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Long Term Outcomes in Extremity Soft Tissue Sarcoma (STS) After a Pathologically Negative Re-Resection and Without Radiotherapy (RT)
I. J. Radiation Oncology d Biology d Physics
S94
Volume 69, Number 3, Supplement, 2007
Results: 1083 patients received 1516 courses of RT for palliation of bone mets. 924/1083 (85%) patients have expired, with a median survival of 12.1 months. Date of bone mets diagnosis could be verified for 1027/1083 (95%) patients. Median time from initial cancer diagnosis to bone mets diagnosis was 5.3 months, and the time from bone mets diagnosis to first RT was 1.6 months. 293/ 1083 (27%) patients required a second course of bone RT at a median time of 3.8 mo. Multiple courses of RT were given at a stable median time interval of 2–4 months depending on tumor type, with approx. 30% of patients requiring more RT after each successive course. Results according to breast, genitourinary (GU), lung, and other cancer types are provided in table. Conclusions: Bone metastases represent a high burden of suffering among cancer patients with advanced disease. Radiotherapy continues to play a significant role in the multi-disciplinary care of these patients. Multiple courses of radiotherapy are often required to palliate pain and other complications. Significant trends for service needs can be identified to optimize care plan and strategies, including active follow up by radiation oncologists. Author Disclosure: J.S.Y. Wu, None; M. Kerba, None; K. Cheetham, None; B. Eigl, None; N. Hagen, None.
167
Patterns of Morbidity by Compartments in Soft Tissue Sarcoma (STS) of the Thigh
A. Rimner, M. F. Brennan, S. Singer, K. M. Alektiar Memorial Sloan-Kettering Cancer Center, New York, NY Purpose/Objective(s): Anatomically, the thigh is divided into 3 compartments: anterior, medial, and posterior. There is little data in the literature on the compartment from which STS arise and the respective outcome, especially morbidity. The purpose of this study was to determine whether differences exist in the pattern of morbidity between the 3 thigh compartments in a group treated with limb-sparing surgery and postoperative radiation therapy (RT). Materials/Methods: Between 8/1982 and 10/2002, 255 patients with primary STS of the thigh were treated with limb-sparing surgery and postoperative RT. The patient data from our prospective sarcoma database were reviewed regarding outcome and treatment-related morbidities (CTCAE criteria). Median age was 52 (range: 17–88 years). Of the 255 tumors, 224 (88%) were .5 cm, 210 (82%) high grade, 237 (93%) deep, and the microscopic margins of resection were positive or close in 84 (33%) patients. The types of RT given were as follows: brachytherapy (BRT) alone (63%; median dose: 45 Gy), postoperative external beam RT (EBRT) alone (31%; median dose: 63 Gy), or a combination (6%) of BRT (median: 20 Gy) and EBRT (median: 45 Gy). Results: The median follow-up was 71 months. The overall 5-year local control (LC) rate was 89% (95% CI: 85–93), 5-year distant metastasis-free survival (DMFS) 61% (95% CI: 54–67), and 5-year overall survival (OS) 66% (95% CI: 60–72). The overall rates for complications were 20% wound complications, 13% edema, 13% joint stiffness, 9% nerve damage (excluding those with nerve resection at surgery), and 6% bone fractures. When the cohort of patients was divided according to compartment, the 3 groups were balanced with regard to tumor grade, size, depth, margin status, and the type of RT used. Outcome data by compartment are shown in Table 1. Conclusions: While local tumor control, distant metastasis free and overall survival rates are similar in all 3 compartments of the thigh, wound complications and edema are greater in medial compartment tumors, while nerve damage is greatest in the posterior compartment. Surgical and RT strategies directed at these compartment-specific complications are warranted. Author Disclosure: A. Rimner, None; M.F. Brennan, None; S. Singer, None; K.M. Alektiar, None.
168
Long Term Outcomes in Extremity Soft Tissue Sarcoma (STS) After a Pathologically Negative Re-Resection and Without Radiotherapy (RT)
O. Cahlon, M. Spierer, M. F. Brennan, S. Singer, K. M. Alektiar Memorial Sloan-Kettering Cancer Center, New York, NY Purpose/Objective(s): It is generally assumed that patients with STS who undergo a pathologically negative re-resection have a low recurrence rate and may not require adjuvant RT (RT). However, this has not been well documented in the literature. The purpose of this study was to define the rate of local recurrence (LR) and identify prognostic factors for LR in patients with extremity STS treated with limb-sparing surgery and a pathologically negative re-resection specimen without RT. Materials/Methods: Review of our prospective sarcoma database identified 132 patients with primary, nonmetastatic, extremity STS treated with limb sparing surgery between 6/82–12/02 who had a pathologically confirmed negative re-resection (no tumor found). None of the patients had adjuvant RT. Patients with low grade (LG) tumors that were less than 5 cm were excluded from this analysis. Median age was 47 (range 16–90) with 42% (n = 56) of patients $50 years old. Site was upper extremity in 36% of patients (n = 47) and lower extremity in 64% (n = 85). Of the 132 patients, 20% (n = 27) had LG tumors and 80% (n = 105) high grade (HG). Tumors .5 cm were present in 39% of patients (n = 51) and\5 cm in 61% (n = 81). AJCC stage grouping was as follows: 27 stage I ($5 cm LG), 85 stage II (#5 cm HG or .5 cm superficial HG) and 20 stage III (.5 cm deep HG). Results: With a median follow-up of 84 months, the 5 year actuarial local recurrence (LR) rate was 12% (95% CI: 6–17%). The 5 year actuarial distant relapse free survival (DRFS) and overall survival (OS) rates were 88% (95% CI: 83–94%) and 85%, (95% CI: 78–91%) respectively. Factors associated with higher local recurrence rates were older age and stage III presentation. The 5-year LR rate was 7% (95% CI: 1–13%) for those \50 compared to 18% (95% CI: 7–28%) for those $50 (p = 0.01). For patients with stage III the LR rate was 23% (95% CI: 3–44%) versus 10% (95% CI: 4–15%) for those with stage I/II (p = 0.038). Tumor site and histology did not have a significant impact on LR. When the cohort of patients was divided into 3 groups based on the number of risk factors present, the 5-year LR were as follows: no risk factors (stage I/II and \50 years old) 8%, 1 risk factor (stage III or $50) 12%, and 2 risk factors (stage III and $50) 35%, p = 0.01. Conclusions: Patients with a pathologically negative re-excision represent a heterogenous group. While the overall rate of local recurrence at 5-years was 12% for the entire cohort, when patients are stratified according to stage and/or age, the risk of LR increases from 8% for those without any risk factors (stage I/II and \50 years old), to 12% for only 1 risk factor (stage III or $50), and to 35% (stage III and $50) for 2 risk factors. Therefore, treatment decisions especially with regard to adjuvant RT should be individualized and not be solely based on the finding of a negative re-resection. Author Disclosure: O. Cahlon, None; M. Spierer, None; M.F. Brennan, None; S. Singer, None; K.M. Alektiar, None.
S94
Volume 69, Number 3, Supplement, 2007
Results: 1083 patients received 1516 courses of RT for palliation of bone mets. 924/1083 (85%) patients have expired, with a median survival of 12.1 months. Date of bone mets diagnosis could be verified for 1027/1083 (95%) patients. Median time from initial cancer diagnosis to bone mets diagnosis was 5.3 months, and the time from bone mets diagnosis to first RT was 1.6 months. 293/ 1083 (27%) patients required a second course of bone RT at a median time of 3.8 mo. Multiple courses of RT were given at a stable median time interval of 2–4 months depending on tumor type, with approx. 30% of patients requiring more RT after each successive course. Results according to breast, genitourinary (GU), lung, and other cancer types are provided in table. Conclusions: Bone metastases represent a high burden of suffering among cancer patients with advanced disease. Radiotherapy continues to play a significant role in the multi-disciplinary care of these patients. Multiple courses of radiotherapy are often required to palliate pain and other complications. Significant trends for service needs can be identified to optimize care plan and strategies, including active follow up by radiation oncologists. Author Disclosure: J.S.Y. Wu, None; M. Kerba, None; K. Cheetham, None; B. Eigl, None; N. Hagen, None.
167
Patterns of Morbidity by Compartments in Soft Tissue Sarcoma (STS) of the Thigh
A. Rimner, M. F. Brennan, S. Singer, K. M. Alektiar Memorial Sloan-Kettering Cancer Center, New York, NY Purpose/Objective(s): Anatomically, the thigh is divided into 3 compartments: anterior, medial, and posterior. There is little data in the literature on the compartment from which STS arise and the respective outcome, especially morbidity. The purpose of this study was to determine whether differences exist in the pattern of morbidity between the 3 thigh compartments in a group treated with limb-sparing surgery and postoperative radiation therapy (RT). Materials/Methods: Between 8/1982 and 10/2002, 255 patients with primary STS of the thigh were treated with limb-sparing surgery and postoperative RT. The patient data from our prospective sarcoma database were reviewed regarding outcome and treatment-related morbidities (CTCAE criteria). Median age was 52 (range: 17–88 years). Of the 255 tumors, 224 (88%) were .5 cm, 210 (82%) high grade, 237 (93%) deep, and the microscopic margins of resection were positive or close in 84 (33%) patients. The types of RT given were as follows: brachytherapy (BRT) alone (63%; median dose: 45 Gy), postoperative external beam RT (EBRT) alone (31%; median dose: 63 Gy), or a combination (6%) of BRT (median: 20 Gy) and EBRT (median: 45 Gy). Results: The median follow-up was 71 months. The overall 5-year local control (LC) rate was 89% (95% CI: 85–93), 5-year distant metastasis-free survival (DMFS) 61% (95% CI: 54–67), and 5-year overall survival (OS) 66% (95% CI: 60–72). The overall rates for complications were 20% wound complications, 13% edema, 13% joint stiffness, 9% nerve damage (excluding those with nerve resection at surgery), and 6% bone fractures. When the cohort of patients was divided according to compartment, the 3 groups were balanced with regard to tumor grade, size, depth, margin status, and the type of RT used. Outcome data by compartment are shown in Table 1. Conclusions: While local tumor control, distant metastasis free and overall survival rates are similar in all 3 compartments of the thigh, wound complications and edema are greater in medial compartment tumors, while nerve damage is greatest in the posterior compartment. Surgical and RT strategies directed at these compartment-specific complications are warranted. Author Disclosure: A. Rimner, None; M.F. Brennan, None; S. Singer, None; K.M. Alektiar, None.
168
Long Term Outcomes in Extremity Soft Tissue Sarcoma (STS) After a Pathologically Negative Re-Resection and Without Radiotherapy (RT)
O. Cahlon, M. Spierer, M. F. Brennan, S. Singer, K. M. Alektiar Memorial Sloan-Kettering Cancer Center, New York, NY Purpose/Objective(s): It is generally assumed that patients with STS who undergo a pathologically negative re-resection have a low recurrence rate and may not require adjuvant RT (RT). However, this has not been well documented in the literature. The purpose of this study was to define the rate of local recurrence (LR) and identify prognostic factors for LR in patients with extremity STS treated with limb-sparing surgery and a pathologically negative re-resection specimen without RT. Materials/Methods: Review of our prospective sarcoma database identified 132 patients with primary, nonmetastatic, extremity STS treated with limb sparing surgery between 6/82–12/02 who had a pathologically confirmed negative re-resection (no tumor found). None of the patients had adjuvant RT. Patients with low grade (LG) tumors that were less than 5 cm were excluded from this analysis. Median age was 47 (range 16–90) with 42% (n = 56) of patients $50 years old. Site was upper extremity in 36% of patients (n = 47) and lower extremity in 64% (n = 85). Of the 132 patients, 20% (n = 27) had LG tumors and 80% (n = 105) high grade (HG). Tumors .5 cm were present in 39% of patients (n = 51) and\5 cm in 61% (n = 81). AJCC stage grouping was as follows: 27 stage I ($5 cm LG), 85 stage II (#5 cm HG or .5 cm superficial HG) and 20 stage III (.5 cm deep HG). Results: With a median follow-up of 84 months, the 5 year actuarial local recurrence (LR) rate was 12% (95% CI: 6–17%). The 5 year actuarial distant relapse free survival (DRFS) and overall survival (OS) rates were 88% (95% CI: 83–94%) and 85%, (95% CI: 78–91%) respectively. Factors associated with higher local recurrence rates were older age and stage III presentation. The 5-year LR rate was 7% (95% CI: 1–13%) for those \50 compared to 18% (95% CI: 7–28%) for those $50 (p = 0.01). For patients with stage III the LR rate was 23% (95% CI: 3–44%) versus 10% (95% CI: 4–15%) for those with stage I/II (p = 0.038). Tumor site and histology did not have a significant impact on LR. When the cohort of patients was divided into 3 groups based on the number of risk factors present, the 5-year LR were as follows: no risk factors (stage I/II and \50 years old) 8%, 1 risk factor (stage III or $50) 12%, and 2 risk factors (stage III and $50) 35%, p = 0.01. Conclusions: Patients with a pathologically negative re-excision represent a heterogenous group. While the overall rate of local recurrence at 5-years was 12% for the entire cohort, when patients are stratified according to stage and/or age, the risk of LR increases from 8% for those without any risk factors (stage I/II and \50 years old), to 12% for only 1 risk factor (stage III or $50), and to 35% (stage III and $50) for 2 risk factors. Therefore, treatment decisions especially with regard to adjuvant RT should be individualized and not be solely based on the finding of a negative re-resection. Author Disclosure: O. Cahlon, None; M. Spierer, None; M.F. Brennan, None; S. Singer, None; K.M. Alektiar, None.