Posters— Radiation Oncology

PREOPERATIVE RADIOTHERAPY IN ADULT SOFT-TISSUE SARCOMAS

T. Morysinski, W. Ruka, P. Rutkowski Soft Tissue/Bone Sarcomas Department; M. Sklodowska-Curie Memorial Cancer Center Institute; Warsaw, Roentgena. 5, Poland

Introduction: Soft-tissue sarcomas are characterized by high local recurrence potential after inadequate treatment. The aim of the study was to analyze the results of the surgical treatment of the soft-tissue sarcomas combined with preoperative radiotherapy.

Materials and Methods: Between 1984 and 1999 167 patients (84 male, 83 female; mean age: 49.2) treated in our institution were enrolled into the study. Twenty five patients (15%) represented stage IA,B (according to UICC/AJCC 1987 classification), 142 (85%) - stage IIA,B + IIIA,B. All patients without distant metastases (MO) were included into the study consecutively. Primary tumors represented 64 (38%) cases, local recurrence or scar after non-radical excision - 103 (62%). The tumors were mainly located in lower limbs (121 patients - 72%). Most of the tumors were > 10 cm in diameter (75%). Tumor characteristics according to histological type were: 38 (23%) synovial sarcoma, 33 (20%) malignant fibrous histiocytoma, 27 (16%) liposarcoma, 23 (14%) malignant schwannoma, 20 (12%) fibrosarcoma and 26 (15%) others. Irradiation fields contained the tumor (primary, recurrent or scar) with drain sites and the margins ~! 5 cm. The patients were divided into two groups: I - 134 patients underwent preoperative radiation in total dose of 20OOcGy (400 cGy/fraction) followed by surgical resection 3-5 days later and 11 - 33 patients underwent “conventional” radiation in total dose of 4000-50OOcGy (2OOcGy/fraction) with operation 6 weeks later. Median follow-up time was 36 months for survivals. The Kaplan-Meier method and the log-rank test were used for statistical analyses.

Results: The 5-year overall survival in group I was 69% and in group 11 was 47 % (p< .05). The 5year local-recurrence free survival in group 1475%) was significantly better than in group 11 (56%) (p=.006).

Conclusions: Preoperative radiotherapy in adult soft-tissue sarcomas used in 5 fraction to total dose of 20OOcGy regimen applied to 3-5 days before operation is connected with better tumor local control rates and demonstrates benefit for overall survival in comparison to conventional 1preoperative radiotherapy group.