|Long-Term Results of Prospective Trial of Selective Use of Surgery Alone For Patients With T1 Extremity and Trunk Soft Tissue Sarcomas (STS)|
|Peter WT Pisters |
UT MD Anderson Cancer Center, Houston, TX
|OBJECTIVE(S): There is increased perception that not all patients with surgically treated STS require adjuvant radiotherapy. There are no prospective trials reported to date of unimodality treatment. We initiated a prospective trial of surgery with selective use of postoperative external-beam radiotherapy (EBRT) for patients with T1 extremity and trunk STS.|
METHODS: Following multidisciplinary case review and informed consent, patients with T1 primary STS were treated with limb-sparing surgery and microscopic assessment of surgical margins. Postoperative EBRT was employed selectively for patients with microscopically positive final surgical margins (R1 Surgery + RT arm). Patients who underwent resection with microscopically negative final margins did not receive radiotherapy (R0 surgery alone arm).
RESULTS: 84 patients were entered on this protocol between February 1996 and April 2002. Site distribution: extremity (n=48), trunk (n=16). Fifty-three (63%) had high-grade STS; 43 patients (51%) had superficial (T1A) disease. 14 patients underwent resection with positive microscopic margins and were treated with postoperative radiation treatment; 70 underwent resection with negative margins (R0) and were treated by surgery alone. The median follow-up is 59 mos. Local recurrences have been observed in 11 patients (13%; R1 arm 5, R0 arm 6). The 5-year overall actuarial overall survival was 93% (95% CI, 86-100%). In the R0 surgery alone arm, 5-year local recurrence (LR)-free survival was 90% (95% CI, 81-99%).
CONCLUSIONS: Selected patients with primary T1 STS of the extremity and trunk can be treated by surgery alone with satisfactory local control and without the short- and long-term risks associated with radiation treatment.
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