Long-term results of a prospective randomized trial of adjuvant brachytherapy in soft tissue sarcoma.

Abstract

Adjuvant brachytherapy improves local control after complete resection of soft tissue sarcomas. This improvement in local control is limited to patients with high-grade histopathology. The reduction in local recurrence in patients with high-grade lesions is not associated with a significant reduction in distant metastasis or improvement in disease-specific survival.

Racial and ethnic differences in treatment and survival among adults with primary extremity soft‐tissue sarcoma

“…26 Differences in disease-specific survival are not necessarily expected given disparities in treatment, beause randomized clinical data indicate no significant survival differences in patients who undergo limb preservation as opposed to amputation. [6][7][8] Treatment differences in the rates of radiation therapy or limb preservation may be attributable to healthcare access barriers, such as the lack of cancer-specific physician expertise, the lack of or poor quality insurance, low patient socioeconomic status, language barriers, or unavailability of reliable transportation. Obesity, diabetes, and hypertension are more prevalent in the black and Hispanic populations compared with the Asian population.…”

“…Our patient population was limited because we excluded cases of ESTS before 1988. Although several significant studies on the role of adjuvant radiation therapy in patients who were eligible for limb-preservation were not published until the 1990s, 6,8,28,29 enough evidence was available by the 1980s 30,31 for the National Institutes of Health to issue a consensus statement on the role of radiation therapy in limb preservation for patients with ESTS. 3 Therefore, we chose to limit the period of our study to the more modern era of ESTS surgery incorporating limb preservation, from 1988 to 2003.…”

“…[6][7][8] Radiation therapy can be used to increase the rate of limb preservation without adversely effecting cancer-related mortality even in the most difficult cases, including those involving large ESTS (>5 cm), high-grade tumors, or those in close proximity to vital neurovascular structures. [9][10][11] Disparities in treatment and disease outcomes related to patient age, race, and ethnicity have been reported for several cancer types.…”

Long‐term outcomes in extremity soft tissue sarcoma after a pathologically negative re‐resection and without radiotherapy

“…This is comparable to the rate that has been achieved in most combined modality series, where local recurrence rates typically range from 10% to 15%. 22,23 In addition, the majority of recurrences occurred in the first 3 years after surgery. We believe this could have potential implications for surveillance imaging.…”

Multidisciplinary management of soft tissue sarcomas: it’s time to make a team!

“…A randomised trial conducted by the National Cancer Institute between 1975 and 1981 comparing amputation versus limb-preserving surgery in extremity STS is considered the fi rst evidence of the effectiveness of a conservative approach. Successive randomised trials comparing limb-sparing surgery against conservative resection alone confi rmed these results, and limb-sparing surgery followed by radiation therapy attained the gold standard level of treatment, being as effective as the more aggressive surgical amputation and resulting in 5-year actuarial local control rates of 74-87% [7][8][9]. Nowadays, amputation is reserved for patients with huge tumours not amenable to an en bloc excision with negative margins, extensive involvement of the neurovascular bundle and nonfunctional limbs at diagnosis.…”