OBJECTIVES: We reviewed our institution's experience in treating soft tissue sarcomas of the extremity to identify factors associated with local recurrence, metastasis, and overall survival, to identify patients who may benefit from intensification of therapy. METHODS: A retrospective analysis was performed for patients who underwent both limb-sparing surgery and external beam radiotherapy for extremity sarcoma. Those who had gross residual disease or who presented with recurrent or metastatic disease were excluded. The Kaplan-Meier product limit and multivariate Cox regression were used to estimate local failure-free probability, distant failure-free probability, and overall survival along with associations with patient, tumor, and treatment characteristics. RESULTS: One hundred eighty-eight patients were included in the analysis. Twenty-five (13%) and 46 (24%) experienced local and distant recurrence, respectively. Patients with high/intermediate-grade tumors [hazard ratio (HR)=5.63, 95% confidence interval (CI): 1.27-24.89, P=0.023] or with multifocally positive margins (HR=4.27, 95% CI: 1.20-15.24, P=0.026) were more likely to fail locally. Those with a preceding local recurrence (HR=8.58, 95% CI: 3.87-19.04, P<0.0001), high/intermediate-grade tumors (HR=5.68, 95% CI: 1.28-25.25, P=0.023), or no secondary reexcision (HR=2.5, 95% CI: 1.09-5.74, P=0.031) were more likely to develop metastasis. Patients with local recurrence (HR=3.6, 95% CI: 1.77-7.29, P<0.001), metastasis (HR=16.0, 95% CI: 7.93-32.31, P<0.0001), or without secondary reexcision (HR=3.2, 95% CI: 1.27-8.09, P=0.014) had decreased overall survival. CONCLUSIONS: Patients whose tumor grade or margin status put them at high risk for local failure should be considered for intensification of therapy. Those with a local recurrence should be considered for increased surveillance or systemic therapy, as local failure is associated with subsequent metastasis and decreased survival.
OBJECTIVES: We reviewed our institution's experience in treating soft tissue sarcomas of the extremity to identify factors associated with local recurrence, metastasis, and overall survival, to identify patients who may benefit from intensification of therapy. METHODS: A retrospective analysis was performed for patients who underwent both limb-sparing surgery and external beam radiotherapy for extremity sarcoma. Those who had gross residual disease or who presented with recurrent or metastatic disease were excluded. The Kaplan-Meier product limit and multivariate Cox regression were used to estimate local failure-free probability, distant failure-free probability, and overall survival along with associations with patient, tumor, and treatment characteristics. RESULTS: One hundred eighty-eight patients were included in the analysis. Twenty-five (13%) and 46 (24%) experienced local and distant recurrence, respectively. Patients with high/intermediate-grade tumors [hazard ratio (HR)=5.63, 95% confidence interval (CI): 1.27-24.89, P=0.023] or with multifocally positive margins (HR=4.27, 95% CI: 1.20-15.24, P=0.026) were more likely to fail locally. Those with a preceding local recurrence (HR=8.58, 95% CI: 3.87-19.04, P<0.0001), high/intermediate-grade tumors (HR=5.68, 95% CI: 1.28-25.25, P=0.023), or no secondary reexcision (HR=2.5, 95% CI: 1.09-5.74, P=0.031) were more likely to develop metastasis. Patients with local recurrence (HR=3.6, 95% CI: 1.77-7.29, P<0.001), metastasis (HR=16.0, 95% CI: 7.93-32.31, P<0.0001), or without secondary reexcision (HR=3.2, 95% CI: 1.27-8.09, P=0.014) had decreased overall survival. CONCLUSIONS:Patients whose tumor grade or margin status put them at high risk for local failure should be considered for intensification of therapy. Those with a local recurrence should be considered for increased surveillance or systemic therapy, as local failure is associated with subsequent metastasis and decreased survival.
Authors: Jenna L Mueller; Henry L Fu; Jeffrey K Mito; Melodi J Whitley; Rhea Chitalia; Alaattin Erkanli; Leslie Dodd; Diana M Cardona; Joseph Geradts; Rebecca M Willett; David G Kirsch; Nimmi Ramanujam Journal: Int J Cancer Date: 2015-06-03 Impact factor: 7.396
Authors: William C Eward; Jeffrey K Mito; Cindy A Eward; Jessica E Carter; Jorge M Ferrer; David G Kirsch; Brian E Brigman Journal: Clin Orthop Relat Res Date: 2013-03 Impact factor: 4.176
Authors: Jason Klein; Alex Ghasem; Samuel Huntley; Nathan Donaldson; Martin Keisch; Sheila Conway Journal: Clin Orthop Relat Res Date: 2018-03 Impact factor: 4.176
Authors: Nisreen S Ezuddin; Juan Pretell-Mazzini; Raphael L Yechieli; Darcy A Kerr; Breelyn A Wilky; Ty K Subhawong Journal: Skeletal Radiol Date: 2018-05-21 Impact factor: 2.199
Authors: Jenna L Mueller; Zachary T Harmany; Jeffrey K Mito; Stephanie A Kennedy; Yongbaek Kim; Leslie Dodd; Joseph Geradts; David G Kirsch; Rebecca M Willett; J Quincy Brown; Nimmi Ramanujam Journal: PLoS One Date: 2013-06-18 Impact factor: 3.240
Authors: Jeffrey K Mito; Jorge M Ferrer; Brian E Brigman; Chang-Lung Lee; Rebecca D Dodd; William C Eward; Lisa F Marshall; Kyle C Cuneo; Jessica E Carter; Shalini Ramasunder; Yongbaek Kim; W David Lee; Linda G Griffith; Moungi G Bawendi; David G Kirsch Journal: Cancer Date: 2012-03-21 Impact factor: 6.860