PURPOSE: This trial was performed to evaluate the impact of adjuvant brachytherapy on local and systemic recurrence rates in patients with soft tissue sarcoma. PATIENTS AND METHODS: In a single-institution prospective randomized trial, 164 patients were randomized intraoperatively to receive either adjuvant brachytherapy (BRT) or no further therapy (no BRT) after complete resection of soft tissue sarcomas of the extremity or superficial trunk. The adjuvant radiation was administered by iridium-192 implant, which delivered 42 to 45 Gy over 4 to 6 days. The two study groups had comparable distributions of patient and tumor factors, including age, sex, tumor site, tumor size, and histologic type and grade. RESULTS: With a median follow-up time of 76 months, the 5-year actuarial local control rates were 82% and 69% in the BRT and no BRT groups (P = .04), respectively. Patients with high-grade lesions had local control rates of 89% (BRT) and 66% (no BRT) (P = .0025). BRT had no impact on local control in patients with low-grade lesions (P = .49). The 5-year freedom-from-distant-recurrence rates were 83% and 76% in the BRT and no BRT groups (P = .60), respectively. Analysis by histologic grade did not demonstrate an impact of BRT on the development of distant metastasis, despite the improvement in local control noted in patients with high-grade lesions. The 5-year disease-specific survival rates for the BRT and no BRT groups were 84% and 81% (P = .65), respectively, with no impact of BRT regardless of tumor grade. CONCLUSION:Adjuvant brachytherapy improves local controlafter complete resection of soft tissue sarcomas. This improvement in local control is limited to patients with high-grade histopathology. The reduction in local recurrence in patients with high-grade lesions is not associated with a significant reduction in distant metastasis or improvement in disease-specific survival.
RCT Entities:
PURPOSE: This trial was performed to evaluate the impact of adjuvant brachytherapy on local and systemic recurrence rates in patients with soft tissue sarcoma. PATIENTS AND METHODS: In a single-institution prospective randomized trial, 164 patients were randomized intraoperatively to receive either adjuvant brachytherapy (BRT) or no further therapy (no BRT) after complete resection of soft tissue sarcomas of the extremity or superficial trunk. The adjuvant radiation was administered by iridium-192 implant, which delivered 42 to 45 Gy over 4 to 6 days. The two study groups had comparable distributions of patient and tumor factors, including age, sex, tumor site, tumor size, and histologic type and grade. RESULTS: With a median follow-up time of 76 months, the 5-year actuarial local control rates were 82% and 69% in the BRT and no BRT groups (P = .04), respectively. Patients with high-grade lesions had local control rates of 89% (BRT) and 66% (no BRT) (P = .0025). BRT had no impact on local control in patients with low-grade lesions (P = .49). The 5-year freedom-from-distant-recurrence rates were 83% and 76% in the BRT and no BRT groups (P = .60), respectively. Analysis by histologic grade did not demonstrate an impact of BRT on the development of distant metastasis, despite the improvement in local control noted in patients with high-grade lesions. The 5-year disease-specific survival rates for the BRT and no BRT groups were 84% and 81% (P = .65), respectively, with no impact of BRT regardless of tumor grade. CONCLUSION: Adjuvant brachytherapy improves local control after complete resection of soft tissue sarcomas. This improvement in local control is limited to patients with high-grade histopathology. The reduction in local recurrence in patients with high-grade lesions is not associated with a significant reduction in distant metastasis or improvement in disease-specific survival.
Authors: Rolf D Issels; Lars H Lindner; Jaap Verweij; Peter Wust; Peter Reichardt; Baard-Christian Schem; Sultan Abdel-Rahman; Soeren Daugaard; Christoph Salat; Clemens-Martin Wendtner; Zeljko Vujaskovic; Rüdiger Wessalowski; Karl-Walter Jauch; Hans Roland Dürr; Ferdinand Ploner; Andrea Baur-Melnyk; Ulrich Mansmann; Wolfgang Hiddemann; Jean-Yves Blay; Peter Hohenberger Journal: Lancet Oncol Date: 2010-04-29 Impact factor: 41.316
Authors: Dian Wang; Qiang Zhang; Burton L Eisenberg; John M Kane; X Allen Li; David Lucas; Ivy A Petersen; Thomas F DeLaney; Carolyn R Freeman; Steven E Finkelstein; Ying J Hitchcock; Manpreet Bedi; Anurag K Singh; George Dundas; David G Kirsch Journal: J Clin Oncol Date: 2015-02-09 Impact factor: 44.544
Authors: Nicole J Look Hong; Francis J Hornicek; David C Harmon; Edwin Choy; Yen-Lin Chen; Sam S Yoon; G Petur Nielsen; Jackie Szymonifka; Beow Y Yeap; Thomas F DeLaney; John T Mullen Journal: Eur J Cancer Date: 2012-10-22 Impact factor: 9.162
Authors: Eelco de Bree; Alexander Karatzanis; Jennifer L Hunt; Primož Strojan; Alessandra Rinaldo; Robert P Takes; Alfio Ferlito; Remco de Bree Journal: Eur Arch Otorhinolaryngol Date: 2014-05-07 Impact factor: 2.503