Preoperative versus postoperative radiotherapy in soft-tissue sarcoma

Multi-institutional analysis of 821 patients

Sagus Sampath, Timothy E. Schultheiss, Ying J. Hitchcock, R Randall, Dennis C. Shrieve, Jeffrey Y.C. Wong

Research output: Contribution to journalReview article

43 Citations (Scopus)

Abstract

Purpose: To assess the impact of radiotherapy (RT) sequencing with surgery on overall survival (OS), cause-specific survival (CSS), local failure, and distant failure in soft-tissue sarcoma (STS). Methods and Materials: A retrospective analysis was conducted using the National Oncology Database, a proprietary database of aggregated tumor registries owned by IMPAC Medical Systems (Sunnyvale, CA). Patients with STS of all major anatomic sites who received definitive surgery and either preoperative (preop) or postoperative (postop) RT were included. Patients were also required to have known stage and grade. Prognostic factors for survival were identified using multivariate techniques. Survival was calculated using the Kaplan-Meier method, and compared for statistical significance (p < 0.05) using the log-rank test. Results: A total of 821 patients met inclusion criteria. The median follow-up time was 63 months. Age, stage, histology, gender, tumor size, and RT sequence were independent predictors for OS (p < 0.05). Preop RT was associated with significantly improved OS and CSS compared with postop RT (hazard ratio [HR] = 0.72, 95% confidence interval [CI] 0.56-0.91, p < 0.01, and HR = 0.64, 95% CI 0.46-0.88, p < 0.01, respectively). The 5-year CSS was 79% and 74%, in favor of preop RT (log-rank, p < 0.05). Preop RT was also significantly associated with a reduced risk for local and distant relapse compared with postop RT. Conclusion: Preoperative RT is associated with a reduced cancer-specific mortality compared with postoperative RT in STS. The results of this study may serve as motivation to conduct future prospective studies with larger patient numbers.

Original languageEnglish (US)
Pages (from-to)498-505
Number of pages8
JournalInternational Journal of Radiation Oncology Biology Physics
Volume81
Issue number2
DOIs
StatePublished - Oct 1 2011
Externally publishedYes

Fingerprint

Sarcoma
radiation therapy
Radiotherapy
cancer
Survival
surgery
hazards
causes
confidence
tumors
rank tests
Databases
Confidence Intervals
intervals
Neoplasms
sequencing
histology
mortality
Registries
grade

Keywords

  • Preoperative
  • Radiotherapy
  • Sarcoma
  • Sequence
  • Soft-tissue

ASJC Scopus subject areas

  • Radiation
  • Oncology
  • Radiology Nuclear Medicine and imaging
  • Cancer Research

Cite this

Preoperative versus postoperative radiotherapy in soft-tissue sarcoma : Multi-institutional analysis of 821 patients. / Sampath, Sagus; Schultheiss, Timothy E.; Hitchcock, Ying J.; Randall, R; Shrieve, Dennis C.; Wong, Jeffrey Y.C.

In: International Journal of Radiation Oncology Biology Physics, Vol. 81, No. 2, 01.10.2011, p. 498-505.

Research output: Contribution to journalReview article

Sampath, Sagus ; Schultheiss, Timothy E. ; Hitchcock, Ying J. ; Randall, R ; Shrieve, Dennis C. ; Wong, Jeffrey Y.C. / Preoperative versus postoperative radiotherapy in soft-tissue sarcoma : Multi-institutional analysis of 821 patients. In: International Journal of Radiation Oncology Biology Physics. 2011 ; Vol. 81, No. 2. pp. 498-505.
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abstract = "Purpose: To assess the impact of radiotherapy (RT) sequencing with surgery on overall survival (OS), cause-specific survival (CSS), local failure, and distant failure in soft-tissue sarcoma (STS). Methods and Materials: A retrospective analysis was conducted using the National Oncology Database, a proprietary database of aggregated tumor registries owned by IMPAC Medical Systems (Sunnyvale, CA). Patients with STS of all major anatomic sites who received definitive surgery and either preoperative (preop) or postoperative (postop) RT were included. Patients were also required to have known stage and grade. Prognostic factors for survival were identified using multivariate techniques. Survival was calculated using the Kaplan-Meier method, and compared for statistical significance (p < 0.05) using the log-rank test. Results: A total of 821 patients met inclusion criteria. The median follow-up time was 63 months. Age, stage, histology, gender, tumor size, and RT sequence were independent predictors for OS (p < 0.05). Preop RT was associated with significantly improved OS and CSS compared with postop RT (hazard ratio [HR] = 0.72, 95{\%} confidence interval [CI] 0.56-0.91, p < 0.01, and HR = 0.64, 95{\%} CI 0.46-0.88, p < 0.01, respectively). The 5-year CSS was 79{\%} and 74{\%}, in favor of preop RT (log-rank, p < 0.05). Preop RT was also significantly associated with a reduced risk for local and distant relapse compared with postop RT. Conclusion: Preoperative RT is associated with a reduced cancer-specific mortality compared with postoperative RT in STS. The results of this study may serve as motivation to conduct future prospective studies with larger patient numbers.",
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AB - Purpose: To assess the impact of radiotherapy (RT) sequencing with surgery on overall survival (OS), cause-specific survival (CSS), local failure, and distant failure in soft-tissue sarcoma (STS). Methods and Materials: A retrospective analysis was conducted using the National Oncology Database, a proprietary database of aggregated tumor registries owned by IMPAC Medical Systems (Sunnyvale, CA). Patients with STS of all major anatomic sites who received definitive surgery and either preoperative (preop) or postoperative (postop) RT were included. Patients were also required to have known stage and grade. Prognostic factors for survival were identified using multivariate techniques. Survival was calculated using the Kaplan-Meier method, and compared for statistical significance (p < 0.05) using the log-rank test. Results: A total of 821 patients met inclusion criteria. The median follow-up time was 63 months. Age, stage, histology, gender, tumor size, and RT sequence were independent predictors for OS (p < 0.05). Preop RT was associated with significantly improved OS and CSS compared with postop RT (hazard ratio [HR] = 0.72, 95% confidence interval [CI] 0.56-0.91, p < 0.01, and HR = 0.64, 95% CI 0.46-0.88, p < 0.01, respectively). The 5-year CSS was 79% and 74%, in favor of preop RT (log-rank, p < 0.05). Preop RT was also significantly associated with a reduced risk for local and distant relapse compared with postop RT. Conclusion: Preoperative RT is associated with a reduced cancer-specific mortality compared with postoperative RT in STS. The results of this study may serve as motivation to conduct future prospective studies with larger patient numbers.

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