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Strahlentherapie und Onkologie
Published in: Strahlentherapie und Onkologie 8/2017

01-08-2017 | Original Article

External-beam radiation therapy combined with limb-sparing surgery in elderly patients (>70 years) with primary soft tissue sarcomas of the extremities

A retrospective analysis

Authors: Dr. med. univ. Claudia Andrä, M.D., Dr. med. Alexander Klein, M.D., Prof. Dr. med. Hans Roland Dürr, M.D., Dr. med. Josefine Rauch, M.D., Priv.-Doz. Dr. med. Lars Hartwin Lindner, M.D., Prof. Dr. med. Thomas Knoesel, M.D., Prof. Dr. med. Martin Angele, M.D., Prof. Dr. med. Andrea Baur-Melnyk, M.D., Prof. Dr. med. Claus Belka, M.D., Priv.-Doz. Dr. med. Falk Roeder, M.D.

Published in: Strahlentherapie und Onkologie | Issue 8/2017

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Abstract

Purpose

To report our experience with EBRT combined with limb-sparing surgery in elderly patients (>70 years) with primary extremity soft tissue sarcomas (STS).

Methods

Retrospectively analyzed were 35 patients (m:f 18:17, median 78 years) who all presented in primary situation without nodal/distant metastases (Charlson score 0/1 in 18 patients; ≥2 in 17 patients). Median tumor size was 10 cm, mainly located in lower limb (83%). Stage at presentation (UICC7th) was Ib:3%, 2a:20%, 2b:20%, and 3:57%. Most lesions were high grade (97%), predominantly leiomyosarcoma (26%) and undifferentiated pleomorphic/malignant fibrous histiocytoma (23%). Limb-sparing surgery was preceded (median 50 Gy) or followed (median 66 Gy) by EBRT.

Results

Median follow-up was 37 months (range 1–128 months). Margins were free in 26 patients (74%) and microscopically positive in 9 (26%). Actuarial 3‑ and 5‑year local control rates were 88 and 81% (4 local recurrences). Corresponding rates for distant control, disease-specific survival, and overall survival were 57/52%, 76/60%, and 72/41%. The 30-day mortality was 0%. Severe postoperative complications were scored in 8 patients (23%). Severe acute radiation-related toxicity was observed in 2 patients (6%). Patients with Charlson score ≥2 had a significantly increased risk for severe postoperative complications and acute radiation-related side effects. Severe late toxicities were found in 7 patients (20%), including fractures in 3 (8.6%). Final limb preservation rate was 97%.

Conclusion

Combination of EBRT and limb-sparing surgery is feasible in elderly patients with acceptable toxicities and encouraging but slightly inferior outcome compared to younger patients. Comorbidity correlated with postoperative complications and acute toxicities. Late fracture risk seems slightly increased.
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Metadata
Title
External-beam radiation therapy combined with limb-sparing surgery in elderly patients (>70 years) with primary soft tissue sarcomas of the extremities
A retrospective analysis
Authors
Dr. med. univ. Claudia Andrä, M.D.
Dr. med. Alexander Klein, M.D.
Prof. Dr. med. Hans Roland Dürr, M.D.
Dr. med. Josefine Rauch, M.D.
Priv.-Doz. Dr. med. Lars Hartwin Lindner, M.D.
Prof. Dr. med. Thomas Knoesel, M.D.
Prof. Dr. med. Martin Angele, M.D.
Prof. Dr. med. Andrea Baur-Melnyk, M.D.
Prof. Dr. med. Claus Belka, M.D.
Priv.-Doz. Dr. med. Falk Roeder, M.D.
Publication date
01-08-2017
Publisher
Springer Berlin Heidelberg
Published in
Strahlentherapie und Onkologie / Issue 8/2017
Print ISSN: 0179-7158
Electronic ISSN: 1439-099X
DOI
https://doi.org/10.1007/s00066-017-1109-x

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