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Comparative Study
. 2014 Oct 10;32(29):3236-41.
doi: 10.1200/JCO.2013.53.9452. Epub 2014 Sep 2.

Comparison of local recurrence with conventional and intensity-modulated radiation therapy for primary soft-tissue sarcomas of the extremity

Michael R Folkert  1 , Samuel Singer  1 , Murray F Brennan  1 , Deborah Kuk  1 , Li-Xuan Qin  1 , Wendy K Kobayashi  1 , Aimee M Crago  1 , Kaled M Alektiar  2
Affiliations
Comparative Study

Comparison of local recurrence with conventional and intensity-modulated radiation therapy for primary soft-tissue sarcomas of the extremity

Michael R Folkert et al. J Clin Oncol. .

Abstract

Purpose: The use of intensity-modulated radiation therapy (IMRT) in the treatment of soft tissue sarcoma (STS) of the extremity is increasing, but no large-scale direct comparison has been reported between conventional external-beam radiation therapy (EBRT) and IMRT.

Methods: Between January 1996 and December 2010, 319 consecutive adult patients with primary nonmetastatic extremity STS were treated with limb-sparing surgery and adjuvant radiotherapy (RT) at a single institution. Conventional EBRT was used in 154 patients and IMRT in 165 with similar dosing schedules. Median follow-up time for the cohort was 58 months.

Results: Treatment groups were comparable in terms of tumor location, histology, tumor size, depth, and use of chemotherapy. Patients treated with IMRT were older (P = .08), had more high-grade lesions (P = .05), close (< 1 mm) or positive margins (P = .04), preoperative radiation (P < .001), and nerve manipulation (P = .04). Median follow-up was 90 months for patients treated with conventional EBRT and 42 months for patients treated with IMRT. On multivariable analysis adjusting for patient age and tumor size, IMRT retained significance as an independent predictor of reduced LR (hazard ratio = 0.46; 95% CI, 0.24 to 0.89; P = .02).

Conclusion: Despite a preponderance of higher-risk features (especially close/positive margin) in the IMRT group, IMRT was associated with significantly reduced local recurrence compared with conventional EBRT for primary STS of the extremity.

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Conflict of interest statement

Authors' disclosures of potential conflicts of interest and author contributions are found at the end of this article.

Figures

Fig 1.
Fig 1.
Consort diagram. EBRT, external-beam radiation therapy; IMRT, intensity-modulated radiation therapy; MSKCC, Memorial Sloan Kettering Cancer Center; RT, radtiation therapy; STS, soft tissue sarcoma.
Fig 2.
Fig 2.
Cumulative incidence curve for local recurrence by radiation treatment group. C-EBRT, conventional external-beam radiation therapy; HR, hazard ratio; IMRT, intensity-modulated radiation therapy; M, multivariable; U, univariable.
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