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Management of Unplanned Excision for Soft-Tissue Sarcoma With Preoperative Radiotherapy Followed by Definitive Resection

Jones, Daniel A. MD; Shideman, Charles MD, PhD; Yuan, Jianling MD, PhD; Dusenbery, Kathryn MD; Carlos Manivel, J. MD; Ogilvie, Christian MD; Clohisy, Denis R. MD; Cheng, Edward Y. MD; Shanley, Ryan MS; Chinsoo Cho, L. MD

American Journal of Clinical Oncology:
doi: 10.1097/COC.0000000000000095
Original Articles: Soft Tissue
Abstract

Background and Objectives: The purpose of this study was to review the outcomes after preoperative radiotherapy and definitive surgery for patients who initially had inadvertent excision for sarcoma.

Materials and Methods: Treatment records of 44 consecutive patients, who initially underwent unplanned excision of soft-tissue sarcoma between January 2004 and January 2012, were reviewed. All patients had clinically localized disease before treatment and received preoperative external-beam radiotherapy followed by definitive oncologic surgery at our institution.

Results: The median follow-up was 36 months. Residual tumor after preoperative radiotherapy and wound bed excision was identified in 39% (17/44) of the cases. Kaplan-Meier estimates for 5-year local control, recurrence-free survival, and overall survival are 95% (95% confidence interval [CI], 80-99), 86% (95% CI, 69-94), and 94% (95% CI, 79-99) respectively. Perioperative morbidity occurred in 25% of patients (11/44.) All patients with perioperative wound complications had lower extremity sarcomas.

Conclusions: Optimal management for unplanned excision of soft-tissue sarcoma is unknown. Our institution has adopted the approach of preoperative radiotherapy, followed by definitive surgery. In our series of 44 patients, local control was excellent at 95%, with perioperative complications seen only in patients with lower extremity sarcomas, suggesting that this is a reasonable approach to manage inadvertently resected sarcoma.

Author Information

Departments of *Radiation Oncology

Laboratory Medicine and Pathology

§Orthopedic Surgery, University of Minnesota Affiliated Hospitals

Biostatistics and Bioinformatics Core, Masonic Cancer Center, University of Minnesota

Department of Laboratory Medicine and Pathology, Veterans Administration Medical Center, Minneapolis, MN

D.A.J., C.S., J.Y., K.D., L.C.C., J.C.M., C.O., D.C., E.C., and R.S.: manuscript writing; D.A.J.: data collection; D.A.J., K.D., L.C.C., C.O., D.C., E.C.: management of patients; J.C.M.: interpretation of pathologic specimens; RS: statistical analysis.

Presented in poster format, ASTRO, American Society for Radiation Oncology 2013, Atlanta, GA, September 22-25, 2013.

The authors declare no conflicts of interest.

Reprints: Daniel A. Jones, MD, Masonic Memorial Building, 424 Harvard St. SE, Room M26, Minneapolis, MN 55455. E-mail: jone2147@umn.edu.

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