Bruce Rougraff | PubMed Health

PubMed2006

Multifocality and multifocal postradiation sarcomas.

UNLABELLED: Hypothetically, any site in a radiation portal has potential for late malignant transformation. Secondary malignant neoplasms may occur after almost any index cancer has been treated with radiation and/or chemotherapy. The incidence of secondary malignant neoplasms, histopathology, time delay, radiation dose, cytotoxic agents, age and type of initial malignancy, and outcome all negatively impact cancer survivors. We highlight the new concept of multifocality, defined as greater than two noncontiguous second malignant neoplasms that develop in a prior radiation port. We identified 48 patients with postradiation sarcomas from three prospectively collected databases. Fifteen of these patients (31%) had evidence of multifocal postradiation sarcomas. Five of 10 women had multifocal postradiation sarcomas after breast-conserving surgery for carcinoma. The longer the time interval between the index cancer and post-radiation sarcoma, the greater the likelihood of multifocal malignant transformation occurring. LEVEL OF EVIDENCE: Therapeutic study, level III.

Adult↗

PubMed2002

Karnofsky performance score as a predictor of survival in soft tissue sarcoma.

Forty-six consecutive patients with nonmetastatic, large, high-grade soft tissue sarcomas were treated with surgical resection and radiation therapy but no adjuvant chemotherapy. Clinical and radiographic followup ranged from 36 to 90 months (mean, 50 months). One patient died of unrelated causes 10 months after the completion of radiation and surgery, leaving the oncologic outcome of 45 patients to be evaluated. Twenty-seven of 45 patients (60%) survived with an average followup of 50 months. The limb salvage rate was 91% and local control was obtained in 43 of 45 patients (96%). During the time of the study, 73% of patients could have been offered chemotherapy. However, only 53% of patients who died of their disease would have been candidates for chemotherapy trials because of medical comorbidities. More importantly, patients with a Karnofsky performance score of 80 or more had a significantly better survival rate than patients with a Karnofsky performance score less than 80 without the use of chemotherapy. Current chemotherapy trials that exclude patients because of medical comorbidities are introducing bias toward improved survival that may not be attributable to the chemotherapy. If a real survival benefit of adjuvant chemotherapy exists, it would be most evident in the largest (> 15 cm) high-grade tumors. Aggressive metastasectomy seems to be most beneficial for patients with isolated nodules.

Comorbidity↗