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Comparison of outcome and toxicity of postoperative intensity-modulated radiation therapy with two-dimensional radiotherapy in patients with soft tissue sarcoma of extremities and trunk.

Authors
  • Wang, Jianyang1
  • Song, Yongwen1
  • Liu, Xinfan1
  • Jin, Jing1
  • Wang, Weihu1
  • Yu, Zihao1
  • Liu, Yueping1
  • Li, Ning1
  • Fang, Hui1
  • Ren, Hua1
  • Tang, Yuan1
  • Tang, Yu1
  • Chen, Bo1
  • Lu, Ningning1
  • Qi, Shunan1
  • Wang, Shulian1
  • Li, Yexiong1
  • 1 Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China. , (China)
Type
Published Article
Journal
Cancer Medicine
Publisher
Wiley
Publication Date
Mar 01, 2019
Volume
8
Issue
3
Pages
902–909
Identifiers
DOI: 10.1002/cam4.1919
PMID: 30740916
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

To compare the survival outcomes and late toxicities of postoperative intensity-modulated radiation therapy (IMRT) with two-dimensional radiotherapy (2D-RT) for patients with soft tissue sarcoma (STS) of extremities and trunk. 274 consecutive patients with nonmetastatic STS of extremities and trunk treated with postoperative IMRT (n = 187) and 2D-RT (n = 87) were analyzed. Survival was calculated by using Kaplan-Meier method. Independent prognostic factors were identified using Cox stepwise regression analysis for variables with a P-value <0.1 in univariate analysis. With a median follow-up time of 58.1 months, 30 local recurrences, 66 distant metastases, and 40 deaths occurred. Compared to 2D-RT group, the IMRT group had higher 5-year local recurrence-free survival (LRFS) (91.1% vs 80.8%; P = 0.029), distant metastasis-free survival (DMFS) (80.0% vs 69.7%; P = 0.048), disease-free survival (DFS) (75.2% vs 59.2%; P = 0.021), and overall survival (OS) (90.2% vs 81.0%; P = 0.029). Multivariate analysis showed IMRT was an independent favorable factor for LRFS, DMFS, DFS, and OS. For late toxicities, the patients in IMRT group enjoyed lower incidences of ≥Grade 2 joint stiffness (3.9% vs 12.3%; P = 0.041) and ≥Grade 3 fractures (0.0% vs 3.4%; P = 0.25) than those in 2D-RT group. ≥Grade 2 Edema was similar between these two groups (4.8% vs 9.2%; P = 0.183). When compared with conventional techniques, postoperative IMRT seems to provide better LRFS, DMFS, DFS, and OS and less late toxicities in patients with STS of extremities and trunk, which should be offered as a preferred treatment. © 2019 The Authors. Cancer Medicine published by John Wiley & Sons Ltd.

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