Yumuşak Doku Sarkomu Olan Hastalarda Radyoterapi Sonuçları ve Prognostik Faktörler

Öz

Objective: We retrospectively evaluated treatment outcomes and prognostic factors in 86 patients with soft tissue sarcoma treated with postoperative or primary radiotherapy. Materials and Methods: Patients with soft tissue sarcoma who received postoperative or primary RT were retrospectively evaluated. Parameters such as stage, location, histopathological type, tumor size, surgical features, chemotherapy status and radiotherapy dose/fractionation were evaluated in terms of prognostic value of the disease. Results: The median age of the patients was 45 years (18-80), 45 (52%) were male and 41 (48%) were female. The median dose of radiotherapy was 60 (40-70) Gy at 1.8-2 Gy/ fraction. The median follow-up period was 53 (3-246 months) months. Five-year overall survival, disease-free survival and local control were 68%, 61% and 76%, respectively. In univariate analysis, tumor size >10 cm (p=0.01), deep location (p=0.001), grade III-IV (p=0.0001), stage III (p=0.02) and (+) surgical margin (p=0.002) for OS, grade III-IV (p=0.0001), stage III (p=0. 030) and (+) surgical margin (p=0.012); for local control, tumor localization (extremity vs other) (p=0.028), grade III-IV (p=0.004), depth (p=0.035) and (+) surgical margin (p<0.0001) were found to be significant prognostic factors. In multivariate analysis, grade III-IV for overall survival and disease-free survival (p=0.004 and p=0.001, respectively), surgical margin for local control (p=0.0001) and tumor localization (p=0.06), although not statistically significant, were found to be significant prognostic factors. Conclusion: In our study; high grade, positive surgical margins and tumor location outside the extremity were found to be the most important prognostic factors. These results are consistent with previous studies and should be taken into consideration in treatment planning.

Anahtar Kelimeler

• Keywords: Grade
• local control
• prognostic factor
• radiotherapy
• soft tissue sarcoma.

Radiotherapy Outcomes and Prognostic Factors in Patients with Soft Tissue Sarcoma

Abstract

Objective: We retrospectively evaluated treatment outcomes and prognostic factors in 86 patients with soft tissue sarcoma treated with postoperative or primary radiotherapy. Materials and Methods: Patients with soft tissue sarcoma who received postoperative or primary RT were retrospectively evaluated. Parameters such as stage, location, histopathological type, tumor size, surgical features, chemotherapy status and radiotherapy dose/fractionation were evaluated in terms of prognostic value of the disease. Results: The median age of the patients was 45 years (18-80), 45 (52%) were male and 41 (48%) were female. The median dose of radiotherapy was 60 (40-70) Gy at 1.8-2 Gy/ fraction. The median follow-up period was 53 (3-246 months) months. Five-year overall survival, disease-free survival and local control were 68%, 61% and 76%, respectively. In univariate analysis, tumor size >10 cm (p=0.01), deep location (p=0.001), grade III-IV (p=0.0001), stage III (p=0.02) and (+) surgical margin (p=0.002) for OS, grade III-IV (p=0.0001), stage III (p=0. 030) and (+) surgical margin (p=0.012); for local control, tumor localization (extremity vs other) (p=0.028), grade III-IV (p=0.004), depth (p=0.035) and (+) surgical margin (p<0.0001) were found to be significant prognostic factors. In multivariate analysis, grade III-IV for overall survival and disease-free survival (p=0.004 and p=0.001, respectively), surgical margin for local control (p=0.0001) and tumor localization (p=0.06), although not statistically significant, were found to be significant prognostic factors. Conclusion: In our study; high grade, positive surgical margins and tumor location outside the extremity were found to be the most important prognostic factors. These results are consistent with previous studies and should be taken into consideration in treatment planning.

Keywords

• Grade
• local control
• prognostic factor
• radiotherapy
• soft tissue sarcoma.

Kaynakça

1. 1. Karakousis CP, Perez RP. Soft tissue sarcomas in adults. CA: a cancer journal for clinicians. 1994;44(4):200-210.
2. 2. Ferrari A, Sultan I, Huang TT, et al. Soft tissue sarcoma across the age spectrum: a population-based study from the Surveillance Epidemiology and End Results database. Pediatric blood & cancer. 2011;57(6):943-949.
3. 3. Penel N, Grosjean J, Robin YM, et al. Frequency of certain established risk factors in soft tissue sarcomas in adults: a prospective descriptive study of 658 cases. Sarcoma. 2008;2008:459386.
4. 4. Demetri GD, Baker LH, Beech D, et al. Soft tissue sarcoma clinical practice guidelines in oncology. Journal of the National Comprehensive Cancer Network : JNCCN. 2005;3(2):158-194.
5. 5. Serban B, Cretu B, Cursaru A, et al. Local recurrence management of extremity soft tissue sarcoma. EFORT open reviews. 2023;8(8):606-614.
6. 6. Park D. Yasal/Özel Etik Kurul İzin Belgesi Alınması 2025 [Available from: https://dergipark.org.tr/tr/pub/ibad/page/9412.
7. 7. Steen S, Stephenson G. Current treatment of soft tissue sarcoma. Proceedings Baylor University Medical Center. 2008;21(4):392-396.
8. 8. Nedea EA, DeLaney TFJHOC. Sarcoma and skin radiation oncology. 2006;20(2):401-429.

9. 9. Cosci I, Del Fiore P, Mocellin S, et al. Gender Differences in Soft Tissue and Bone Sarcoma: A Narrative Review. Cancers. 2023;16(1).
10. 10. Katz D, Palmerini E, Pollack SM. More Than 50 Subtypes of Soft Tissue Sarcoma: Paving the Path for Histology-Driven Treatments. 2018(38):925-938.
11. 11. Yildiz C, Erler K, Bilgiç S, et al. The effects of surgical margins on local control and survival in extremity soft tissue sarcomas. Acta orthopaedica et traumatologica turcica. 2003;37(5):359-367.
12. 12. O'Donnell PW, Griffin AM, Eward WC, et al. The effect of the setting of a positive surgical margin in soft tissue sarcoma. 2014;120(18):2866-2875.
13. 13. Cheng EYJHOC. Surgical management of sarcomas. 2005;19(3):451-470.
14. 14. Eilber FC, Eilber FR, Eckardt J, et al. The impact of chemotherapy on the survival of patients with high-grade primary extremity liposarcoma. Annals of surgery. 2004;240(4):686-695; discussion 695-687.
15. 15. Rakici SY, Çinar Y, Eren M. Total scalp irradiation: the comparison of five different plans using volumetric modulated arc therapy-simultaneous integrated boost (VMAT-SIB) technique. 2017;32(3).
16. 16. Schwartz DL, Einck J, Hunt K, et al. The effect of delayed postoperative irradiation on local control of soft tissue sarcomas of the extremity and torso. Int J Radiat Oncol Biol Phys. 2002;52(5):1352-1359.