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Fifteen Years of Experience in Radiation-Induced Soft-Tissue Sarcoma: Presented at ESSO

By Chris Berrie

VENICE, ITALY -- December 4, 2006 -- Although it is a rare disease, careful assessment and treatment planning is required for patients with radiation-induced soft-tissue sarcoma (RIS), particularly as they show high relapse rates and low survival rates, and adjuvant radiotherapy is not usually an option.

Co-investigator Matthew Clark, MD, PhD, associate professor, general surgeon and surgical oncologist, department of general surgery, Middlemore Hospital, Auckland, New Zealand, presented results of a prospective analysis here on November 30^th at the 13^th Congress of the European Society of Surgical Oncology (ESSO).

"Radiation-induced sarcoma is a rare complication of radiotherapy, and radiotherapy has a huge role to play in modern surgical oncology, so for the most part, the benefits far outweigh the risks," said Dr. Clark. Thus, RIS is seen as a small proportion of all sarcomas, which are a rare form of tumour.

However, there is the need for further information relating to the treatment of patients with RIS, as with better patient survival through multi-modal therapies, an aging population, and the more frequent use of radiotherapy, that the incidence of RIS is likely to increase, Dr. Clark said.

In their study, the researchers defines this patient group for disease characteristics and prognosis through a review of the prospective sarcoma database of the Royal Marsden Hospital (RMH) database for the 15-year period from 1990 to 2005. Diagnosis criteria for RIS included a background of generally accepted criteria, with irradiation at least 3 years prior to diagnosis, sarcoma within or adjacent to the field of previous irradiation therapy, and different histology to the previous tumour.

The RMH database provided 76 patients, which represents the largest patient group in a European surgical series for RIS, Dr. Clark said. The median radiation dose was 50 Gy, and median interval to development of radiation-induced sarcoma was 10 years.

The most common indications for the prior radiotherapy were breast cancer (44.7%), lymphoma (14.5%), testicular cancer (9.2%) and head and neck cancer (9.2%), including gynaecological cancers (6.6%), male gastrourinary cancers (4.0%), Ewing's sarcoma (4.0%), synovial sarcoma (2.6%), fibrosarcoma (2.6%), cauda equina (1.3%) and scalp ringworm (1.3%).

Surgery was carried out as primary treatment in all patients, as chemotherapy benefits are known to be very poor, with a 2-year survival of about 10%, and radiotherapy usually unacceptable due to prior treatment.

Median tumour size was 7 cm, with often complex surgery needed, along with reconstruction (26.3%). Amputation was also more likely than for primary soft-tissue sarcoma.

Histological types varied as follows: leiomyosarcoma (26.2%), spindle-cell sarcoma (21.1%), angiosarcoma (14.5%), fibrosarcoma (10.5%), malignant fibrous histiocytoma (7.9%) and osteosarcoma (7.9%). The remaining were synovial, rhabdomyo, chondro and lymphangio sarcomas (11.8%).

"The overall survival [from RIS diagnosis] of this group of patients is really poor, with a 5-year survival of just under 40%, which is similar to what has been shown in most trials," said Dr. Clark. Furthermore, the 5-year probabilities of remaining free of developing metastatic disease or local recurrence (38.2%, 39.5%, respectively) provide a probability of remaining relapse-free at 5 years of 19.7%, "indicating that most of the patients will get recurrent disease at some stage," he added.

Dr. Clark also said that while these survival data were comparable to those previously reported for RIS, when these reports are considered on a chronological basis, there might be evidence of an increase in survival now being seen. A recent study has also indicated that the independent prognostic factors for poor survival of patients with RIS are high-grade tumours, age greater than 60 years and gross positive resection margin.

Although most physicians will see few cases of patients with RIS during their career, DR. Clark stressed that due to the complexity of RIS and its treatment, careful assessment and planning is required, with the likelihood being that the incidence of patients with RIS will increase.


[Presentation title: Radiation-Induced Soft-Tissue Sarcoma: Fifteen Years of Experience in a Specialist Unit. Abstract 042]

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