Impact of intensity-modulated radiation therapy on local control in primary soft-tissue sarcoma of the extremity Journal Article


Authors: Alektiar, K. M.; Brennan, M. F.; Healey, J. H.; Singer, S.
Article Title: Impact of intensity-modulated radiation therapy on local control in primary soft-tissue sarcoma of the extremity
Abstract: Purpose: One of the concerns about intensity-modulated radiation therapy (IMRT) is that its tight dose distribution, an advantage in reducing RT morbidity to surrounding normal structures, might compromise tumor coverage. The purpose of this study is to determine if such concern is warranted in soft-tissue sarcoma (STS) of the extremity. Methods: Between 02/02 and 05/05, 41 adult patients with primary STS of the extremity were treated with limb-sparing surgery and adjuvant IMRT. The margins were positive/within 1 mm in 21. Tumor size was more than 10 cm in 68% of patients and grade was high in 83%. Preoperative IMRT was given to 7 patients (50 Gy) and postoperative IMRT (median dose, 63 Gy) was given to 34 patients. Complete gross resection including periosteal stripping/bone resection was required in 11, and neurolysis/nerve resection in 24. Results: With a median follow-up time of 35 months, two (4.8%) of 41 patients developed local recurrence. The 5-year actuarial local control rate was 94% (95% CI, 86% to 100%). The local control rate was also 94% for patients with negative or positive/close margin. Other prognostic factors such as age, size, and grade did not impact local control either. The 5-year distant control rate was 61% (95% CI, 45% to 76%) and the overall survival rate was 64% (95% CI, 45% to 84%). Conclusion: IMRT in STS of the extremity provides excellent local control in a group of patients with high risk features. This suggests that the precision with which IMRT dose is distributed has a beneficiary effect in sparing normal tissue and improving local control. © 2008 by the American Society of Clinical Oncology.
Keywords: survival; adult; cancer survival; clinical article; controlled study; treatment outcome; aged; aged, 80 and over; bone neoplasms; middle aged; survival analysis; bone tumor; fracture; mortality; cancer recurrence; intensity modulated radiation therapy; adjuvant therapy; cancer radiotherapy; radiation dose; radiotherapy, adjuvant; cancer staging; follow up; methodology; follow-up studies; neoplasm staging; cancer grading; edema; cohort studies; neoplasm recurrence, local; tumor volume; radiotherapy dosage; cohort analysis; pathology; radiation injury; risk assessment; sarcoma; kaplan-meiers estimate; cancer invasion; limb; radiotherapy, intensity-modulated; probability; tumor recurrence; radiation injuries; soft tissue sarcoma; extremities; nerve injury; neoplasm invasiveness; kaplan meier method; cancer control; wound infection; statistics, nonparametric; neurolysis; joint stiffness; nonparametric test; bone resection
Journal Title: Journal of Clinical Oncology
Volume: 26
Issue: 20
ISSN: 0732-183X
Publisher: American Society of Clinical Oncology  
Date Published: 2008-07-10
Start Page: 3440
End Page: 3444
Language: English
DOI: 10.1200/jco.2008.16.6249
PUBMED: 18612160
PROVIDER: scopus
DOI/URL:
Notes: --- - "Cited By (since 1996): 16" - "Export Date: 17 November 2011" - "CODEN: JCOND" - "Source: Scopus"
Altmetric Score
MSK Authors
  1. Murray F Brennan
    759 Brennan
  2. Kaled M Alektiar
    248 Alektiar
  3. Samuel Singer
    225 Singer
  4. John H Healey
    374 Healey