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Radiotherapy and extent of surgical resection in retroperitoneal soft‐tissue sarcoma: Multi‐institutional analysis of 261 patients
Author(s) -
Sampath Sagus,
Hitchcock Ying J.,
Shrieve Dennis C.,
Randall R. Lor,
Schultheiss Timothy E.,
Wong Jeffrey Y.C.
Publication year - 2010
Publication title -
journal of surgical oncology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.201
H-Index - 111
eISSN - 1096-9098
pISSN - 0022-4790
DOI - 10.1002/jso.21474
Subject(s) - medicine , hazard ratio , soft tissue sarcoma , confidence interval , surgical margin , proportional hazards model , radiation therapy , adjuvant radiotherapy , log rank test , resection margin , survival analysis , soft tissue , surgery , sarcoma , retrospective cohort study , adjuvant therapy , oncology , resection , chemotherapy , pathology
Background and Objective To examine the impact of adjuvant radiotherapy (RT) and surgical technique on survival in retroperitoneal soft‐tissue sarcoma. Methods A retrospective analysis was conducted using the National Oncology Database, a proprietary database of aggregated tumor registries owned by IMPAC® Medical Systems (Sunnyvale, CA). Patients who received definitive surgery with negative or microscopic‐positive margins were included. Multivariate analysis was performed using the Cox proportional hazards model. Survival curves were estimated by the Kaplan–Meier method and were compared for statistical significance ( P < 0.05) using the log‐rank test. Results Two hundred sixty‐one patients met inclusion criteria. The median follow‐up was 59 months (range 0.2–186 months). The 5‐year cause‐specific survival (CSS) and local failure‐free survival (LFFS) were 73% and 66%, respectively. Grade, margin status, and histology were independent predictors for CSS ( P < 0.05). Adjuvant RT was associated with a significant improvement in LFFS over surgery alone (hazard ratio = 0.42, 95% confidence interval 0.21–0.86, P < 0.05). Patients receiving simple excision and RT had a 5‐year LFFS of 88%, significantly higher than wide resection with or without RT (log‐rank, P < 0.05). Conclusion Adjuvant RT is associated with a lower risk of local relapse compared to surgery alone. The impact of surgical technique on adjuvant RT efficacy warrants further study. J. Surg. Oncol. 2010; 101:345–350. © 2010 Wiley‐Liss, Inc.