Long-term clinical outcome of patients with soft tissue sarcomas treated with limb-sparing surgery and postoperative radiotherapy

Figures & data

Table I. Patient characteristics.

	N	%
Gender
Female	60	50.8
Male	58	49.2
Age
≤ 50 years	49	41.5
> 50 years	69	58.5
Presentation
Primary	109	92.4
Recurrent	9	7.6
Site
Upper extremity	29	24.6
Lower extremity	89	75.4
Histological subtype (WHO classification 2002 [10])
Sarcoma NOS	7	5.9
Fibroblastic/myofibroblastic tumors:
Low grade myofibroblastic sarcoma	2	1.7
Myxoinflammatory fibroblastic sarcoma	1	0.8
Myxofibrosarcoma	17	14.4
Low grade fibromyxoid sarcoma/hyalizing spindle cell tumor	1	0.8
Adipocytic tumors:
Dedifferentiated liposarcoma	2	1.7
Myxoid liposarcoma	17	14.4
Pleomorphic liposarcoma	3	2.5
Atypical lipomatous tumor	1	0.8
So-called Fibrohistiocytic tumors:
Pleomorphic MFH/Undiff pleomorphic sarcoma	7	5.9
Giant cell MFH/Undiff pleopmorphic sarcoma with giant cells	1	0.8
Smooth muscle tumors:
Leiomyosarcoma	15	12.7
Skeletal muscle tumors:
Pleomorphic rhabdomyosarcoma	3	2.5
Chondro-osseous tumors:
Extraskeletal osteosarcoma	3	2.5
Tumors of uncertain differentiation:
Myoepithelioma, malignant	2	1.7
Synovial sarcoma	14	11.9
Epitheloid sarcoma	4	3.4
Clear cell sarcoma	3	2.5
Extraskeletal Ewing sarcoma	2	1.7
MPNST	11	9.3
Granular cell tumor, malignant	2	1.7
Size (pathology/clinical)
≤ 5.0 cm	46	39.0
5.1–10.0 cm	43	36.4
> 10.0 cm	29	24.6
Grade
Grade I + II	28	23.7
Grade III	90	76.3
Surgical margins
Involved	29	24.5
Marginal	75	63.6
Wide	12	10.2
Unknown	2	1.7
Anatomical depth
Deep	79	66.9
Superficial	35	29.7
Unknown	4	3.4

Table II. Characteristics and treatment results of patients with local and regional recurrence.

Characteristics (n = 19)	Local recurrence (n = 12)		Regional recurrence (n = 7)
	N	%	N	%
Histologic subtype
Myxofibrosarcoma	2/17	11.8	1/17	5.9
Synovial sarcoma	2/14	14.3	1/14	7.1
Clear cell sarcoma	0/3	0	2/3	66.7
MPNST	3/11	27.3	1/11	9.1
Other	5/73	6.8	2/73	2.7
Surgical margins (initial surgery)
Involved	4/29	13.8	3/30	10.3
Marginal	8/75	10.7	3/77	4.0
Wide	0/12	0	1/12	8.3
Radiation field
In field	9/12	75.0	0/7	0
Out-of-field	0/12	0	4/7	57.1
Edge of field	2/12	16.7	3/7	42.9
Unknown	1/12	8.3	0/7	0
Salvage treatment
Yes, type:	12/12	100.0	4/7	57.1
S	7/12	58.3	1/7	14.3
S + RT	2/12	16.7	2/7	28.6
S + RT + CT	1/12	8.3	0/7	0
S + CT	1/12	8.3	0/7	0
CT	1/12	8.3	1/7	14.3
No/unknown	0/12	0	3/7	42.9
Results treatment (at 6 months)
LC	9/12	75.0	2/7	28.6
SD	1/12	8.3	0/7	0
PD	2/12	16.7	3/7	42.9
Unknown	0/12	0	2/7	28.6
2nd recurrence
Yes	3/12	25.0	0/7	0
local	2/12	16.7	0/7	0
regional	1/12	8.3	0/7	0
No	9/12	75.0	7/7	100.0
Metastasis
Yes	8/12	66.7	6/7	85.7
No	4/12	33.3	1/7	14.3

CT, chemotherapy; LC, local control; PD, progressive disease; RT, radiotherapy; S, surgery; SD, stable disease.

Figure 1. Probability of overall survival and disease-free survival.

Table III. Univariate analysis for local recurrence.

Characteristic (n = 118)	Local recurrence (n = 12)		No local recurrence (n = 106)		Log-rank p-value
	N	%	N	%
Gender					0.78
Male	6	10.3	52	89.7
Female	6	10.0	54	90.0
Age					0.68
≤50 year	6	12.2	43	87.8
>50 year	6	8.7	63	91.3
Presentation					0.68
Primary	11	10.1	98	89.9
Recurrent	1	11.1	8	88.9
Site					0.04
Upper extremity, incl. axilla	7	24.1	22	75.9
Lower extremity, incl. groin	5	5.6	84	94.4
Size					0.16
≤5 cm	2	4.3	44	95.7
>5, ≤10	6	13.9	37	86.0
>10 cm	4	13.8	25	86.2
Grade					0.51
I + II	2	7.1	26	92.9
III	10	11.1	80	88.9
Surgical margins					0.36
Involved	4	13.8	25	86.2
Marginal	8	10.7	67	89.3
Wide	0	0	12	100.0
Unknown*	0	0	2	100.0
Anatomical depth					0.47
Superficial	2	5.7	33	94.3
Deep	10	12.7	69	87.3
Unknown*	0	0	4	100.0
Radiation dose					0.68
≤56 Gy	0	0	3	100.0
60 Gy	12	11.0	97	89.0
66 Gy	0	0	6	100.0

*Not included in statistical analysis.

Table IV. Univariate analysis for overall survival (OS).

Characteristic (n = 118)	N	% 5-year OS	% 10-year OS	Univariate log-rank p-value
Gender				0.41
Female	60	70.7	57.9
Male	58	67.5	46.6
Age				0.09
50 year	49	69.8	69.8
> 50 year	69	68.5	38.9
Presentation				0.49
Primary	109	70.2	54.5
Recurrent	9	53.6	53.6
Site				0.38
Upper extremity incl. axilla	29	63.0	52.3
Lower extremity incl. groin	89	71.4	53.9
Size				0.14
≤ 5 cm	46	82.4	62.5
> 5, ≤ 10	43	62.2	47.2
> 10 cm	29	58.3	48.6
Grade				0.53
I + II	28	77.2	59.4
III	90	66.7	52.0
Surgical margins				0.08
Involved	29	57.3	50.1
Marginal	75	69.1	50.3
Wide	12	90.9	80.8
Unknown*	2
Tumor depth				0.95
Superficial	35	75.8	53.2
Deep	79	68.8	55.8
Unknown*	4
Radiation dose				0.92
≤ 56 Gy	3	66.7	66.7
60 Gy	109	69.3	52.4
66 Gy	6	80.0	80.0

*Not included in statistical analysis.

Table V. Late radiation toxicities according to the Common Terminology Criteria for Adverse Events (CTCAE) version 4.0.

	N	%
Late toxicity
No	24	20.3
Yes	84	71.1
CTC grade 1	59	50.0
CTC grade 2	21	17.8
CTC grade 3	4	3.4
Unknown*	10	8.5
Late skin toxicity
Hyperpigmentation
No	59	50
Yes	50	42.4
CTC grade 1	48	40.7
CTC grade 2	2	1.7
Telangiectasia
No	79	66.9
Yes	30	25.4
CTC grade 1	26	22.0
CTC grade 2	4	3.4
Late musculoskeletal toxicity
Fibrosis
No	44	37.3
Yes	65	55.1
CTC grade 1	47	39.8
CTC grade 2	16	13.6
CTC grade 3	2	1.7
Joint range of motion decreased
No	82	69.5
Yes	27	22.9
CTC grade 1	22	18.6
CTC grade 2	2	1.7
CTC grade 3	3	2.5
Limb edema
No	79	66.9
Yes	30	25.4
CTC grade 1	30	25.4
Fatigue
No	104	88.1
Yes	5	4.2
CTC grade 1	5	4.2
Pain (arthralgia)
No	108	91.5
Yes	1	0.8
CTC grade 1	0	0
CTC grade 2	1	0.8

*Not included in analysis.

Fletcher CDM, Rydholm A, Singer S, Sundaram M, Coindre JM. WHO classification of soft tissue tumours. In: Fletcher CDM, Unni KK, Mertens F, editors. World health organization classification of tumours. Pathology and genetics of tumours of soft tissue and bone. Lyon: IARC Press; 2002. p. 9–18.

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