 5.01) and a worse RFS (Group 2 vs Group 1: HR 1.72, 95%CI 1.03-2.88). Leiomyosarcoma was marked by the highest number of PD according to both RECIST and CHOI criteria, and Group 1 had the highest RR, when changes in tumor density were accounted for with CHOI criteria. Conclusions: In this series of localized high-risk limb and trunk wall STS, leiomyosarcoma performed worse than the other types. This may be the product of the combination of natural history and chemosensitivity. At least in part, the latter may correlate with the outcome.

Phase II Study of Preoperative Intensity Modulated Radiation Therapy for Lower Limb Soft Tissue Sarcoma

Phase II Study of Preoperative Intensity Modulated Radiation Therapy for Lower Limb Soft Tissue Sarcoma

Actualisation de la stratégie thérapeutique locorégionale dans les sarcomes des tissus mous et les tumeurs desmoïdes des membres

The treatment of soft tissue sarcomas of limbs should be discussed within an experienced multimodality team. Surgical resection remains the cornerstone of therapy for localized disease and achieves a five years overall survival around 75% and a local recurrence rate as low as 10% in the best series. In complex cases, neo-adjuvant treatments may be used such as systemic chemotherapy, isolated limb perfusion, or radiotherapy to achieve an optimal conservative approach. Molecular genetics of sarcomas and quality of margins are essential to guide diagnosis and therapeutic selection. In case of marginal or incomplete resection, a new enlarged surgical resection should always be discussed before administration of any adjuvant treatments. Many retrospective studies and two randomized studies (one of adjuvant brachytherapy and one of external beam radiotherapy) have shown that adjuvant radiotherapy after complete surgery significantly reduces the risk of local recurrence in extremity soft tissue sarcomas. A randomized study has compared pre- to postoperative radiotherapy. The results in terms of local control are similar in both arms. The risk of surgical complications is higher in the preoperative arm and the risk of late sequelae is higher in the postoperative arm. A randomized study within the French sarcoma group is ongoing evaluating the omission of postoperative radiotherapy in favourable cases. Presently, the role of systematic first-line invasive treatment (including surgery and/or radiotherapy) of desmoids is debated. It is becoming evident that up to 50% of patients with desmoids benefit from a front-line non-aggressive policy, because growth arrest is a common feature of this disease. Additional study of the molecular determinants of desmoid behaviour is needed to guide treatment.

Detection of local recurrences of limb soft tissue sarcomas: Is magnetic resonance imaging (MRI) relevant?

The role of systematic magnetic resonance imaging (MRI) after resection of soft tissue sarcomas (STS) of the limb is opened to debate. The aim of our study was to retrospectively evaluate the effectiveness of a systematic MRI examination performed in 124 adult patients treated between 1996 and 2006 for a non-metastatic limb STS at our centre: 86 patients (70%) had clear resection margins (R0) and 111 patients (90%) received an adjuvant radiotherapy. Among the 11 local recurrences (9%) which were observed, MRI was able to detect only 2 asymptomatic local recurrences, one with and one without synchronous metastasis. Both had microscopically involved margins (R1). In contrast, MRI showed 11 false positive cases. As the predictive positive value of MRI was 42%, clinical follow-up seems to be more effective. As observed in our study, systematic MRI examination is not relevant for the follow-up of all limb soft tissue sarcomas. A prospective study could be promoted to evaluate the role of MRI in patients at high risk of local recurrence.

Oxaliplatin-dacarbazine combination chemotherapy for the treatment of advanced soft tissue sarcoma of the limbs

BackgroundThis study was designed to explore the feasibility, safety, and outcomes of pre-operative oxaliplatin-dacarbazine combination therapy for the treatment of advanced soft tissue sarcoma (STS) of the limb.Patients and MethodsBetween November 2005 and November 2008, 31 patients with advanced limb STS classified with stage IV STS were randomly assigned into experimental or control groups, and both were given 2 cycles of chemotherapy before undergoing surgery. The regimen for the experimental group was oxaliplatin (120 mg/m2, d1) in combination with dacarbazine (175 mg/m2, d1-3), while that for the control group was a standard vincristine, epirubicin, cyclophosphamide therapy. Operations were carried out four weeks after the second chemotherapy cycle, followed by another 2-4 more chemotherapy cycles of the previous regimen.ResultsFollowing preoperative chemotherapy, the experimental group exhibited a significant improvement in tumor regression compared to controls. Both regimens were well-tolerated, and no significant differences in adverse reactions were noted. At a median follow-up of 24 months, 28 patients were still alive and had normal limb function. The progression free survival rate of the experimental group was significantly higher than that of the control group (10/15 vs. 4/16, p < 0.05).ConclusionOxaliplatin- dacarbazine neoadjuvant/adjuvant chemotherapy improved the prognosis of patients with advanced limb STS in comparison with vincristine, epirubicin, cyclophosphamide combination therapy.

Detection of local recurrences of limb soft-tissue sarcomas: Is magnetic resonance imaging (MRI) relevant?

10582 Background: The role of systematic magnetic resonance imaging (MRI) surveillance after resection of soft-tissue sarcomas (STS) of the limb is opened to debate. The aim of our study was to retrospectively evaluate the effectiveness of a MRI surveillance schedule performed in adult patients. Methods: 124 adult patients have been treated from 1996 to 2006 for a non-metastatic limb STS at our centre: 86 patients (70%) had clear resection margins (R0) and 111 patients (90%) received an adjuvant radiotherapy. 663 MRI examinations were performed, with a median of 5 per patient [range: 1 to 5]. The rythm of surveillance schedule was respected in 57% of the examinations. Results: Forty-one patients (33%) prematurely withdrew from the planned radiological surveillance due to metastasis diagnosis (15 cases), 5-year remission duration (5 cases), other reasons (12 cases), and drop out (9 cases). Among the 11 local recurrences (9%) which were observed, MRI was able to detect only 2 asymptomatic local recurrences, 1 with and 1 without synchronous metastasis, both had microscopically involved margins (R1). In contrast, MRI showed 11 false-positive cases. As the predictive positive value of MRI was 42%, clinical surveillance seems to be more effective. The evaluation of the cost of the systematic MRI surveillance is 200,000 euros. Clinical examination failed in 2 cases (2 asymptomatic local recurrences detected by MRI) as did MRI surveillance (2 false negative cases). In our study, cost-effectiveness was better with clinical examination than MRI surveillance. Conclusions: As observed in our study, systematic MRI surveillance is not relevant for the follow-up of all limb soft-tissue sarcomas. A prospective study could be promoted to evaluate the MRI surveillance of patient at high risk of local recurrence. No significant financial relationships to disclose.

The treatment of limb soft tissue sarcoma with TNF-alfa and pegylated liposomal doxorubicin (PLD): Phase I-II study

10583 Background: Hyperthermic isolation perfusion (HILP) has been employed for STS as limb salvage procedure. Fifty-eight patients affected with unresectable STS have been treated with doxorubicin and 1 mg of TNF-alfa. The CR and PR were 34% and 48% respectively, with a limb salvage rate of 84%. Unfortunately, the limb toxicity was quite high, therefore we decided to employ PLD. Methods: Fourteen patients have been treated with escalating dose of liposomal doxorubicin, starting from 10 mg/L of limb volume up to 18 mg/L, at mean muscle temperature of 41.5C. During HILP blood samples were taken from both systemic and perfusional circulation at 10 minutes intervals. At the end of HILP a tumor and muscle biopsy was carried out in order to evaluate the doxorubicin concentration. A total of 18 STS patients have been treated with PLD. All the patients were monitored in terms of grade of limb toxicity (Wieberdink classification) and systemic toxicity (WHO classification). Eleven patients have been later treated ...

Results of limb‐salvage surgery with vascular reconstruction for soft tissue sarcoma in the lower extremity: Comparison between only arterial and arterovenous reconstruction

Reports on vascular reconstruction in conjunction with limb salvage techniques for soft tissue sarcomas in the lower extremity have been published. The aim of this study was to investigate the necessity for venous reconstruction by comparing the results of arterial reconstruction alone and those of arteriovenous reconstruction. Twenty-five (6.7%) of 373 patients underwent vascular resections for lower limb soft tissue sarcomas. Only arterial reconstruction was performed for 12 patients. Arteriovenous reconstruction was performed for 13 patients. The clinical results, complications, and postoperative function were compared between only arterial reconstruction group and arteriovenous reconstruction group. Limb salvage was achieved in 92% of all cases. No local recurrence has been observed. Nineteen patients (76%) are continuously free of disease. Histopathologic examination of the specimens showed that blood vessels had been infiltrated in 24%. The mean Musculoskeletal Tumor Society score was 70%. There were no significant differences in complication rate and postoperative function between two groups. Wide resection with vascular reconstruction for patients of soft tissue sarcomas involving major vessels in the lower limb provide long term local control and limb salvage. This study could not indicate the usefulness of additional venous reconstruction after vascular resection in the lower extremity.

54 INVITED Long-term cancer survivorship issues: Is there a role for CAM?

Upper limb preservation after soft tissue sarcoma resection often requires flap reconstruction. The aim of this study was to compare pre- and post-operative upper limb function following shoulder, elbow or wrist/hand sarcoma resection and soft tissue reconstruction with a pedicled or free flap.Between 1989 and 2008, 113 patients underwent resection of an upper limb soft tissue sarcoma and required flap reconstruction. Perioperative morbidity, mortality and flap loss were studied. Functional outcome was assessed pre and postoperatively using the Toronto Extremity Salvage Score (TESS), a measure of disability, and the Musculoskeletal Tumour Society Rating Scale (MSTS), a measure of impairment. Statistical analyses were performed to evaluate the relationship between flap type and functional outcome scores.Patients underwent soft tissue sarcoma excision in the shoulder (n = 64), elbow (n = 27) or wrist/hand (n = 22) region with soft tissue reconstruction using either a pedicled (n = 76) or free flap (n = 37). Comparison of the post-operative MSTS (n = 88) and TESS (n = 84) revealed no significant differences between the free and pedicled flap groups. A significant pre- to post-operative difference was identified in MSTS 87 scores for patients in both the pedicled (p < 0.02) and free flap groups (p < 0.04). Comparison of the pre- and post-operative MSTS 93 scores also revealed a significant difference (p < 0.01) but this was limited to the free flap group. The most notable post-operative score reductions in these patients were due to major joint, nerve, tendon or muscle group resection.Reconstruction of the soft tissue defect following sarcoma resection in the upper limb maintains a similar satisfactory level of upper limb activity with either pedicled or free flap reconstructions. Based on TESS scores, patients rated themselves as having better function compared to impairment measures such as MSTS.

Chirurgie des sarcomes des tissus mous des membres chez l'adulte : historique et avancées thérapeutiques

In the seventies, limb-sparing surgery and radiation therapy appeared capable of successfully treating the great majority of adult patients with soft tissue sarcomas of the extremities. No survival benefit could be demonstrated in the patients selected for amputation. Microscopically positive surgical margins are related to a greater risk of local recurrence, whereas overall survival is compromised by high grade and large tumor size. Presurgery multidisciplinary discussion, management in reference center and management within cancer network independently predict conformity to the clinical practice guidelines. Reoperation should be a planned part of definitive management whenever the initial surgical procedure was done without a histologic diagnosis or was not planned to be a wide excision. Soft tissue flap reconstruction facilitates therapy for patients with locally advanced tumors so that patients with larger tumors can undergo resection, limiting complications and limb sacrifice. Vascular reconstruction is a feasible option in case of involvement of major vessels. Isolated limb perfusion (ILP) with TNF and chemotherapy is an efficient limb-sparing neoadjuvant therapy for locally advanced limb soft tissue sarcomas. Efficacy and safety of low-dose TNFα could greatly facilitate ILP procedures in the near future.

Decreased response rates by the combination of histamine and IL-2 in melphalan-based isolated limb perfusion.

Histamine (Hi) combined to melphalan in a rat experimental model of isolated limb perfusion (ILP) for lower limb soft tissue sarcoma, resulted in overall response rates (OR) of 66%. Likewise, ILP with interleukin-2 (IL-2) resulted in OR of 67%, when combined to melphalan, in the same experimental model. In systemic immunotherapy, the combination of IL-2 and Hi has been used for solid tumor treatment based on immunomodulatory effects. In this study, we used our well-established ILP experimental model to evaluate whether the synergistic effect between the two drugs seen in the systemic setting, could further improve response rates in a loco-regional setting. Histological evaluation was done directly and 24 h after ILP. Melphalan uptake by tumor and muscle were measured. Hi and IL-2 together, combined to melphalan in the ILP led to OR of only 28%. Histology of tumors demonstrated partial loss of Hi-induced hemorrhagic effect when IL-2 was present. Melphalan accumulation in the tumor when both Hi and IL-2 were added (3.1-fold) was very similar to accumulation with Hi only (2.8-fold), or IL-2 only (3.5-fold) combined to melphalan. In vitro there was no synergy between the drugs. In conclusion there was a negative synergistic effect between IL-2 and Hi in the regional setting.

A single team experience of adjuvant radiation therapy in adults with intermediate or high-grade limb soft tissue sarcoma

19509 Background: Limb Soft tissue sarcomas (STS) are currently treated with limb sparing surgery (LSS) followed by radiation therapy (RT). This paper summarizes a one-team experience with homogenous population of adult patients, with intermediate or high grade STS confined to a limb, who were approached by LSS and postoperative RT. Methods: From October 1994 through October 2002, 133 adult patients (75 males, 58 females, age range 18–88 years, median 54) with biopsy-proven intermediate or high-grade limb STS were approached by LSS followed by RT. Their files were retrospectively reviewed for treatment outcome: local control, RT side effects, and time to progression. Tumor site was classified according to its proximal border. STS that involved the arm and the upper axilla was classified as axillary STS. Results: RT related toxicity was manageable, with a low rate of severe effects. At 4-year median follow up, there were 48 recurrences of any type, 23 of isolated local failure, and 35 of systemic spread w/o local failure. DFS and OS were influenced by disease stage II versus I, primary site in the upper limb versus lower limb, MPNST versus other types, induction therapy versus no induction, adequate resection Vs marginal resection or involved margins, and good response to induction therapy versus bad response. DFS and OS were Patient’s age and sex, tumor depth, acute or late toxicity of RT, or the interval of time between the date of definitive surgery and the start of RT did not affect DFS and or OS. Conclusions: The RT protocol is applicable in the era of complicated, expensive and time-consuming 3-D therapy. Our results of LSS + RT in adults with limb HG STS are satisfactory. No significant financial relationships to disclose.

Limb sparing approach: Adjuvant radiation therapy in adults with intermediate or high-grade limb soft tissue sarcoma

Background Limb soft tissue sarcomas (STS) are currently treated with limb sparing surgery (LSS) followed by radiation therapy (RT). Patients and methods Between October 1994 and October 2002, 133 adult patients with intermediate or high-grade limb STS were approached by LSS+RT. Results RT related toxicity was manageable, with a low rate of severe effects. At 4-year median follow-up, there were 48 recurrences of any type, 23 of isolated local failure, and 35 of systemic spread w/o local failure. DFS and OS were influenced by disease stage II vs I, primary site in the upper limb vs lower limb, MPNST vs other types, induction therapy vs no induction, adequate resection vs marginal resection or involved margins, and good response to induction therapy vs bad response. DFS and OS were Patient's age and sex, tumor depth, acute or late toxicity of RT, or the interval of time between the date of definitive surgery and the start of RT did not affect DFS and or OS. Conclusions The RT protocol is applicable in the era of complicated, expensive and time-consuming 3D therapy. Our results of LSS+RT in adults with limb HG STS are satisfactory.

Results of limb-sparing surgery with vascular replacement for soft tissue sarcoma in the lower extremity

To evaluate limb-salvage surgery with vascular resection for lower extremity soft tissue sarcomas (STS) in adult patients and to classify blood vessel involvement. Subjects were consecutive patients (median age, 56 years) who underwent vascular replacement during surgery of STS in the lower limb between January 1988 and December 2003. Blood vessel involvement by STS was classified as follows: type I, artery and vein; type II, artery only; type III, vein only; and type IV, neither artery nor vein (excluded from the analysis). Patient data were prospectively gathered in a computerized database. Twenty-one (9.9%) of 213 patients underwent vascular resections for lower limb STS. Besides 17 type I tumors (81.0%), 3 (14.3%) type II and 1 (4.7%) type III STS were diagnosed. Arterial reconstruction was performed for all type I and II tumors. Venous replacement in type I and III tumors was performed in 66.7% of patients. Autologous vein (n = 8) and synthetic (Dacron and expanded polytetrafluoroethylene; n = 12) bypasses were used with comparable frequency for arterial repair, whereas expanded polytetrafluoroethylene prostheses were implanted in veins. Morbidity was 57.2% (hematoma, thrombosis, and infection), and mortality was 5% (embolism). At a median follow-up of 34 months, the primary and secondary patency rates of arterial (venous) reconstructions were 58.3% (54.9%) and 78.3% (54.9%). Limb salvage was achieved in 94.1% of all cases. The 5-year local control rate and survival rate were 80.4% and 52%, respectively. We observed a 5-year metastasis-free survival rate of 37.7% and found vessel infiltration and higher tumor grade (low-grade vs intermediate grade and high grade tumors) to be negative prognostic factors at univariate and multivariate analysis. Long-term bypass patency rates, the high percentage of limb salvage, and the oncologic outcome underline the efficacy of en bloc resection of STS involving major vessels in the lower limb. Disease-specific morbidity must be anticipated. The classification of vascular involvement (type I to IV) is useful for surgical management.

Radiotherapy for spinal cord compression in patients with soft-tissue sarcoma

<h2>Abstract</h2><h3>Purpose</h3> Spinal metastases of soft-tissue sarcoma (STS) occur rarely and pose a therapeutic problem. Although wide resection is warranted for best local control, it is rarely feasible. A radiotherapy (RT) dose of 70 Gy is usually needed to treat limb STS, but only 45 Gy can be given to the spine. In the present series, we report our experience using RT to treat spinal cord compression (SpCC) associated with STS. <h3>Methods and materials</h3> The medical files of 19 adult patients with STS and SpCC were reviewed. RT was considered in all the cases, together with steroids and analgesics. The prescribed dose was 30 Gy in 10 fractions within 12 days. The effect of treatment was evaluated on a clinical basis. <h3>Results</h3> Twenty-three events of SpCC were found. The prevailing symptom was pain. The Karnofsky performance status was 40–70% at presentation. RT was given in all but 1 patient and surgical decompression in 3. Small, but important, improvements in signs and Karnofsky performance status were noted in 14 of 23 cases of SpCC, expressed mainly by pain alleviation and restoration of independence. The median survival after the diagnosis of SpCC was 5 months. <h3>Conclusion</h3> Radiotherapy is an important tool in palliating SpCC in patients with STS.

Radiotherapy for spinal cord compression in patients with soft-tissue sarcoma

Purpose Spinal metastases of soft-tissue sarcoma (STS) occur rarely and pose a therapeutic problem. Although wide resection is warranted for best local control, it is rarely feasible. A radiotherapy (RT) dose of 70 Gy is usually needed to treat limb STS, but only 45 Gy can be given to the spine. In the present series, we report our experience using RT to treat spinal cord compression (SpCC) associated with STS. Methods and materials The medical files of 19 adult patients with STS and SpCC were reviewed. RT was considered in all the cases, together with steroids and analgesics. The prescribed dose was 30 Gy in 10 fractions within 12 days. The effect of treatment was evaluated on a clinical basis. Results Twenty-three events of SpCC were found. The prevailing symptom was pain. The Karnofsky performance status was 40–70% at presentation. RT was given in all but 1 patient and surgical decompression in 3. Small, but important, improvements in signs and Karnofsky performance status were noted in 14 of 23 cases of SpCC, expressed mainly by pain alleviation and restoration of independence. The median survival after the diagnosis of SpCC was 5 months. Conclusion Radiotherapy is an important tool in palliating SpCC in patients with STS.