Reirradiation leads to serious complications in soft-tissue sarcoma patients

Local control of recurrent soft-tissue sarcoma (STS) remains a challenge, according to a recent study, noting that reoperation and reirradiation can cause debilitating complications affecting function and quality of life.

The investigators reviewed records of patients treated with primary conservative surgery and radiation therapy (RT) for STS, followed by salvage resection and reirradiation for a local recurrence at the University of Florida in the US. Twenty-three patients treated between 1976 and 2014 (median follow-up, 46 months) were included in the analysis.

Tumour sites were as follows: proximal extremity (n=11), trunk (n=6), distal extremity (n=5), and head and neck (n=1). All patients had conservative gross total resection of the recurrent tumour without amputation. For irradiation, 16 patients received external-beam RT alone, six external-beam RT and brachytherapy, and one brachytherapy alone. Two patients underwent chemotherapy.

The 5-year overall survival, cause-specific survival, local control, and distant control rates after retreatment were 39 percent, 42 percent, 46 percent, and 60 percent, respectively. Ten patients had local recurrences, one experienced regional recurrence, and nine developed distant metastases.

Complications associated with retreatment ranged from delayed wound healing to limb amputation; eight patient required amputation, and only three remained disease-free at last follow-up. There were no significant associations noted between treatment factors (eg, RT dose) and local control.

“Compared with radical resection alone, perioperative RT combined with neurovascular preserving surgery is the standard for the management of virgin STS,” the investigators said.