BACKGROUND AND OBJECTIVES: The role of a radiation therapy (RT) boost for positive margins following pre-operative RT and surgery in extremity soft tissue sarcomas (STS) is unclear. We assessed the contribution of a boost to local control (LC), disease-free survival (DFS), and overall survival (OS). METHODS: We identified 67 patients treated from 1987 to 2011 with pre-operative RT and surgery with positive margin(s). Select patients received a boost delivered as peri-operative Iridium-192 brachytherapy (BRT), intra-operative electrons (IORT), or post-operative external beam RT (EBRT). RESULTS: Ten patients received no RT boost, 10 received a BRT or IORT boost, and 47 received an EBRT boost. Five-year LC rates for no boost, BRT/IORT boost, and EBRT boost were 100%, 78%, and 71% (P = 0.5). On multivariate analysis, there were no significant predictors for LC. Variables associated with improved DFS rates were single positive margin (P = 0.007) and low tumor grade (P = 0.03). Tumor size <5 cm (P = 0.003), low grade (P = 0.001), and boost (P = 0.02) were associated with longer survival. CONCLUSIONS: We did not identify a LC advantage for an RT boost. Given the unidentified selection factors for delivery of boost and its potential toxicities, its role in this setting remains unproven.
BACKGROUND AND OBJECTIVES: The role of a radiation therapy (RT) boost for positive margins following pre-operative RT and surgery in extremity soft tissue sarcomas (STS) is unclear. We assessed the contribution of a boost to local control (LC), disease-free survival (DFS), and overall survival (OS). METHODS: We identified 67 patients treated from 1987 to 2011 with pre-operative RT and surgery with positive margin(s). Select patients received a boost delivered as peri-operative Iridium-192 brachytherapy (BRT), intra-operative electrons (IORT), or post-operative external beam RT (EBRT). RESULTS: Ten patients received no RT boost, 10 received a BRT or IORT boost, and 47 received an EBRT boost. Five-year LC rates for no boost, BRT/IORT boost, and EBRT boost were 100%, 78%, and 71% (P = 0.5). On multivariate analysis, there were no significant predictors for LC. Variables associated with improved DFS rates were single positive margin (P = 0.007) and low tumor grade (P = 0.03). Tumor size <5 cm (P = 0.003), low grade (P = 0.001), and boost (P = 0.02) were associated with longer survival. CONCLUSIONS: We did not identify a LC advantage for an RT boost. Given the unidentified selection factors for delivery of boost and its potential toxicities, its role in this setting remains unproven.
Authors: Esther Carbó-Laso; Pablo Sanz-Ruiz; José Antonio Calvo-Haro; Miguel Cuervo-Dehesa; Rubén Pérez-Mañanes; Lydia Mediavilla-Santos; Coral Sánchez-Pérez; Ana Álvarez-González; Javier Vaquero-Martín Journal: Int J Clin Oncol Date: 2017-07-17 Impact factor: 3.402
Authors: Rick L M Haas; Aisha B Miah; Cécile LePechoux; Thomas F DeLaney; Elizabeth H Baldini; Kaled Alektiar; Brian O'Sullivan Journal: Radiother Oncol Date: 2015-12-21 Impact factor: 6.280
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