The clinical and functional outcome for patients with radiation-induced soft tissue sarcoma

Authors

  • Soha Riad Bsc,

    1. University Musculoskeletal Oncology Unit, Orthopedic Surgery, Mount Sinai Hospital, Toronto, Ontario, Canada
    2. Sarcoma Site Group and Department of Surgical Oncology, Princess Margaret Hospital, Toronto, Ontario, Canada
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  • David Biau MD, PhD,

    1. University Musculoskeletal Oncology Unit, Orthopedic Surgery, Mount Sinai Hospital, Toronto, Ontario, Canada
    2. Sarcoma Site Group and Department of Surgical Oncology, Princess Margaret Hospital, Toronto, Ontario, Canada
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  • Ginger E. Holt MD, FACS,

    1. Vanderbilt Orthopedic Institute, Nashville, Tennessee
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  • Joel Werier MD, FRCSC,

    1. Division of Orthopedics, Ottawa General Hospital, Ottawa, Ontario, Canada
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  • Robert E. Turcotte MD, FRCSC,

    1. Orthopaedic Oncology Unit, McGill University Health Center, Montreal, Quebec, Canada
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  • Peter C. Ferguson MD, MSc, FRCSC,

    1. University Musculoskeletal Oncology Unit, Orthopedic Surgery, Mount Sinai Hospital, Toronto, Ontario, Canada
    2. Sarcoma Site Group and Department of Surgical Oncology, Princess Margaret Hospital, Toronto, Ontario, Canada
    3. Division of Orthopedic Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
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  • Anthony M. Griffin MSc,

    1. University Musculoskeletal Oncology Unit, Orthopedic Surgery, Mount Sinai Hospital, Toronto, Ontario, Canada
    2. Sarcoma Site Group and Department of Surgical Oncology, Princess Margaret Hospital, Toronto, Ontario, Canada
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  • Colleen I. Dickie BSc,

    1. Sarcoma Site Group and Department of Radiation Oncology, Princess Margaret Hospital, University of Toronto, Toronto, Ontario, Canada
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  • Peter W. Chung MD,

    1. Sarcoma Site Group and Department of Radiation Oncology, Princess Margaret Hospital, University of Toronto, Toronto, Ontario, Canada
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  • Charles N. Catton MD,

    1. Sarcoma Site Group and Department of Radiation Oncology, Princess Margaret Hospital, University of Toronto, Toronto, Ontario, Canada
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  • Brian O'sullivan MD, FRCPC,

    1. Sarcoma Site Group and Department of Radiation Oncology, Princess Margaret Hospital, University of Toronto, Toronto, Ontario, Canada
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  • Jay S. Wunder MD, MSc, FRCSC

    Corresponding author
    1. University Musculoskeletal Oncology Unit, Orthopedic Surgery, Mount Sinai Hospital, Toronto, Ontario, Canada
    2. Sarcoma Site Group and Department of Surgical Oncology, Princess Margaret Hospital, Toronto, Ontario, Canada
    3. Division of Orthopedic Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
    • University Musculoskeletal Oncology Unit, Mount Sinai Hospital, 600 University Avenue, Room 476, Toronto, Ontario, Canada M5G 1X5

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Abstract

BACKGROUND:

Radiation-induced soft tissue sarcomas (RI-STS) are rare, and it is believed that they are associated with a poor prognosis.The authors of this report compared the clinical and functional outcomes of adults who had extremity RI-STS with the outcomes of adults with sporadic STS.

METHODS:

Forty-four patients who were diagnosed with RI-STS from 1989 to 2009 were identified from 4 prospectively collected databases. Patient demographics, surgical and adjuvant treatment parameters, and oncologic and functional outcomes were evaluated.

RESULTS:

The median latent period from irradiation of the primary condition to RI-STS diagnosis was 16 years. The median radiotherapy dose used for the index condition was 45 gray. The median age at RI-STS diagnosis was 56 years. The most common primary diagnoses were breast cancer (36.4%) and lymphoma (34.1%). The most common RI-STS histologies were malignant fibrous histiocytoma (36.4%) and angiosarcoma (18.2%). Forty-two patients underwent surgery, 13 patients received adjuvant radiotherapy, and 8 patients received adjuvant chemotherapy. Systemic metastases occurred in 50% of treated patients (n = 21), and 26% (n = 11) developed local recurrence, the risk of which was lower among patients who received reirradiation (P = .043). The 5-year disease-free interval (DFI) and overall survival (OS) rates for patients with RI-STS who presented without metastasis were 36% and 44%, respectively. Patients who had International Union Against Cancer TNM stage III RI-STS had a significantly worse DFI compared with patients who had stage III sporadic STS (multivariate analysis, P = .051). Eighteen patients with RI-STS underwent functional assessment after surgery, and their results were comparable to those of patients with sporadic STS.

CONCLUSIONS:

Despite aggressive surgical treatment, patients who have RI-STS remain at greater risk of both local and systemic recurrence compared with patients who have sporadic STS, but they can anticipate similar functional outcomes. Reirradiation can be relatively safe and effective if used properly. Cancer 2011. © 2011 American Cancer Society.

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