Nicholas P Gannon1, David M King1, Cecilia G Ethun2, John Charlson3, Thuy B Tran4, George Poultsides4, Valerie Grignol5, J Harrison Howard6, Jennifer Tseng7, Kevin K Roggin7, Konstantinos Votanopoulos8, Bradley Krasnick9, Ryan C Fields9, Kenneth Cardona2, Meena Bedi10. 1. Department of Orthopaedic Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin. 2. Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, Georgia. 3. Division of Hematology and Oncology, Department of Internal Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin. 4. Department of Surgery, Stanford University, Palo Alto, California. 5. Division of Surgical Oncology, Department of Surgery, The Ohio State University, Columbus, Ohio. 6. Division of Surgical Oncology, Department of Surgery, University of South Alabama, Mobile, Alabama. 7. Department of Surgery, University of Chicago, Chicago, Illinois. 8. Department of Surgery, Wake Forest University, Winston-Salem, North Carolina. 9. Department of Surgery, Washington University, St. Louis, Missouri. 10. Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin.
Abstract
BACKGROUND AND OBJECTIVES: Soft-tissue sarcomas (STSs) are often treated with resection and radiation (RT)±chemotherapy. The role of RT in decreasing resection width to achieve local control is unclear. We evaluated RT on margin width to achieve local control and local recurrence (LR). METHODS: From 2000 to 2016, 514 patients with localized STS were identified from the US Sarcoma Collaborative database. Patients were stratified by a margin and local control was compared amongst treatment groups. RESULTS: LR was 9% with positive, 4.2% with ≤1 mm, and 9.3% with >1 mm margins (P = .315). In the ≤1 mm group, LR was 5.7% without RT, 0% with preoperative RT, and 0% with postoperative RT (P < .0001). In the >1 mm group, LR was 10.2%, 0%, and 3.7% in the no preoperative and postoperative RT groups, respectively (P = .005). RT did not influence LR in patients with positive margins. In stage I-III and II-III patients, local recurrence-free survival was higher following RT (P = .008 and P = .05, respectively). CONCLUSIONS: RT may play a larger role in minimizing LR than margin status. In patients with positive margins, RT may decrease LR to similar rates as a negative margin without RT and may be considered to decrease the risk of LR with anticipated close/positive margins.
BACKGROUND AND OBJECTIVES: Soft-tissue sarcomas (STSs) are often treated with resection and radiation (RT)±chemotherapy. The role of RT in decreasing resection width to achieve local control is unclear. We evaluated RT on margin width to achieve local control and local recurrence (LR). METHODS: From 2000 to 2016, 514 patients with localized STS were identified from the US Sarcoma Collaborative database. Patients were stratified by a margin and local control was compared amongst treatment groups. RESULTS: LR was 9% with positive, 4.2% with ≤1 mm, and 9.3% with >1 mm margins (P = .315). In the ≤1 mm group, LR was 5.7% without RT, 0% with preoperative RT, and 0% with postoperative RT (P < .0001). In the >1 mm group, LR was 10.2%, 0%, and 3.7% in the no preoperative and postoperative RT groups, respectively (P = .005). RT did not influence LR in patients with positive margins. In stage I-III and II-III patients, local recurrence-free survival was higher following RT (P = .008 and P = .05, respectively). CONCLUSIONS: RT may play a larger role in minimizing LR than margin status. In patients with positive margins, RT may decrease LR to similar rates as a negative margin without RT and may be considered to decrease the risk of LR with anticipated close/positive margins.