High-risk extracranial XXXX : long-term results of surgery and radiation therapy.

@entity1 @entity511 @entity853 @entity5
BACKGROUND: A study was undertaken to evaluate results of surgery and radiotherapy (RT) for high-risk extracranial @entity511 . METHODS: Between 1986 and 2006, 60 @entity1 underwent surgery and RT for @entity853 . Preoperative RT (median, 50 gray [Gy]) and postoperative RT (median, 60 Gy) were used in 40% and 60% @entity1 , respectively. Sites included pelvis/lower extremity (48%), chest wall (22%), spine/paraspinal (17%), and head and neck (13%). Overall, median @entity5 size was 7 cm (range, 1-22 cm), and @entity5 grade was I, II, and III in 22%, 64%, and 14% of cases, respectively. RESULTS: Pathologically clear surgical margins (R0) were present in 50%, microscopic positive margins (R1) in 28%, and gross positive margins (R2) in 13%, half of whom had clinically detectable residual disease; surgical margin was unknown in 8%. Median follow-up was 75 months (range, 5-230 months). The crude local control rate was 90%. @entity1 with R0, R1, and R2 resections had local control of 100%, 94%, and 42%, respectively. Of the 8 cases that had R2 resection, 3 experienced uncontrolled progression, but 5 @entity1 had stable disease with long-term follow-up. The 10-year overall survival, progression-free survival, and cause-specific survival were 86%, 80.5%, and 89.4%, respectively. Younger age and @entity5 were associated with worse progression-free survival (P = .03 and .0003, respectively). CONCLUSIONS: Although surgery with complete resection is paramount in management of @entity511 , RT is a useful adjuvant treatment and appears to offer excellent and durable local control where wide surgical resection is difficult to accomplish.
