56. The role of external irradiation in postoperative treatment of soft tissue sarcomas – last decade of gliwice experience
Abstract
Aim of the study was to evaluate the role of postoperative external irradiation in the treatment of patients with high risk of local relapse of soft tissue sarcomas, as well as to evaluate the long-term results of this combined treatment. Data charts of the 77 patients with STS treated by surgery and postoperative external beam radiotherapy in Institute of Oncology in Gliwice during the period 1990–1999 has been reviewed. Extremity was the most frequent tumour site (75%), followed by trunk (10%), pelvis (7%), head and neck (4%) and retroperitoneal space (4%). Histological types included liposarcoma (27%), MFH (23%), fibrosarcoma (22%), neurosarcoma (12%), synovial sarcoma (8%) and others (8%). Only in 52% of patients the grade of the tumour was evaluated (G1–12 pts, G2–14 pts, G3–14 pts). Only 23 patients (30%) was treated by chemotherapy after local treatment. In majority patients were primary operated at general surgery departments, outside the reference centre with technique typical for benign tumours. Because of non-radical first surgical treatment and large number of early local recurrences in a whole group over 140 operations has been undertaken. Surgical margins were proven by histological procedures only in 29% of the patients. Long term OS, DFS and LC rates have been 64%, 56% and 69% respectively. Distant metastases have occurred in 30% of pts. during the first 2 years of observation. Prognostic factors have been evaluated in both univariate and multivariate analysis. The most important positive prognostic factors were as follows: radical surgical treatment and concomitant chemo-radiotherapy.
The first, often proven or suspected as non-radical, tumour excision is the most important and probably independent negative prognostic factor for tumour cure and patient survival. For such clinical situations secondary surgical approach as a wide excision is recommended. Because of a large number of cases in analysed material with single or multiple local relapses decision of adjuvant therapy has to be considered individually. It seems that in such clinical situation, postoperative radiotherapy or aggressive radio-chemotherapy in cases with no clinically detected local relapse gives the best chance for survival. The long time of anamnesis, several surgical treatments of tumour relapses with no sarcoma policy stress the need to establish the general national rules for diagnosis and adjuvant treatment of soft tissue sarcomas.