Comparison of local recurrence with conventional and intensity-modulated radiation therapy for primary soft-tissue sarcomas of the extremity Journal Article

Authors: Folkert, M. R.; Singer, S.; Brennan, M. F.; Kuk, D.; Qin, L. X.; Kobayashi, W. K.; Crago, A. M.; Alektiar, K. M.
Article Title: Comparison of local recurrence with conventional and intensity-modulated radiation therapy for primary soft-tissue sarcomas of the extremity
Abstract: Purpose: The use of intensity-modulated radiation therapy (IMRT) in the treatment of soft tissue sarcoma (STS) of the extremity is increasing, but no large-scale direct comparison has been reported between conventional external-beam radiation therapy (EBRT) and IMRT. Results: Treatment groups were comparable in terms of tumor location, histology, tumor size, depth, and use of chemotherapy. Patients treated with IMRT were older (P =.08), had more high-grade lesions (P =.05), close (< 1 mm) or positive margins (P =.04), preoperative radiation (P <.001), and nerve manipulation (P =.04). Median follow-up was 90 months for patients treated with conventional EBRT and 42 months for patients treated with IMRT. On multivariable analysis adjusting for patient age and tumor size, IMRT retained significance as an independent predictor of reduced LR (hazard ratio = 0.46; 95% CI, 0.24 to 0.89; P =.02) Methods: Between January 1996 and December 2010, 319 consecutive adult patients with primary nonmetastatic extremity STS were treated with limb-sparing surgery and adjuvant radiotherapy (RT) at a single institution. Conventional EBRT was used in 154 patients and IMRT in 165 with similar dosing schedules. Median follow-up time for the cohort was 58 months. Conclusion: Despite a preponderance of higher-risk features (especially close/positive margin) in the IMRT group, IMRT was associated with significantly reduced local recurrence compared with conventional EBRT for primary STS of the extremity.
Keywords: adolescent; adult; cancer chemotherapy; aged; fracture; major clinical study; cancer localization; cancer recurrence; intensity modulated radiation therapy; salvage therapy; treatment duration; cancer radiotherapy; comparative study; follow up; edema; histology; cancer size; soft tissue sarcoma; nerve injury; external beam radiotherapy; leiomyosarcoma; malignant fibrous histiocytoma; synovial sarcoma; acute toxicity; wound complication; radiation dermatitis; liposarcoma; joint stiffness; preoperative radiotherapy; human; article
Journal Title: Journal of Clinical Oncology
Volume: 32
Issue: 29
ISSN: 0732-183X
Publisher: American Society of Clinical Oncology  
Date Published: 2014-10-10
Start Page: 3236
End Page: 3241
Language: English
DOI: 10.1200/jco.2013.53.9452
PROVIDER: scopus
PMCID: PMC4178522
PUBMED: 25185087
Notes: Export Date: 3 November 2014 -- Source: Scopus
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MSK Authors
  1. Murray F Brennan
    748 Brennan
  2. Kaled M Alektiar
    247 Alektiar
  3. Michael Ryan Folkert
    36 Folkert
  4. Li-Xuan Qin
    111 Qin
  5. Aimee Marie Crago
    53 Crago
  6. Samuel Singer
    224 Singer
  7. Deborah Kuk
    77 Kuk