Do radiation-associated soft tissue sarcomas have the same prognosis as sporadic soft tissue sarcomas? Journal Article


Authors: Gladdy, R. A.; Qin, L. X.; Moraco, N.; Edgar, M. A.; Antonescu, C. R.; Alektiar, K. M.; Brennan, M. F.; Singer, S.
Article Title: Do radiation-associated soft tissue sarcomas have the same prognosis as sporadic soft tissue sarcomas?
Abstract: Purpose: To determine the prognostic significance of histologic type in radiation-associated soft tissue sarcomas (RASs) and determine whether RASs are associated with an inferior prognosis compared with sporadic soft tissue sarcomas (STSs). Patients and Methods: One hundred thirty primary RASs were identified from 7,649 STS patients from 1982 to 2007. Multivariate analysis of clinicopathologic factors for disease-specific survival (DSS) was performed for RASs, and a multivariate analysis of radiation exposure was also performed for RASs and sporadic sarcomas. A matched-cohort analysis was performed for radiation-associated and sporadic malignant fibrous histiocytoma (MFH). Results: Most RASs were high grade (83%), deep (87%), and truncal (61.5%). The median interval between radiation therapy and RAS development was 10 years (range, 1.3 to 74 years), which varied significantly by histologic type (P = .003). The 5-year DSS was 58%, and independent predictors were size > 5 cm, margin positivity, and histologic type. Multivariate analysis of histologic types of primary, high-grade radiation-associated and sporadic STSs showed that RAS was associated with a worse DSS (hazard ratio, 1.7; range, 1.1 to 2.4; P = .007). For pleomorphic MFH - the most common RAS type - the 5-year DSS was 44% versus 66% in a matched cohort of sporadic MFH patients (P = .07). DSS was significantly worse in primary RAS malignant peripheral nerve sheath tumors (MPNSTs) compared with unmatched sporadic MPNSTs (P = .001). Conclusion: Histologic type, margin status, and tumor size are the most important independent predictors of DSS in patients with RASs. DSS in patients with primary RAS is significantly worse compared with sporadic STS independent of sarcoma histologic type. © 2010 by American Society of Clinical Oncology.
Keywords: adolescent; adult; cancer survival; controlled study; aged; aged, 80 and over; middle aged; primary tumor; young adult; major clinical study; mortality; comparative study; cancer staging; neoplasm staging; proportional hazards models; radiotherapy; risk factors; pathology; angiosarcoma; hemangiosarcoma; risk factor; histology; radiation exposure; time; time factors; risk assessment; sarcoma; kaplan-meiers estimate; proportional hazards model; fibrosarcoma; neoplasms, radiation-induced; soft tissue sarcoma; kaplan meier method; leiomyosarcoma; malignant fibrous histiocytoma; nerve sheath tumor; nerve sheath neoplasms; disease specific survival; radiation carcinogenesis; radiation induced neoplasm; histiocytoma, malignant fibrous
Journal Title: Journal of Clinical Oncology
Volume: 28
Issue: 12
ISSN: 0732-183X
Publisher: American Society of Clinical Oncology  
Date Published: 2010-04-20
Start Page: 2064
End Page: 2069
Language: English
DOI: 10.1200/jco.2009.25.1728
PUBMED: 20308666
PROVIDER: scopus
PMCID: PMC3651600
DOI/URL:
Notes: --- - "Cited By (since 1996): 1" - "Export Date: 20 April 2011" - "CODEN: JCOND" - "Source: Scopus"
Altmetric Score
MSK Authors
  1. Murray F Brennan
    743 Brennan
  2. Kaled M Alektiar
    247 Alektiar
  3. Cristina R Antonescu
    599 Antonescu
  4. Mark Allen Edgar
    45 Edgar
  5. Rebecca Anne Gladdy
    6 Gladdy
  6. Li-Xuan Qin
    111 Qin
  7. Samuel Singer
    224 Singer
  8. Nicole Heather Moraco
    14 Moraco