The Role of Irradiation in the Management of Locally Recurrent Non-Metastatic Soft Tissue Sarcoma of Extremity/Trunkal Locations

[摘要] Background:Patients who have had initial curative intent therapy for non-metastatic soft tissue sarcoma, and whosubsequently relapse at the initial site without evidence of metastatic disease, have various options regarding local treatment.The treatment options available will be determined by the extent of relapse, previous therapy rendered, and patientcharacteristics. We reported on a series of 31 patients treated initially with only surgery for extremity/trunkal high-grade softtissue sarcoma and then seen for recurrence at our institution between 1980 and 1999. Local re-treatment consistedof combined modality therapy, most often aggressive surgical debulking/resection and irradiation, in an effort to reducethe need for amputation and, where anatomically allowable, to maintain a functional limb. We report our results inre-establishing local control, subsequent survival, and complication rates.Methods:Thirty-one patients with locally recurrent, non-metastatic high-grade soft tissue sarcoma, (excluding extraabdominaldesmoid) were retrospectively reviewed to determine local control, survival, and complication rates associatedwith the relapsed disease. All patients had multimodality re-treatment most often utilizing aggressive surgical debulking andirradiation. The irradiation consisted of either external beam alone, brachytherapy alone, or a combination of external beamand brachytherapy. Nine patients also received multi-agent, multi-cycle chemotherapy using various regimens. In addition,the impact of surgical margin at the time of re-resection (gross versus microscopic disease), radiation treatment type, totalradiation dose delivered, size of relapse, histological sub-type, sex and age, were evaluated to determine if they had anyimpact on the re-establishment of local control and subsequent survival.Results:Local control was re-established in 25 of 31 (80.6%) patients. Two additional patients with isolated local relapseafter irradiation were salvaged with amputation and remain NED at last follow-up. With these patients a total of 27/31 (87%)are now with local control. At last follow-up, which ranged from 23 to 192 months, 23 of 31 (74%) remained alive. Of theeight patients who have died, four had evidence of local and distant failure. Two additional patients died of distant failurewhile the treated sites remained in local control and two patients, both NED, died of intracurrent processes. Follow-up forthose patients who had re-established local control has ranged from 23 to 192 months (median=60.5 months). Time tolocal failure following re-treatment ranged between 3 and 72 months following re-treatment (median=12 months). Fivepatients had significant treatment related complications. Included are two patients in which amputation was required due tolocal recurrences. Two patients developed a soft tissue necrosis and one patient had a wound healing problem that resolvedwith conservative management. No statistical significance in the development of local control could be found based onsurgical margin status, total dose of irradiation (greater or less than 60 Gy), size of recurrence (greater than 5 cm),histological sub-type, sex, or age (greater than 50 years). There was a trend for negative impact for those patients receivingonly external beam irradiation.Conclusion:Selective locally recurrent, non-metastatic soft tissue sarcoma of the extremity/trunkal regions should still beconsidered eligible for aggressive limb-sparing therapy. Our experience suggests that a majority of patients re-establish localcontrol following aggressive surgical resection/debulking and irradiation and this appears to be durable in its nature. The roleof chemotherapy in this group of patients remains investigational. In a surprising finding, one patient re-relapsed in there-treatment site at 72 months, thus justifying continued strict surveillance not only in the primary site but also forsubsequent metastatic disease.

[学科分类] 肿瘤学