Yang, J Clin Oncol 1998 - Randomized Prospective Study of the Benefit of Adjuvant Radiation Therapy in the Treatment of Soft Tissue Sarcomas of the Extremity
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Randomized Prospective Study of the Benefit of Adjuvant Radiation Therapy in the Treatment of Soft Tissue Sarcomas of the Extremity
Yang, Rosenberg, et al.·J Clin Oncol·1998·1,530 citations·RCT
Yang and colleagues tested whether adding postoperative external‑beam radiation to limb‑sparing surgery for extremity soft tissue sarcoma lowered local recurrence, changed overall survival and affected quality of life.
Randomized trial of 91 patients with high‑grade and 50 with low‑grade extremity lesions after limb‑sparing surgery, median follow‑up 9.6 years in the high‑grade group.
Methods
Design
Randomized prospective trial
Randomized separately by tumor grade
Patients
Extremity tumors suitable for limb‑sparing surgery
91 with high‑grade sarcomas (44 radiation, 47 no radiation)
50 with low‑grade sarcoma or a locally aggressive benign tumor (26 radiation, 24 no radiation)
Groups
Postoperative external‑beam radiation vs no radiation
High‑grade patients also received adjuvant chemotherapy
Low‑grade patients randomized after surgery alone
Follow-up
Median 9.6 years (high‑grade)
Outcomes
Local recurrence
Overall survival
Quality of life
Key Findings
No high‑grade patient randomized to radiation had a local recurrence as first recurrence, vs 9 without radiation (two‑sided p = 0.003, median follow‑up 9.6 years).
Estimated 10‑year actuarial local failure was 22% (95% CI 12% to 37%) in high‑grade patients given chemotherapy without radiation.
Estimated 10‑year overall survival in high‑grade patients was 75% with radiation vs 74% without (p = 0.71, 95% CI on the difference −18% to +19%).
In the 50 low‑grade patients, radiation also lowered the probability of local recurrence (p = 0.016), with no difference in overall survival.
Radiated limbs had significantly less joint motion at 6, 12, 24 and 36 months, yet global quality of life (FLIC) and daily activities did not differ significantly between arms.
No patient with a widely negative resection margin developed local recurrence, whichever arm they were in.
Board pearl
Radiation lowered local recurrence in both the high‑grade and low‑grade cohorts, but overall survival did not differ in either, so better local control did not translate into longer survival here.
Authors' conclusion
This study indicates that although postoperative external-beam radiotherapy is highly effective in preventing LRs, selected patients with extremity soft tissue sarcoma who have a low risk of LR may not require adjuvant XRT after limb-sparing surgery (LSS).
Yang and colleagues tested whether adding postoperative external‑beam radiation to limb‑sparing surgery for extremity soft tissue sarcoma lowered local recurrence, changed overall survival and affected quality of life.
Randomized trial of 91 patients with high‑grade and 50 with low‑grade extremity lesions after limb‑sparing surgery, median follow‑up 9.6 years in the high‑grade group.
Methods
Design
Randomized prospective trial
Randomized separately by tumor grade
Patients
Extremity tumors suitable for limb‑sparing surgery
91 with high‑grade sarcomas (44 radiation, 47 no radiation)
50 with low‑grade sarcoma or a locally aggressive benign tumor (26 radiation, 24 no radiation)
Groups
Postoperative external‑beam radiation vs no radiation
High‑grade patients also received adjuvant chemotherapy
Low‑grade patients randomized after surgery alone
Follow-up
Median 9.6 years (high‑grade)
Outcomes
Local recurrence
Overall survival
Quality of life
Key Findings
No high‑grade patient randomized to radiation had a local recurrence as first recurrence, vs 9 without radiation (two‑sided p = 0.003, median follow‑up 9.6 years).
Estimated 10‑year actuarial local failure was 22% (95% CI 12% to 37%) in high‑grade patients given chemotherapy without radiation.
Estimated 10‑year overall survival in high‑grade patients was 75% with radiation vs 74% without (p = 0.71, 95% CI on the difference −18% to +19%).
In the 50 low‑grade patients, radiation also lowered the probability of local recurrence (p = 0.016), with no difference in overall survival.
Radiated limbs had significantly less joint motion at 6, 12, 24 and 36 months, yet global quality of life (FLIC) and daily activities did not differ significantly between arms.
No patient with a widely negative resection margin developed local recurrence, whichever arm they were in.
Board pearl
Radiation lowered local recurrence in both the high‑grade and low‑grade cohorts, but overall survival did not differ in either, so better local control did not translate into longer survival here.
Authors' conclusion
This study indicates that although postoperative external-beam radiotherapy is highly effective in preventing LRs, selected patients with extremity soft tissue sarcoma who have a low risk of LR may not require adjuvant XRT after limb-sparing surgery (LSS).