Presenter: S. Goldberg Affiliation: Harvard Medical School, Mass General Hospital, Boston, MA Other Authors: A. Agarwal, T. DeLaney, M. Niemerko, A. Niemerko, H. Suit
Bone and soft tissue extremity sarcoma is usually treated with a combination of surgery and radiation
Proton radiation has been used post-operatively in selected cases at MGH since 1971.
Material and Methods
This is a retrospective, single institutional review of sarcomas treated with proton radiotherapy
216 patients with primary soft tissue sarcoma were treated with protons between January 1971 and December 2005
The following variables were reviewed:
anatomical site, size (< 5 cm or > 5 cm), grade (1-4/4), extent of surgical resection (biopsy, R2, R1, or R0), curative vs. palliative intent, gender, radiation dose, T-stage, N-stage
Median Radiation Dose:
Soft tissue sarcoma: 64.8 CGE
Bone sarcoma: 71.9 CGE (chordomas were treated with higher doses: 74.2 CGE)
Mean follow-up: 40 months (median 60 months)
Local failure: 33% at 5 yr and 47% at 10 yr
Overall survival: 72% at 5 yr and 62% at 10 yr
The only variable that was significant for local failure was size (p=0.02), and none of the other variables were significant in terms of local failure or survival
The local control and overall survival rates in this series are worse than what would be expected for extremity sarcomas, probably reflecting the selection of these patients for proton radiotherapy
Smaller tumors (<5 cm) showed a statistically significantly better local control when treated with proton radiotherapy, although overall survival was the same irrespective of tumor size
Theis long-term series represents one of the largest sarcoma experiences for patients treated with protons
This analysis is consistent with historically identified prognostic factors
Clinical and Scientific Implications
This retrospective review of 216 patients with sarcoma treated with proton radiotherapy will serve as a historical control for future studies
Proton therapy is an excellent method to deliver adjuvant radiation, especially in difficult to treat areas
It is surprising that only size fell out as an important prognostic factor. Previous studies have shown that grade, margin status, and stage correlated with local control and overall survival, and it is unclear why only size was important in this series.
Aug 20, 2014 - Despite a lower prevalence of amputations, limb salvage surgery may not offer a more effective outcome for health-related quality of life for younger individuals with bone and soft tissue sarcomas of the leg, according to a review published online Aug. 10 in Cancer.