Abstract
Background
Optimal surveillance imaging (SI) regimens following radiation therapy (RT) and radical resection for localized soft tissue sarcoma (STS) are unknown and practice patterns vary.
Methods
Between 2006 and 2014, 94 patients with localized STS of the extremity/trunk treated with preoperative RT and radical resection were identified. Timing of local recurrence (LR), distant recurrence (DR), and SI were evaluated. The Kaplan–Meier method was used to determine recurrence-free and overall survival (OS), and the method of recurrence detection (SI or due to signs/symptoms) was determined.
Results
Median tumor size was 7.5 cm, and 92% were intermediate/high grade. After a median follow-up of 60 months for surviving patients, 30 patients (32%) recurred, including 5 LRs and 26 DRs. The median time to LR and DR was 36.2 months (range 14.4–65.7) and 10.4 months (range 5.2–76.9), respectively, and the 5-year local recurrence-free survival (RFS), distant RFS, and OS was 95, 71, and 76%, respectively. Local SI was performed for 90% of patients, mostly by magnetic resonance imaging (MRI; 91%). Of the five LRs, two were detected by SI and three had signs/symptoms preceding imaging. All patients underwent distant SI. Of the 26 DRs, 23 (88%) were in the lung. SI detected 22 (85%) DRs, and only 4 of 26 had signs/symptoms prompting imaging.
Conclusion
Given excellent local control with RT and radical resection for intermediate/high-grade STS of the extremity/trunk, SI of the primary site should be reserved for select patients at high risk of LR. Conversely, due to frequent occurrence of asymptomatic DR in the lungs, periodic lung SI is appropriate. Routine abdominopelvic SI may not be indicated for most histologies.
Similar content being viewed by others
References
Siegel RL, Miller KD, Jemal A. Cancer statistics, 2016. CA 2016;66:7–30.
Rosenberg SA, Tepper J, Glatstein E, et al. The treatment of soft-tissue sarcomas of the extremities: prospective randomized evaluations of (1) limb-sparing surgery plus radiation therapy compared with amputation and (2) the role of adjuvant chemotherapy. Ann Surg. 1982;196:305–15.
Yang JC, Chang AE, Baker AR, et al. Randomized prospective study of the benefit of adjuvant radiation therapy in the treatment of soft tissue sarcomas of the extremity. J Clin Oncol. 1998;16(1):197–203.
Pisters PW, Harrison LB, Leung DH, et al. Long-term results of a prospective randomized trial of adjuvant brachytherapy in soft tissue sarcoma. J Clin Oncol. 1996;14(3):859–68.
Von Mehren M, Lor Randall R, Benjamin RS, et al. Soft tissue sarcoma, version 2.2016, clinical practice guidelines in oncology. J Natl Compr Canc Netw. 2016;14:758–86.
O’Sullivan B, Davis AM, Turcotte R, et al. Preoperative versus postoperative radiotherapy in soft-tissue sarcoma of the limbs: a randomised trial. Lancet. 2002;359:2235–41.
Baldini EH, Lapidus MR, Wang Q, et al. Predictors for major wound complications following preoperative radiotherapy and surgery for soft-tissue sarcoma of the extremities and trunk: importance of tumor proximity to skin surface. Ann Surg Oncol. 2013;20:1494–9.
Folkert MR, Singer S, Brennan MF, et al. Comparison of local recurrence with conventional and intensity-modulated radiation therapy for primary soft-tissue sarcomas of the extremity. J Clin Oncol. 2014;32:3236–41.
McGee L, Indelicato DJ, Dagan R, et al. Long-term results following postoperative radiotherapy for soft tissue sarcomas of the extremity. Int J Radiot Oncol Biol Phys. 2012;84:1003–9.
Pisters PW, Leung DH, Woodruff J, et al. Analysis of prognostic factors in 1,041 patients with localized soft tissue sarcomas of the extremities. J Clin Oncol. 1996;14:1679–89.
Zagars GK, Ballo MT, Pisters PW, et al. Prognostic factors for patients with localized soft-tissue sarcoma treated with conservation surgery and radiation therapy: an analysis of 1225. Cancer. 2003;97:2530–43.
Callegaro D, Miceli R, Bonvalot S, et al. Development and external validation of two nomograms to predict overall survival and occurrence of distal metastases in adults after surgical resection of localized soft-tissue sarcomas of the extremities: a retrospective analysis. Lancet Oncol. 2016; 7:671–80.
Kattan MW, Leung DH, Brennan MF. Postoperative nomogram for 12-year sarcoma-specific death. J Clin Oncol. 2002;20:791–96.
Gadd MA, Casper ES, Woodruff JM, et al. Development and treatment of pulmonary metastases in adult patients with extremity soft tissue sarcoma. Ann Surg. 1993;218:705–12.
Billingsley KG, Burt ME, Jara E, et al. Pulmonary metastases from soft tissue sarcoma: analysis of patterns of disease and postmetastasis survival. Ann Surg. 1999;229:602–10.
Zagars GK, Ballo MT, Pisters PW, et al. Prognostic factors for disease-specific survival after first relapse of soft-tissue sarcoma: analysis of 402 patients with disease relapse after initial conservative surgery and radiotherapy. Int J Radiat Oncol Biol Phys. 2003;57:739–47.
Daigeler A, Zmarsly I, Hirsch T, et al. Long-term outcome after local recurrence of soft tissue sarcoma: a retrospective analysis of factors predictive of survival in 135 patients with locally recurrent soft tissue sarcoma. Br J Cancer. 2014;110:1456–64.
Dhakal S, Corbin KS, Milano MT, et al. Stereotactic body radiotherapy for pulmonary metastases from soft-tissue sarcomas: excellent local lesion control and improved patient survival. Int J Radiat Oncol Biol Phys. 2012;82:940–5.
Beitler AL, Virgo KS, Johnson FE, et al. Current follow-up strategies after potentially curative resection of extremity sarcomas: results of a survey of the members of the Society of Surgical Oncology. Cancer. 2000;88:777–85.
Johnson FE, Sakata K, Sarka S, et al. Patient surveillance after treatment for soft-tissue sarcoma. Int J Oncol. 2011;38:233–39.
Gerrand CH, Billingham LJ, Woll PJ, et al. Follow up after primary treatment of soft tissue sarcoma: a survey of current practice in the United Kingdom. Sarcoma. 2007;2007:34128.
The ESMO/European Sarcoma Network Working Group. Soft tissue and visceral sarcomas: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2014;25:iii102–12.
Wang D, Zhang Q, Burton LE, et al. Significant reduction of late toxicities in patients with extremity sarcoma treated with image-guided radiation therapy to a reduced target volume: results of radiation therapy oncology group RTOG-0630 trial. J Clin Oncol. 2015;33:2231–8.
Grimer R, Judson I, Peake D, et al. Guidelines for the management of soft tissue sarcomas. Sarcoma 2010;2010:506182. doi:10.1155/2010/506182.
Kane JM. Surveillance strategies for patients following surgical resection of soft tissue sarcomas. Curr Opin Oncol. 2004;16:328–32.
Labarre D, Aziza R, Filleron T, et al. Detection of local recurrence of limb soft tissue sarcomas: Is magnetic resonance imaging (MRI) relevant? Eur J Radiol. 2009;72:50–53.
Cheney MD, Giraud C, Goldberg SI, et al. MRI surveillance following treatment of extremity soft tissue sarcoma. J Surg Oncol. 2014;109:593–96.
Odrini G, Renard-Oldrini S, Leroux A, et al. Imaging follow-up of soft tissue sarcomas. J Radiol. 2011;92:915–9.
Whooley BP, Gibbs JF, Mooney MM, et al. Primary extremity sarcoma: what is the appropriate follow-up? Ann Surg Oncol. 2000;7:9–14.
Centers for Medicare and Medicaid Services. Physician Fee Schedule Search. HCPS code: 73720. https://www.cms.gov/apps/physician-fee-schedule/search/search-results.aspx?Y=0&T=0&HT=0&CT=3&H1=73720&M=4. Accessed 30 Sep 2016.
Guadagnolo BA, Zagars GK, Ballo MT, et al. Excellent local control rates and distinctive patterns of failure in myxoid liposarcoma treated with conservation surgery and radiotherapy. Int J Radiat Oncol Biol Phys. 2008;70:760–5.
Rutkowski P, Kugowska I. Follow-up in soft tissue sarcomas. Memo. 2014;7:92–96.
Arya S, Nagarkatti DG, Dudhat SB, et al. Soft tissue sarcomas: ultrasonographic evaluation of local recurrences. Clin Radiol. 2000;55:193–7.
Choi H, Varma DG, Fornage BD, et al. Soft-tissue sarcoma: MR imaging vs. sonography for detection of local recurrence after surgery. Am J Roentgenol. 1991;157:353–8.
Fleming JB, Cantor SB, Varma DG, et al. Utility of chest computed tomography for staging in patients with T1 extremity soft tissue sarcomas. Cancer. 2001;92:863–8.
Porter GA, Cantor SB, Ahmad SA, et al. Cost-effectiveness of staging computed tomography of the chest in patients with T2 soft tissue sarcomas. Cancer. 2002;94:197–204.
Puri A, Gulia A, Hawaldar R, et al. Does intensity of surveillance affect survival after surgery for sarcomas? Results of a randomized noninferiority trial. Clin Orthop Relat Res. 2014;472:1568–75.
Cho HS, Park IH, Jeong WJ, et al. Prognostic value of computed tomography for monitoring pulmonary metastases in soft tissue sarcoma patients after surgical management: a retrospective cohort study. Ann Surg Oncol. 2011;18:3392–8.
Brenner DJ, Hall EJ. Computed tomography: an increasing source of radiation exposure. N Engl J Med. 2007;357:2277–84.
Disclosures
None.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Patel, S.A., Royce, T.J., Barysauskas, C.M. et al. Surveillance Imaging Patterns and Outcomes Following Radiation Therapy and Radical Resection for Localized Extremity and Trunk Soft Tissue Sarcoma. Ann Surg Oncol 24, 1588–1595 (2017). https://doi.org/10.1245/s10434-016-5755-5
Received:
Published:
Issue Date:
DOI: https://doi.org/10.1245/s10434-016-5755-5