Skip to main content

The Role of Radiation Therapy in the Treatment of Bone and Soft-tissue Sarcomas

  • Chapter
Musculoskeletal Cancer Surgery
  • 942 Accesses

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 189.00
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 249.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 299.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Wang, CC, Schultz MD. Ewing’s sarcoma: a study of fifty cases treated at the Massachusetts General Hospital, 1930–1952 inclusive. N Engl J Med. 1953;248:571–6

    CAS  PubMed  Google Scholar 

  2. Phillips TL, Sheline GE. Radiation therapy of malignant bone tumors. Radiology. 1969;92:1537–45.

    CAS  PubMed  Google Scholar 

  3. Rosenberg SA, Tepper J, Glatstein E et al. The treatment of soft-tissue sarcomas of the extremities: prospective randomized evaluation of (1) limb-sparing surgery plus radiation therapy compared with amputation and (2) the role of adjuvant chemotherapy. Ann Surg. 1982;196:305–15

    CAS  PubMed  Google Scholar 

  4. Yang JC, Chang AE, Baker AR et al. Randomized prospective study of the benefit of adjuvant radiation therapy in the treatment of soft tissue sarcomas of the extremity. J Clin Oncol. 1998;16:197–203.

    CAS  PubMed  Google Scholar 

  5. Ruka W, Taghian A, Gioioso D, Fletcher JA, Preffer F, Suit HD. Comparison between the in vitro intrinsic radiation sensitivity of human soft tissue sarcoma and breast cancer cell lines. J Surg Oncol. 1996;61:290–4.

    Article  CAS  PubMed  Google Scholar 

  6. Mundt AJ, Awan A, Sibley GS et al. Conservative surgery and adjuvant radiation therapy in the management of adult soft tissue sarcoma of the extremities: clinical and radiobiological results. Int J Radiat Oncol Biol Phys. 1995; 32:977–85.

    CAS  PubMed  Google Scholar 

  7. Dahlberg WK, Little JB, Fletcher JA et al. Radiosensitivity of human soft tissue sarcoma cell lines and skin fibroblasts derived from the same patients. Int J Radiat Oncol Biol Phys. 1993;63:191–8.

    CAS  Google Scholar 

  8. Berlin O, Stener B, Angervall L et al. Surgery for soft tissue sarcoma in the extremities: a multivariate analysis of the 6–26 year prognosis in 137 patients. Acta Orthop Scand. 1990;61:475–86.

    CAS  PubMed  Google Scholar 

  9. Rydholm A, Gustafson, P, Rööser et al. Limb-sparing surgery without radiotherapy based on anatomic location of soft tissue sarcoma. J ClinOncol. 1991;9:1757–65.

    CAS  Google Scholar 

  10. Karakousis CP, Proimakis C, Walsh DL. Primary soft tissue sarcoma of the extremities in adults. Br J Surg. 1995;82: 1208–12.

    CAS  PubMed  Google Scholar 

  11. Geer RJ, Woodruff J, Casper ES, Brennan MF. Management of small soft-tissue sarcoma of the extremity in adults. Arch Surg. 1992;127:1285–9.

    CAS  PubMed  Google Scholar 

  12. Baldini EH, Goldberg J, Jenner C et al. Long-term outcomes after function-sparing surgery without radiotherapy for soft tissue sarcoma of the extremities and trunk. J Clin Oncol. 1999;17:3532–9.

    Google Scholar 

  13. Gibbs CP, Peabody TD, Mundt AJ et al. Oncological outcomes of operative treatment of subcutaneous softtissue sarcomas of the extremities. J Bone Joint Surg. 1997; 79A:888–97.

    Google Scholar 

  14. Markhede G, Angervall L, Stener B. A multivariate analysis of the prognosis after surgical treatment of malignant soft-tissue tumors. Cancer. 1982;49:1721–33.

    CAS  PubMed  Google Scholar 

  15. Leibel SA, Tanbaugh RF, Wara WM, Beckstead JH, Bovill EG, Phillips TL. Soft tissue sarcomas of the extremities: survival and patterns of failure with conservative surgery and postoperative irradiation compared to surgery alone. Cancer. 1982;50:1076–83.

    CAS  PubMed  Google Scholar 

  16. Tepper JE, Suit HD. Radiation therapy alone for sarcoma of soft tissue Cancer. 1985;56:475–9.

    CAS  PubMed  Google Scholar 

  17. Atkinson L, Garvan JM, Newton NC. Behavior and management of soft tissue connective sarcoma. Cancer. 1963;16:1552–62.

    CAS  PubMed  Google Scholar 

  18. Cantin J, McNeer GP Chu FC, Booher RJ. The problem of local recurrence after treatment of soft tissue sarcoma. Ann Surg. 1968;168:47–54.

    CAS  PubMed  Google Scholar 

  19. McNeer GP Cantin J, Chu F, Nickson JJ. Effectiveness of radiation therapy in the management of sarcoma for the soft somatic tissues. Cancer. 1968;22:391–7.

    CAS  PubMed  Google Scholar 

  20. Suit HD, Russell WO, Martin RG. Management of patients with sarcoma of soft tissue in an extremity. Cancer. 1973; 31:1247–55.

    CAS  PubMed  Google Scholar 

  21. Suit HD, Russell WO, Martin RG. Sarcoma of soft tissue: clinical and histopathologic parameters and response to treatment. Cancer. 1975;35:1478–83.

    CAS  PubMed  Google Scholar 

  22. Suit HD, Mankin HJ, Wood WC, Proppe KH. Preoperative, intraoperative, and postoperative radiation in the treatment of primary soft tissue sarcoma. Cancer. 1985;55: 2659–67.

    CAS  PubMed  Google Scholar 

  23. Potter DA, Kinsella T, Glatstein E et al. High-grade soft tissue sarcomas of the extremities. Cancer. 1986;58:190–205.

    CAS  PubMed  Google Scholar 

  24. Bramwell V, Rouesse J, Steward W, Santoro A, Shraffordt-Koops H. Adjuvant CYVADIC chemotherapy for adult soft tissue sarcoma — reduced local recurrence but no improvement in survival. A study of the European Organization for Research and Treatment of Cancer Soft Tissue and Bone Sarcoma Group. J Clin Oncol. 1994;12: 1137–49.

    CAS  PubMed  Google Scholar 

  25. Lindberg RD, Martin RG, Romsdahl MM, Barkley HT. Conservative surgery andpostoperative radiotherapy in 300 adults with soft-tissue sarcomas. Cancer. 1981;47: 2391–7.

    CAS  PubMed  Google Scholar 

  26. Wood WC, Suit HD, Mankin HJ, Cohen AM, Proppe K. Radiation and conservative surgery in the treatment of soft tissue sarcoma. Am J Surg. 1984;147:537–41.

    Article  CAS  PubMed  Google Scholar 

  27. Wilson AN, Davis A, Bell RS et al. Local control of soft tissue sarcoma of the extremity: the experience of a multidisciplinary sarcoma group with definitive surgery and radiotherapy. Eur J Cancer. 1994;30A:746–51.

    CAS  PubMed  Google Scholar 

  28. Dinges S, Budach V, Budach W, Feldmann HJ, Stuschke M, Sack H. Local recurrences of soft tissue sarcomas in adults: a retrospective analysis of prognostic factors in 102 cases after surgery and radiation therapy. Eur J Cancer. 1994;30A: 1636–42.

    CAS  PubMed  Google Scholar 

  29. Keus RB, Th Rutgers EJ, Ho GH, Gortzak E, Albus-Lutter CE, Hart AAM. Limb-sparing therapy of extremity soft tissue sarcomas: treatment outcome and long-term functional results. Eur J Cancer. 1994;30A:1459–63.

    CAS  PubMed  Google Scholar 

  30. Fein DA, Lee WR, Lanciano RM et al. Management of extremity soft tissue sarcomas with limb-sparing surgery and postoperative irradiation: do total dose, overall treatment time, and the surgery-radiotherapy interval impact on local control? Int J Radiat Oncol Biol Phys. 1995; 32:969–76.

    CAS  PubMed  Google Scholar 

  31. Pollak A, Zagars GK, Goswitz MS, Pollock RA, Feig BW, Pisters PWT. Preoperative vs. postoperative radiotherapy in the treatment of soft tissue sarcomas: a matter of presentation. Int J Radiat Oncol Biol Phys. 1998;42:563–72.

    Google Scholar 

  32. Herbert SH, Corn BW, Solin LJ et al. Limb-preserving treatment for soft tissue sarcomas of the extremities. Cancer 1993;72:1230–8.

    CAS  PubMed  Google Scholar 

  33. Collin CF, Friedrich C, Godbold J, Brennan MF. Prognostic factors for local recurrence and survival in patients with localized extremity soft-tissue sarcoma. Sem Surg Oncol. 1988;4:30–7.

    CAS  Google Scholar 

  34. Pisters PWT, Leung DHY, Woodruff J, Shui W, Brennan MF. Analysis of prognostic factors in 1041 patients with localized soft tissue sarcomas of the extremities. J Clin Oncol. 1996;14:1679–89.

    CAS  PubMed  Google Scholar 

  35. Gaynor JJ, Tan CC, Casper ES et al. Refinement of clinocopathologic staging for localized soft tissue sarcoma of the extremity: a study of 423 adults. J Clin Oncol. 1992;10: 1317–29.

    CAS  PubMed  Google Scholar 

  36. Pisters PW, Pollack R. Staging and prognostic factors in soft tissue sarcoma. Semin Radiat Oncol. 1999:9:307–14.

    CAS  PubMed  Google Scholar 

  37. LeVay J, O’Sullivan B, Catton C et al. Outcome and prognostic factors in soft tissue sarcoma in the adult. Int J Radiat Oncol Biol Phys. 1993;27:1091–9.

    CAS  PubMed  Google Scholar 

  38. Vraa S, Keller J, Nielsen OS, Sneppen O, Juvik AG, Jensen OM. Prognostic factors in soft tissue sarcomas: the Aarhus experience. Eur J Cancer. 1998;34:1876–82.

    Article  CAS  PubMed  Google Scholar 

  39. Cany L, Stoekle E, Coindre JM, Kantor G, Bonichon F, Bui BN. Prognostic factors in superficial adult soft tissue sarcomas: analysis of a series of 105 patients. J Surg Oncol. 1999;71:4–9.

    Article  CAS  PubMed  Google Scholar 

  40. Singer S, Corson JM, Gonin R, Labow B, Eberlein TJ. Prognostic factors predictive of survival and local recurrence for extremity soft tissue sarcoma. Ann Surg. 1994; 219:165–73.

    CAS  PubMed  Google Scholar 

  41. Cakir S, Dincbas FO, Uzel O, Koca SS, Okkan S. Multivariate analysis of prognostic factors in 75 patients with soft tissue sarcoma. Radiother Oncol. 1995;37:10–16.

    Article  CAS  PubMed  Google Scholar 

  42. Coindre J, Terrier P, Binh Bui N et al. Prognostic factors in adult patients with locally controlled soft tissue sarcoma: a study of 546 patients from the French Federation of Cancer Centers Sarcoma Group. J Clin Oncol. 1996;14: 869–77.

    CAS  PubMed  Google Scholar 

  43. Zagars GK, Mullern JR, Pollack A. Malignant fibrous histocytoma: outcome and prognostic factors following conservation surgery and radiotherapy. Int J Radiat Oncol Biol Phys. 1996;34:983–94.

    Article  CAS  PubMed  Google Scholar 

  44. Zagars GK, Goswitz MS, Pollack A. Liposarcoma: outcome and prognostic factors following conservation surgery and radiation therapy. Int J Radiat Oncol Biol Phys. 1996;36:311–19.

    Article  CAS  PubMed  Google Scholar 

  45. Mandard AM, Petiot JF, Marnay J et al. Prognostic factors in soft tissue sarcomas: a multivariate analysis of 109 cases. Cancer. 1989;63:1437–51.

    CAS  PubMed  Google Scholar 

  46. Chang HR, Hajdu SI, Collin C, Brennan MF. The prognostic value of histologic subtypes in primary extremity liposarcoma. Cancer. 1989;64:1514–20.

    CAS  PubMed  Google Scholar 

  47. Pao WJ, Pilepich MV. Postoperative radiotherapy in the treatment of extremity soft tissue sarcomas. Int J Radiat Oncol Biol Phys. 1990;19:907–11.

    CAS  PubMed  Google Scholar 

  48. Pisters PWT, Harrison LB, Leung DHY, Woodruf JM, Casper ES, Brennan MF. Long-term results of a prospective randomized trial of adjuvant brachytherapy in soft tissue sarcoma. J Clin Oncol. 1996;14:859–68.

    CAS  PubMed  Google Scholar 

  49. Harrison LB, Franzse F, Gaynor JJ, Brennan MF. Long-term results of a prospective randomized trial of adjuvant brachytherapy in the management of completely resected soft tissue sarcomas of the extremity and superficial trunk. Radiat Oncol Biol Phys. 1993;27:259–65.

    CAS  Google Scholar 

  50. Wang YN, Zhu WQ, Shen ZZ, Li S, Liu SY. Treatment of locally recurrent soft tissue sarcomas of the retroperitoneum: report of 30 cases. J Surg Oncol. 1994 Aug; 56(4):213–6.

    CAS  PubMed  Google Scholar 

  51. Kinsella TJ, Sindelar WF, Lack E, Glatstein E, Rosenberg SA. Preliminary results of a randomized study of adjuvant radiation therapy in resectable adult retroperitoneal soft tissue sarcomas. J Clin Oncol. 1988;6:18–25.

    CAS  PubMed  Google Scholar 

  52. Cody III HS, Turnbull AD, Fortner JG, Hadju SI. The continuing challenge of retroperitoneal sarcomas. Cancer. 1981;47:2147–52.

    PubMed  Google Scholar 

  53. Stotter AT, A’Hern RP, Fischer C, Mitt AF, Fallowfield ME, Westbury G. The influence of local recurrence of extremity soft tissue sarcoma on metastasis and survival. Cancer. 1990;65:1119–29.

    CAS  PubMed  Google Scholar 

  54. Peabody TD, Monson D, Montag A, Schell MJ, Finn H, Simon MA. A comparison of the prognoses for deep and subcutaneous sarcomas of the extremities. J Bone Joint Surg Am. 1994;76:1167–73.

    CAS  PubMed  Google Scholar 

  55. Abbatucci JS, Boulier N, DeRanieri J et al. Local control and survival in soft tissue sarcomas of the limbs, trunk walls and head and neck: a study of 113 cases. Int J Radiat Oncol Biol Phys. 1986;42:579–86.

    Google Scholar 

  56. Zornig C, Peiper M, Schröder R. Re-excision of soft tissue sarcoma after inadequate initial operation. Br J Surg. 1995;82:278–9.

    CAS  PubMed  Google Scholar 

  57. Association of Directors of Anatomic and Surgical Pathology. Recommendations for the reporting of soft tissue sarcomas (special article). Mod Pathol. 1998;11: 1257–61.

    Google Scholar 

  58. Fagundes HM, Lai PP Dehner LP, Perez CA. Postoperative radiotherapy for malignant fibrous histiocytoma. Int J Radiat Oncol Biol Phys. 1992;23:615–19.

    CAS  PubMed  Google Scholar 

  59. Bell RS, O’Sullivan B, Liu FF et al. The surgical margin in soft-tissue sarcoma. J Bone Joint Surg. 1989;71A.:370–5.

    Google Scholar 

  60. Giuliano AE, Eilber FR. The rationale for planned reoperation after unplanned total excision of soft-tissue sarcomas. J Clin Oncol. 1985;3:1344–8.

    CAS  PubMed  Google Scholar 

  61. Noria S, Davis A, Kandel R et al. Residual disease following unplanned excision of a soft-tissue sarcoma of an extremity. J Bone Joint Surg Am. 1996;78:650–5.

    CAS  PubMed  Google Scholar 

  62. Davis AM, Kandel RA, Wunder JS et al. The impact of residual disease on local recurrence in patients treated by initial unplanned resection for soft tissue sarcoma of the extremity. J Surg Oncol. 1997;66:81–7.

    Article  CAS  PubMed  Google Scholar 

  63. Brennan MF, Hilaris B, Shiu MH et al. Local recurrence in adult soft-tissue sarcoma: a randomized trial of brachytherapy. Arch Surg. 1987;122:1289–93.

    CAS  PubMed  Google Scholar 

  64. Tepper J. Rosenberg SA. Glatstein E. Radiation therapy technique in soft tissue sarcomas of the extremity — policies of treatment at the National Cancer Institute. Int J Radiat Oncol Biol Phys. 1982;8:263–73.

    CAS  PubMed  Google Scholar 

  65. Wolfson AH, Benedetto PW, Mnaymneh W et al. Does a radiation dose-response relation exist concerning survival of patients who have soft-tissue sarcomas of the extremities? Radiation dose-response relation for softtissue sarcomas. Am J Clin Oncol. 1998;21:270–4

    Article  CAS  PubMed  Google Scholar 

  66. Eilber PR, Morton DL, Eckardt J, Grant T, Weisenburger T. Limb salvage for skeletal and soft tissue sarcomas. Multidisciplinary preoperative therapy. Cancer. 1984;53: 2579–84.

    CAS  PubMed  Google Scholar 

  67. Robinson MH, Keus RB, Shasha D, Harrison LB. Is preoperative radiotherapy superior to postoperative radiotherapy in the treatment of soft tissue sarcoma? Eur J Cancer. 1998;34:1309–16.

    Article  CAS  PubMed  Google Scholar 

  68. Mansson E, Willems J, Aparisi T, Jakobsson, Nilsonne U, Ringborg U. Preoperative radiation therapy of high malignancy grade soft tissue sarcoma: a preliminary investigation. Acta Radiol Oncol. 1983;22:461–4.

    CAS  PubMed  Google Scholar 

  69. Selch MT, Kopald KH, Ferreiro GA, Mirra JM, Parker RG, Eilber FR. Limb salvage therapy for soft tissue sarcomas of the foot. Int J Radiat Oncol Biol Phys. 1990;19:41–8.

    CAS  PubMed  Google Scholar 

  70. Morton DL, Eilber FR, Townsend CM Jr, Grant TT, Mirra J, Weisenburger TH. Limb salvage from a multidisciplinary treatment approach for skeletal and soft tissue sarcomas of the extremity. Ann Surg. 1976;184:268–78.

    CAS  PubMed  Google Scholar 

  71. Eilber FR, Huth JF, Mirra J, Rosen G. Progress in the recognition and treatment of soft tissue sarcomas. Cancer. 1990;65:660–6.

    CAS  PubMed  Google Scholar 

  72. Eilber F, Eckardt J, Rosen G, Forscher C, Selch M, Fu YS. Preoperative therapy for soft tissue sarcoma. Hematol Oncol Clin N Am. 1995;9:817–23.

    CAS  Google Scholar 

  73. Goodnight JE Jr, Bargar WL, Voegeli T, Blaisdell FW. Limbsparing surgery for extremity sarcomas after preoperative intraarterial doxorubicin and radiation therapy. Am J Surg. 1985;150:109–13.

    Article  PubMed  Google Scholar 

  74. Wanebo HJ, Temple WJ, Popp MB, Constable W, Aron B, Cunningham SL. Preoperative regional therapy for extremity sarcoma. A tricenter update. Cancer. 1995;75:2299–306.

    CAS  PubMed  Google Scholar 

  75. Suit HD, Mankin HJ, Wood WC et al. Treatment of the patient with stage M0 soft tissue sarcoma. J Clin Oncol. 1988;6:854–62.

    CAS  PubMed  Google Scholar 

  76. Spiro IJ, Suit HD. Role of radiation therapy in management of patients with sarcoma of soft tissue. American Society for Therapeutic Radiology and Oncology, 1988 Refresher Course: Sarcoma of soft tissue in the adult. 40th Annual Meeting, 8 October 1998.

    Google Scholar 

  77. Barkley HT, Martin RG, Romsdahl MM, Lindberg R, Zagars GK. Treatment of soft tissue sarcomas by preoperative irradiation and conservative surgical resection. Int J Radiat Oncol Biol Phys. 1988;14:693–9.

    PubMed  Google Scholar 

  78. Brant TA, Parsons JT, Marcus Jr RB et al. Preoperative irradiation for soft tissue sarcomas of the trunk and extremities in adults. Int J Radiat Oncol Biol Phys. 1990;19: 899–906.

    CAS  PubMed  Google Scholar 

  79. Mullen JR, Zagars GK. Synovial sarcoma outcome following conservation surgery and radiotherapy. Radiother Oncol. 1994;33:23–70.

    Article  CAS  PubMed  Google Scholar 

  80. Cheng EY, Dusenbery KE, Winters MR, Thompson RC. Soft tissue sarcomas: preoperative versus postoperative radiotherapy. J Surg Oncol. 1996;61:90–9.

    Article  CAS  PubMed  Google Scholar 

  81. Sadoski C, Suit HD, Rosenberg A, Mankin H, Efird J. Preoperative radiation, surgical margins, and local control of extremity sarcomas of soft tissues. J Surg Oncol. 1993; 52:223–30.

    CAS  PubMed  Google Scholar 

  82. Tanabe KK, Pollock RE, Ellis LM, Murphy A, Sherman N, Romsdahl MM. Influence of surgical margins on outcome in patients with preoperatively irradiated extremity soft tissue sarcomas. Cancer. 1994;73:1652–9.

    CAS  PubMed  Google Scholar 

  83. Nielsen OS, Cummings B, O’Sullivan B, Catton C, Bell RS, Fornasier VL. Preoperative and postoperative irradiation of soft tissue sarcomas: effect on radiation field size. Int J Radiat Oncol Biol Phys. 1991;21:1595–9.

    CAS  PubMed  Google Scholar 

  84. Bujko K, Suit HD, Springfield DS, Convery K. Wound healing after preoperative radiation for sarcoma of soft tissue. Surg Gynecol Obstet. 1993;176:124–34.

    CAS  PubMed  Google Scholar 

  85. O’Sullivan B, Davis R, Bell R et al. Phase III randomized trial of pre-operative versus post-operative radiotherapy in the curative management of extremity soft tissue sarcoma: a Canadian Sarcoma Group and NCI Canada Clinical Trials Group study. Proc Am Soc Clin Oncol. 1999; 18:534a.

    Google Scholar 

  86. Gemer LS, Trowbridge DR, Neff J et al. Local recurrence of soft tissue sarcoma following brachytherapy. Int J Radiat Oncol Biol Phys. 1991;20:587–92.

    CAS  PubMed  Google Scholar 

  87. Schray MF, Gunderson LL, Sim FH, Pritchard DJ, Shives TC, Yeakel PD. Soft tissue sarcoma: integration of brachytherapy, resection, and external irradiation. Cancer. 1990;66:451–6.

    CAS  PubMed  Google Scholar 

  88. Hilaris B, Bodner WR, Mastoras C. Role of brachytherapy in adult soft tissue sarcomas. Semin Surg Oncol. 1997;13: 196–203.

    CAS  PubMed  Google Scholar 

  89. Shiu MH, Turnbull AD, Nori D, Hajdu S, Hilaris B. Control of locally advanced extremity soft tissue sarcomas by function-saving resection and brachytherapy. Cancer. 1984;53:1385–92.

    CAS  PubMed  Google Scholar 

  90. Arbeit J, Hilaris B, Brennan MR. Wound complications in the multimodality treatment of extremity and superfical truncal sarcomas. J Clin Oncol. 1987;5:480–8.

    CAS  PubMed  Google Scholar 

  91. Shiu MH, Hilaris BS, Harrison LB, Brennan MF. Brachytherapy and function-saving resection of soft tissue sarcoma arising in the limb. Int J Radiat Oncol Biol Phys. 1991;21:1485–92.

    CAS  PubMed  Google Scholar 

  92. Ormsby MV, Hilaris BS, Nori D, Brennan MF. Wound complications of adjuvant radiation therapy in patients with soft-tissue sarcomas. Ann Surg. 1989;210:93–9.

    CAS  PubMed  Google Scholar 

  93. Harrison LB. Brachytherapy for sarcomas. 36th Annual Meeting, American Society for Therapeutic Radiology and Oncology, San Francisco, California, 3 October 1994.

    Google Scholar 

  94. O’Connor MI, Pritchard DJ, Gunderson LL. Integration of limb-sparing surgery, brachytherapy, and external-beam irradiation in the treatment of soft-tissue sarcomas. Clin Orthop. 1993;289:73–80.

    PubMed  Google Scholar 

  95. Zelefsky MJ, Nori D, Shiu MH, Brennan MF. Limb salvage in soft tissue sarcomas involving neurovascular structures using combined surgical resection and brachytherapy. Int J Radiat Oncol Biol Phys. 1990;19:913–18.

    CAS  PubMed  Google Scholar 

  96. Alekhteyar KM, Leung DH, Brennan MF, Harrison LB. The effect of combined external beam radiotherapy and brachytherapy on local control and wound complications in patients with high-grade soft tissue sarcomas of the extremity with positive microscopic margin. Int J Radiat Oncol Biol Phys. 1996;36:321–4.

    Article  CAS  PubMed  Google Scholar 

  97. Mills EED, Hering ER. Management of soft tissue tumours by limited surgery combined with tumour bed irradiation using brachytherapy and supplementary teletherapy. Br J Radiol. 1981;54:312–17.

    CAS  PubMed  Google Scholar 

  98. Koizumi M, Inoue T, Yamazaki H et al. Perioperative fractioned high-dose rate brachytherapy for malignant bone and soft tissue tumors. Int J Radiat Oncol Biol Phys. 1999;43:989–93.

    Article  CAS  PubMed  Google Scholar 

  99. Hilaris B, Bodner WR, Mastoras C. Role of brachytherapy in adult soft tissue sarcomas. Semin Surg Oncol. 1997;13:196–203.

    CAS  PubMed  Google Scholar 

  100. Devlin PM, Harrison LB. Brachytherapy for soft tissue sarcomas. In: Verwij J, Pinedo HM, Suit HD, editors. Soft Tissue Sarcomas: Present Achievements and Future Prospects. Boston: Kluwer; 1997:107–28.

    Google Scholar 

  101. Roy J, Hilaris BS, Nori D et al. Adjuvant endocurie-therapy in the management of liposarcomas of the extremities. Endocurie Hypertherm Oncol. 1986;2:29–35.

    Google Scholar 

  102. Chaudhury AJ, Laskar S, Badhwar R. Interstitial brachytherapy in soft tissue sarcomas: The Tata memorial hospital experience. Strahlenther Onkol. 1998;174:522–8.

    Google Scholar 

  103. Mills EED, Hering ER. Management of soft tissue tumours by limited surgery combined with tumour bed irradiation using brachytherapy and supplementary teletherapy. Br J Radiol. 1981;54:312–17.

    CAS  PubMed  Google Scholar 

  104. Burmeister BH, Dickinson I, Bryant G, Doody J. Intraoperative implant brachytherapy in the management of soft-tissue sarcomas. Aust NZ J Surg. 1997;67:5–8.

    CAS  Google Scholar 

  105. Eble MJ, Lehnert Th, Schwarzbach M et al. IORT for extremity sarcomas. In: Vaeth JM, editor. Intraoperative Radiation Therapy in the Treatment of Cancer. Front Radiat Ther Oncol, vol. 31. Basel: Karger; 1997;146–50.

    Google Scholar 

  106. Haddock MG, Petersen IA, Pritchard D, Gunderson LL. IORT in the management of extremity and limb girdle soft tissue sarcomas. In: Vaeth JM, editor. Intraoperative Radiation Therapy in the Treatment of Cancer. Front Radiat Ther Oncol, vol. 31. Basel: Karger; 1997:151–2 (abstract).

    Google Scholar 

  107. Catterall M. The treatment of advanced cancer by fast neutrons from the Medical Research Council’s cyclotron at Hammersmith Hospital, London. Eur J Cancer. 1974; 10:343–7.

    CAS  PubMed  Google Scholar 

  108. Salinas R, Hussey DH, Fletcher GH et al. Experience with fast neutron therapy for locally advanced sarcomas. Int J Radiat Oncol Biol Phys. 1980;6:267–72.

    CAS  PubMed  Google Scholar 

  109. Schmitt G, Scherer E, von Essen CF. Neutron and neutron boost irradiation of soft tissue sarcomas. Strahlentherapie. 1985;161:784–6.

    CAS  PubMed  Google Scholar 

  110. Schmitt G, Fürst G, Bamberg M. The value of neutron-and neutron-boost irradiation for the local control of advanced soft tissue sarcomas. Bull Cancer (Paris). 1986; 73:577–81.

    CAS  Google Scholar 

  111. Richard F, Renard l, Wambersie A. Neutron therapy for soft tissue sarcoma at Louvain-la-Neuve (interim results 1987). Strahlenther Onkol. 1989;165;306–8.

    CAS  PubMed  Google Scholar 

  112. Pickering DG, Stewart JS, Rampling R, Errington RD, Stamp G, Chia Y. Fastneutron therapy for soft tissue sarcoma. Int J Radiat Oncol Biol Phys. 1987;13:1489–95.

    CAS  PubMed  Google Scholar 

  113. Griffin TW, Wambersie A, Laramore G, Castro J. High LET: heavy particle trials. Int J Radiat Oncol Biol Phys. 1988;14:S83–92.

    Google Scholar 

  114. Greiner R, Munkel G, Kann R et al. Pion irradiation at Paul Scherrer Institute. Results of dynamic treatment of unresectable soft tissue sarcoma. Strahlenther Onkol. 1990;166:30–3.

    CAS  PubMed  Google Scholar 

  115. Austin-Seymour M, Munzenrider J, Willet et al. Consideration in fractionated proton radiation therapy: clinicalpotential and results. Radiother Oncol. 1990;17: 29–35.

    CAS  PubMed  Google Scholar 

  116. Hug EB, Markus MF, Liebsch NJ, Munzenrider JE. Locally challenging osteo-and chondrogenic tumors of the axial skeleton: results of combined proton and photon radiation therapy using three-dimensional treatment planning. Int J Radiat Oncol Biol Phys. 1995;31:467–76.

    Article  CAS  PubMed  Google Scholar 

  117. Coleman CN. Chemical sensitizers and protectors. Int J Radiat Oncol Biol Phys. 1998;42:781–3.

    Article  CAS  PubMed  Google Scholar 

  118. Coleman CN, Mitchell JB. Clinical radiosensitization: why it does and does not work (editorial). J Clin Oncol. 1999;17:1–3.

    CAS  PubMed  Google Scholar 

  119. Coleman CN. Radiation and chemotherapy sensitizers and protectors. In: Chabner BA et al, editors. Cancer Chemotherapy and Biotherapy, 2nd edn. Philadelphia: Lippincott-Raven; 1996:553.

    Google Scholar 

  120. Kinsella TJ, Glatstein E. Clinical experience with intravenous radiosensitizers in unresectable sarcomas. Cancer. 1987;59:908–15.

    CAS  PubMed  Google Scholar 

  121. Martinez A, Goffinet DR, Donaldson SS, Bagshaw MA, Kaplan HS. Intra-arterial infusion of radiosensitizers (BUdR) combined with hypofractionated irradiation and chemotherapy for primary treatment of osteogenic sarcoma. Int J Radiat Oncol Biol Phys. 1985;11:123–8.

    CAS  PubMed  Google Scholar 

  122. Goffman T, Tochner Z, Glatstein E. Primary treatment of large and massive adult sarcomas with iododeoxyuridine and aggressive hyperfractionated irradiation. Cancer. 1991;67:572–6.

    CAS  PubMed  Google Scholar 

  123. Sondak VK, Robertson JM, Sussman JJ, Saran PA, Chang AE, Lawrence TS. Preoperative idoxuridine and radiation for large soft tissue sarcomas: clinical results with five-year follow-up. Ann Surg Oncol. 1998;5:106–12.

    Article  CAS  PubMed  Google Scholar 

  124. Rhomberg W, Hassenstein EO, Gefeller D. Radiotherapy vs. radiotherapy and razoxane in the treatment of soft tissue sarcomas: final results of a randomized study. Int J Radiat Oncol Biol Phys. 1996;36:1077–84.

    Article  CAS  PubMed  Google Scholar 

  125. Lewis JJ, Leung D, Woodruff JM, Brennan MF. Retroperitoneal soft-tissue sarcoma: analysis of 500 patients treated and followed at a single institution. Ann Surg. 1998;228:355–65.

    Article  CAS  PubMed  Google Scholar 

  126. Heslin MJ, Lewis JJ, Nadler E et al. Prognostic factors associated with long-term survival for retroperitoneal sarcoma: implications for management. J Clin Oncol. 1997;15:2832–9.

    CAS  PubMed  Google Scholar 

  127. Singer S, Corson JM, Demetri GD, Healey EA, Marcus K, Ebelein TJ. Prognostic factors predictive of survival for truncal and retroperitoneal soft-tissue sarcoma. Ann Surg. 1995;221:185–95.

    CAS  PubMed  Google Scholar 

  128. Kilkenny III JW, Bland KI, Copeland III EM. Retroperitoneal sarcoma: the University of Florida experience. J Am Coll Surg. 1996;182:329–39.

    PubMed  Google Scholar 

  129. Jacques DP, Coit DG, Hajdu SI, Brennan MF. Management of primary and recurrent soft-tissue sarcoma of the retroperitoneum. Ann Surg. 1990;212:51–9.

    Google Scholar 

  130. McGrath PC, Neifeld JP, Lawrence W et al. Improved survival following complete excision of retroperitoneal sarcomas. Ann Surg. 1984;200:200–4.

    CAS  PubMed  Google Scholar 

  131. Harrison LB, Gutirrez E, Fischer JJ. Retroperitoneal sarcomas: the Yale experience and a review of the literature. J Surg Oncol. 1986;32:159–64.

    CAS  PubMed  Google Scholar 

  132. Kinne DW, Chu FCH, Huvos AG, Yagoda A, Fortner JG. Treatment of primary and recurrent retroperitoneal liposarcoma: twenty-five-yearexperience at Memorial Hospital. Cancer. 1973;31:53–64.

    CAS  PubMed  Google Scholar 

  133. Alvarenga JC, Ball ABS, Fisher C, Fryatt I, Jones L, Thomas JM. Limitations of surgery in the treatment of retroperitoneal sarcoma. Br J Surg. 1991;78:912–16.

    CAS  PubMed  Google Scholar 

  134. Bevilacqua RG, Rogatko A, Hadju S, Brennan MF. Prognostic factors in primary retroperitoneal soft tissue sarcomas. Arch Surg. 1991;126:328–34.

    CAS  PubMed  Google Scholar 

  135. Karakousis CP, Velez AF, Emrich LJ. Management of retroperitoneal sarcomas and patient survival. Am J Surg. 1985;150:376–80.

    Article  CAS  PubMed  Google Scholar 

  136. Sindelar WF, Kinsella TJ, Chen PW et al. Intraoperative radiotherapy in retroperitoneal sarcomas: final results of a prospective, randomized, clinical trial. Arch Surg. 1993;128:402–10.

    CAS  PubMed  Google Scholar 

  137. Fortner JG, Martin S, Hajdu S, Turnbull A. Primary sarcoma of the retroperitoneum. Semin Oncol. 1981;8:180–4.

    CAS  PubMed  Google Scholar 

  138. Tepper JE, Suit HD, Wood WC, Proppe KH, Harmon D, McNulty P. Radiation therapy of retroperitoneal soft tissue sarcomas. Int J Radiat Oncol Biol Phys. 1984;10: 825–30.

    CAS  PubMed  Google Scholar 

  139. Testolin A, Pozza F, Fior SD et al. Surgical and adjuvant radiation therapy of resectable retroperitoneal soft tissue sarcomas in adults. Tumori. 1992;78:388–91.

    CAS  PubMed  Google Scholar 

  140. van Doorn RC, Gallee MPW, Hart AAM et al. Resectable retroperitoneal soft tissue sarcomas. Cancer. 1994;73: 637–42.

    PubMed  Google Scholar 

  141. Catton CN, O’Sullivan B, Kotwall C et al. Outcome and prognosis in retroperitoneal soft tissue sarcoma. Int J Radiat Oncol Biol Phys. 1994;29:1005–10.

    CAS  PubMed  Google Scholar 

  142. Fein DA, Corn BW, Lanciano RM, Herbert SH, Hoffman JP, Coia LR. Management of retroperitoneal sarcomas: does dose escalation impact on locoregional control. Int J Radiat Onclo Biol Phys. 1995;31:129–34.

    CAS  Google Scholar 

  143. Greiner RH, Munkel G, Blattmann H et al. Conformal radiotherapy for unresectable retroperitoneal soft tissue sarcoma. Int J Radiat Oncol Biol Phys. 1991;22:333–41.

    Google Scholar 

  144. Willet CG, Suit HD, Tepper JE et al. Intraoperative electron beam radiation therapy for retroperitoneal soft tissue sarcoma. Cancer. 1991;68:278–83.

    Google Scholar 

  145. Gunderson LL, Nagorney DM, McIlrath DC et al. External beam and intraoperative electron irradiation for locally advanced soft tissue sarcomas. Int J Radiat Oncol Biol Phys. 1993;25:647–58.

    CAS  PubMed  Google Scholar 

  146. Bussiéres E, Stöckle EP, Richaud PM, Avril AR et al. Retroperitoneal soft tissue sarcomas: a pilot study of intraoperative radiation therapy. J Surg Oncol. 1996;62:49–56.

    PubMed  Google Scholar 

  147. Granowetter L. Ewing’s sarcoma and extracranial primitive neuroectodermal tumors. Curr Opin Oncol. 1996 Jul;8(4):305–10.

    CAS  PubMed  Google Scholar 

  148. de Alava E, Gerald WL. Molecular biology of the Ewing’s sarcoma/primitive neuroectodermal tumor family. J Clin Oncol. 2000;18:204–13.

    PubMed  Google Scholar 

  149. Pritchard DJ, Dahlin DC, Dauphine RT et al. Ewing’s sarcoma: a clinicopathological and statistical analysis of patients surviving five years or longer. J Bone Joint Surg. 1975;57A:10–16.

    Google Scholar 

  150. Pritchard DJ. Indications for surgical treatment of localized Ewing’s sarcoma of bone. Clin Orthop Rel Res. 1980;153:39–43.

    Google Scholar 

  151. Pritchard DJ. Surgical experience in the management of Ewing’s sarcoma of bone. Natl Cancer Inst Monogr. 1981;56:169–71.

    PubMed  Google Scholar 

  152. Wilkins RM, Pritchard DJ, Burgert EM et al. Ewing’s sarcoma of bone: experience with 140 patients. Cancer. 1986;58:2551–5.

    CAS  PubMed  Google Scholar 

  153. Sailor SL, Harmon DC, Mankin HJ. Ewing’s sarcoma surgical resection as a prognostic factor. Int J Radiat Oncol Biol Phys. 1988;15:43–52.

    Google Scholar 

  154. Toni A, Neff JR, Sudanese A et al. The role of surgical therapy in patients with nonmetastatic Ewing’s sarcoma of the limbs. Clin Orthop Rel Res. 1993;286:225–40.

    Google Scholar 

  155. Arai Y, Kun LE, Brooks MT et al. Ewing’s sarcoma: local tumor control and patterns of failure following limited-volume radiation therapy. Int J Radiat Oncol Biol Phys. 1991;21:1501–8.

    CAS  PubMed  Google Scholar 

  156. Barbieri E, Emiliani E, Zini G et al. Combined therapy of localized Ewing’s sarcoma of bone: analysis of results in 100 patients. Int J Radiat Oncol Biol Phys. 1990;19: 1165–70.

    CAS  PubMed  Google Scholar 

  157. Donaldson SS, Torrey M, Link MP et al. A multidisciplinary study investigating radiotherapy in Ewing’s sarcoma: end results of POG #8346. Int J Radiat Oncol Biol Phys. 1998;42:125–35.

    Article  CAS  PubMed  Google Scholar 

  158. Sauer R, Jürgens H, Burgers JMV et al. Prognostic factors in the treatment of Ewing’s sarcoma: the Ewing’ Sarcoma Study Group of the German Society of Pediatric Oncology CESS 81. Radiother Oncol. 1987;10:101–10.

    CAS  PubMed  Google Scholar 

  159. Ozaki T, Hillmann A, Hoffmann C et al. Ewing’s sarcoma of the femur: prognosis in 69 patients treated by CESS group. Acta Orthop Scand. 1997;68:20–4.

    CAS  PubMed  Google Scholar 

  160. Thomas PRM, Perez CA, Neff JR et al. The management of Ewing’s sarcoma: role of radiotherapy in local tumor control. Cancer Treat Rep. 1984;68:703–10.

    CAS  PubMed  Google Scholar 

  161. Villarroel M, Tordecilla J, Salgado C et al. Multimodal therapy for children and adolescents with Ewing’ sarcoma: results of the first national Chilean trial (1986–1991). Med Pediatr Oncol. 1997;29:190–6.

    Article  CAS  PubMed  Google Scholar 

  162. Razek A, Perez CA, Tefft M et al. Intergroup Ewing’s sarcoma study: local control related to radiation dose, volume, and site of primary lesion in Ewing’s sarcoma. Cancer. 1980;46:516–21.

    CAS  PubMed  Google Scholar 

  163. Kinsella TJ, Miser JS, Waller B et al. Long-term follow-up of Ewing’s sarcoma of bone treated with combined modality therapy. Int J Radiat Oncol Biol Phys. 1991;20: 389–95.

    CAS  PubMed  Google Scholar 

  164. Wexler LH, DeLaney TF, Tsokos M et al. Ifosfamide and etoposide plus vincristrine, doxorubicin, and cyclophosphamide for newly diagnosed Ewing’s sarcoma family of tumors. Cancer. 1996;78:901–11.

    Article  CAS  PubMed  Google Scholar 

  165. Marcus Jr RB, Cantor A, Heare TC et al. Local control and function after twice-a-day radiotherapy for Ewing’s sarcoma of bone. Int J Radiat Oncol Biol Phys. 1991;21: 1509–15.

    PubMed  Google Scholar 

  166. Bolek TW, Marcus RB, Mendenhall NP et al. Local control and functional results after twice-daily radiotherapy for Ewing’s sarcoma of the extremities. Int J Radiat Oncol Biol Phys. 1996;35:687–92.

    Article  CAS  PubMed  Google Scholar 

  167. Perez CA, Tefft M, Nesbit ME et al. Radiation therapy in the mulimodal management of Ewing’s sarcoma of bone. Report of the intergroup Ewing’s sarcoma study. Natl Cancer Inst Monogr. 1981;56:263–71.

    PubMed  Google Scholar 

  168. Perez CA, Tefft M, Nesbit ME et al. The role of radiation therapy in the management of non-metastatic Ewing’ sarcoma of bone. Report of the intergroup Ewing’s sarcoma study. Int J Radiat Oncol Biol Phys. 1981;7:141–9.

    CAS  PubMed  Google Scholar 

  169. Ewing J. Diffuse endothelioma of bone. Proc. NY Pathol Soc. 1921;21:17–24.

    Google Scholar 

  170. Suit HD. Role of therapeutic radiology in cancer of bone. Cancer. 1975;35:930–5.

    CAS  PubMed  Google Scholar 

  171. Nesbit ME, Gehan EA, Burgert EO et al. Multimodal therapy for the management of primary, nonmetastatic Ewing’s sarcoma of bone: a long-term follow-up of the first intergroup study. J Clin Oncol. 1990;8:1664–74.

    PubMed  Google Scholar 

  172. Marcove RC, Rosen G. Radical en bloc excision of Ewing’s sarcoma. Clin Orthop Rel Res. 1980;153:86–91.

    Google Scholar 

  173. Jenkins RDT. Ewing’s sarcoma: radiation treatment at the primary site — regarding Dunst et al. Int J Radiat Oncol Biol Phys. 1995;32:919–30. Int J Radiat Oncol Biol Phys. 1995;32:1253–4 (editorial).

    Google Scholar 

  174. Perez CA, Razek A, Tefft M et al. Analysis of local tumor control in Ewing’s sarcoma: preliminary results of a cooperative intergroup study. Cancer. 1977;40:2864–73.

    CAS  PubMed  Google Scholar 

  175. Burgert OE, Nesbit ME, Garnsey LA et al. Multimodal therapy for the management of nonpelvic, localized Ewing’s sarcoma of bone: Intergroup study IESS-II. J Clin Oncol. 1990;8:1514–24.

    PubMed  Google Scholar 

  176. Jürgens H, Exner U, Gadner H et al. Multidisciplinary treatment of primary Ewing’s sarcoma of bone: a 6-year experience of a European cooperative trial. Cancer. 1988;61:23–32.

    PubMed  Google Scholar 

  177. Dunst J, Jürgens H, Sauer R et al. Radiation therapy in Ewing’s sarcoma: an update of the CESS 86 trial. Int J Radiat Oncol Biol Phys. 1995;32:919–30.

    Article  CAS  PubMed  Google Scholar 

  178. Bacci G, Ferrari S, Bertoni F et al. Prognostic factors in nonmetastatic Ewing’s sarcoma of bone treated with adjuvant chemotherapy: analysis of 359 patients at the Istituto Ortopedic Rizzoli. J Clin Oncol. 2000;18:4–11.

    CAS  PubMed  Google Scholar 

  179. Marcus RB, Graham-Pole JR, Springfield DS et al. High-risk Ewing’s sarcoma: end-intensification using autologous bone marrow transplantation. Int J Radiat Oncol Biol Phys. 1988;15:53–9.

    PubMed  Google Scholar 

  180. Picci P, Bacci BG, Sangiorgi L et al. Chemotherapy-induced tumor necrosis as a prognostic factor in localized Ewing’s sarcoma of the extremities. J Clin Oncol. 1997;15:1553–9.

    CAS  PubMed  Google Scholar 

  181. Nilbert M, Saeter G, Elomaa I et al. Ewing’s sarcoma treatment in Scandinavia 1984–1990. Acta Oncol. 1998; 37:375–8.

    CAS  PubMed  Google Scholar 

  182. Evans R, Nesbit M, Askin F et al. Local recurrence, rate and sites of metastases, and time to relapse as a function of treatment regimen, size of primary and surgical history in 62 patients presenting with non-metastatic Ewing’s sarcoma of the pelvic bones. Int J Radiat Oncol Biol Phys. 1985;11:129–36.

    CAS  PubMed  Google Scholar 

  183. Brown AP, Fixsen JA, Plowman PN. Local control of Ewing’s sarcoma: an analysis of 678 patients. Br J Radiol. 1987;60:261–8.

    CAS  PubMed  Google Scholar 

  184. Craft AW, Cotterill SJ, Bullimore JA, Pearson D. Long-term results from the first UKCCSG Ewing’s tumor study (ET-1). Eur J Cancer. 1997;33:1061–9.

    Article  CAS  PubMed  Google Scholar 

  185. Raney RB, Asmar L, Newton WA. Ewing’s sarcoma of soft tissues in childhood: a report from the intergroup rhabdomyosarcoma study, 1972 to 1991. J Clin Oncol. 1997;15:574–82.

    CAS  PubMed  Google Scholar 

  186. Gasparini M, Lombardi F, Ballerini E et al. Long-term outcome of patients with monostotic Ewing’s sarcoma treated with combined modality. Med Pediatr Oncol. 1994;23:406–12.

    CAS  PubMed  Google Scholar 

  187. Rosen G, Caparros B, Nirenberg A et al. Ewing’s sarcoma: ten-year experience with adjuvant chemotherapy. Cancer. 1981;47:2204–13.

    CAS  PubMed  Google Scholar 

  188. Bacci G, Toni A, Avella M et al. Long-term results in localized Ewing’s sarcoma patients treated with combined therapy. Cancer. 1989;63:1477–86.

    CAS  PubMed  Google Scholar 

  189. Scully SP, Temple HT, O’Keefe RJ et al. Role of surgical resection in pelvic Ewing’s sarcoma. J Clin Oncol. 1995;13:2336–41.

    CAS  PubMed  Google Scholar 

  190. Burgers JMV, Oldenburger F, de Kraker J et al. Ewing’s sarcoma of the pelvis: changes over 25 years in treatment and results. Eur J Cancer. 1997;33:2360–7.

    Article  CAS  PubMed  Google Scholar 

  191. Evans RG, Nesbit ME, Gehan EA, Garnsey L et al. Multimodal therapy for the management of localized Ewing’s sarcoma of pelvic and sacral bones: a report from the second intergroup study. J Clin Oncol. 1991; 9:1173–80.

    CAS  PubMed  Google Scholar 

  192. Li WK, Lane JM, Rosen G et al. Pelvic Ewing’s sarcoma: advances in treatment. J Bone Joint Surg. 1983;65A: 738–47.

    Google Scholar 

  193. Frassica FJ, Frassica DA, Pritchard DJ et al. Ewing’s sarcoma of the pelvis: clinopathological features and treatment. J Bone Joint Surg. 1993;75A:1457–65.

    Google Scholar 

  194. Le Vu B, De Vathaire F, Shamsaldin A et al. Radiation dose, chemotherapy and risk of osteosarcoma after solid tumours during childhood. Int J Cancer. 1998;77:370–7.

    PubMed  Google Scholar 

  195. Dunst J, Ahrens S, Paulussen M et al. Second malignancies after treatment of Ewing’s sarcoma: a report of the CESS-studies. Int J Radiat Oncol Biol Phys. 1999;42: 379–84.

    Google Scholar 

  196. Horowitz M, Neff Jr Kun LE. Ewing’s sarcoma: radiotherapy versus surgery for local control. Pediatr Clin N Am. 1991;38:365–80.

    CAS  Google Scholar 

  197. Tucker MA, D’Angio GJ, Boice JD et al. for the Late Effects Study Group. Bone sarcomas linked to radiotherapy and chemotherapy. N Engl J Med. 1987;317:588–93.

    CAS  PubMed  Google Scholar 

  198. Medeows AT, Baum E, Fossati-Bellani F et al. Second malignant neoplasms in children: an update from the Late Effects Study Group. J. Clin Oncol. 1985;3:532–8.

    Google Scholar 

  199. Strong LC, Herson J, Osborne BM, Sutow WW. Risk of radiation-related subsequent malignant tumors in survivors of Ewing’s sarcoma. J Natl Cancer Inst. 1979; 62:1401–6.

    CAS  PubMed  Google Scholar 

  200. Kuttesch JF, Wexler LH, Narcus RB et al. Second malignancies after Ewing’s sarcoma: radiation dose-dependency of secondary sarcomas. J Clin Oncol. 1996;14:2818–25.

    PubMed  Google Scholar 

  201. Smith LM, Cox RS, Donaldson SS. Second cancers in long-terms survivors of Ewing’s sarcoma. Clin Orthop Rel Res. 1992;274:275–81.

    Google Scholar 

  202. Rosen G, Caparros B, Huvos AG et al. Preoperative chemotherapy for osteogenic sarcoma. Cancer. 1982;49:1221–30.

    CAS  PubMed  Google Scholar 

  203. Meyer WH, Malawer MM. Osteosarcoma: clinical features and evolving surgical and chemotherapeutic strategies. Pediatr Clin N Am. 1991;38:317–48.

    CAS  Google Scholar 

  204. Weiner MA, Harris MB, Lewis M et al. Neoadjuvant high dose methotrexate, cisplatin and doxorubicin for the management of patients with nonmetastatic osteosarcoma. Cancer Treat Rep. 1986;70:1431.

    CAS  PubMed  Google Scholar 

  205. Marti C, Kroner T, Remagen W, Berchtold W, Cserhati M, Varini M. High-dose ifosfamide in advanced osteosarcoma. Cancer Treat Rep. 1985;69:115–17.

    CAS  PubMed  Google Scholar 

  206. Michelagnoli MP, Lewis IJ, Gattamaneni HR, Bailey CC, Lashford LS. Ifosfamide/etoposide alternating with high-dose methotrexate: evaluation of a chemotherapy regimen for poor-risk osteosarcoma. Br J Cancer. 1999; 79:1174–8.

    Article  CAS  PubMed  Google Scholar 

  207. Gentet JC, Brunat-Mentigny M, Demaille MC et al. Ifosfamide and etoposide in childhood osteosarcoma. A phase II study of the French Society of Pediatric Oncology. Eur J Cancer. 1997;33:232–7.

    Article  CAS  PubMed  Google Scholar 

  208. Link MP, Goorin AM et al. The effect of adjuvant chemotherapy on relapse-free survival in patients with osteosarcoma of the extremity. N Engl J Med. 1986;314: 1600–6.

    CAS  PubMed  Google Scholar 

  209. Eilber F, Giuliano A, Eckardt J, Patterson K, Moseley S, Goodnight J. Adjuvant chemotherapy for osteosarcoma: a randomized prospective trial. J Clin Oncol. 1987;5:21–6.

    CAS  PubMed  Google Scholar 

  210. Davis AM, Bell RS, Goodwin PJ. Prognostic factors in osteosarcoma: a critical review. J Clin Oncol. 1994;12: 423–31.

    CAS  PubMed  Google Scholar 

  211. Rosen G, Marcove R, Caparros B, Nirenberg A, Kosloff C, Huvos AG. Primary osteogenic sarcoma: the rationale for preoperative chemotherapy and delayed surgery. Cancer. 1979;43:2163–77.

    CAS  PubMed  Google Scholar 

  212. Bramwell V The role of chemotherapy in the management of non-metastatic operable extremity osteosarcoma. Semin Oncol. 1997;24:561–71.

    CAS  PubMed  Google Scholar 

  213. Sundaresan N, Rosen G, Huvos AG, Krol G. Combined treatment of osteosarcoma of the spine. Neurosurgery. 1988;23:714–19.

    CAS  PubMed  Google Scholar 

  214. Fahey M, Spanier S, Vander Griend, RA. Osteosarcoma of the pelvis: a clinical and histopathological study of twenty-five patients. J Bone Joint Surg. 1992;74A:321–30.

    Google Scholar 

  215. Chambers RG, Mahaney WD. Osteogenic sarcoma of the mandible: current management. Am Surg. 1970;35:463–71.

    Google Scholar 

  216. deFries HO, Perlin E, Leibel SA. Treatment of osteogenic sarcoma of the mandible. Arch Otolaryngol. 1979; 105:358–9.

    Google Scholar 

  217. Slootweg PJ, Muller H. Osteosarcoma of the jaw bones. Analysis of 18 cases. J Maxillofac Surg. 1985; 13:158–66.

    CAS  PubMed  Google Scholar 

  218. Mark RJ, Sercarz JA, Tran L, Dodd LG, Selch M, Calcaterra TC. Osteogenic sarcoma of the head and neck. The UCLA experience. Arch Otolaryngol Head Neck Surg. 1991;117:761–6.

    CAS  PubMed  Google Scholar 

  219. August M, Magnesia P, Dewitt D. Osteogenic sarcoma of the jaws: factors influencing prognosis. Int J Oral Maxillofac Surg. 1997;26:198–204.

    CAS  PubMed  Google Scholar 

  220. Schmitt G, Rehwald U, Bamberg M. Neutron irradiation of primary bone tumors: results of a pilot study and presentation of a modified protocol. J Eur Radiother. 1982;3:1145–6.

    Google Scholar 

  221. Laramore GE, Griffith JT, Boespflug M et al. Fast neutron radiotherapy for sarcomas of soft tissue, bone and cartilage. Am J Clin Oncol. 1989;12:320–6.

    CAS  PubMed  Google Scholar 

  222. Ferguson AB. Treatment of osteogenic sarcoma. J Bone Joint Surg. 1940;22:92–6.

    Google Scholar 

  223. Cade S. Osteogenic sarcoma: a study based on 133 patients. J R Coll Surg Edinb. 1955;1:79–111.

    CAS  PubMed  Google Scholar 

  224. Allen CV, Stevens KR. Preoperative irradiation for osteogenic sarcoma. Cancer. 1973;31:1364–6.

    CAS  PubMed  Google Scholar 

  225. Jenkin RD, Allt WEC, Fitzpatrick PJ. Osteosarcoma: an assessment of management with particular reference to primary irradiation and selective delayed amputation. Cancer. 1972;30:393–400.

    CAS  PubMed  Google Scholar 

  226. Jaffe N. Recent advances in the chemotherapy of metastatic osteogenic sarcoma. Cancer. 1972;30:1627–31.

    CAS  PubMed  Google Scholar 

  227. Mills EED. Osteosarcoma — the winds of change. S Afr Med J. 1978;53:695–8.

    CAS  PubMed  Google Scholar 

  228. Copeland MM, Suttow WW. Osteogenic sarcoma: the past, present and future. Int Adv Surg Oncol. 1979;2: 177–200.

    CAS  PubMed  Google Scholar 

  229. Cortes EF; Holland JF, Glidewell O. Amputation and adriamycin in primary osteosarcoma: a 5-year report. Cancer Treat Rep. 1978;62:271–7.

    CAS  PubMed  Google Scholar 

  230. Eilber FR, Guiliano AE, Huth JF, Eckhardt J. Limb salvage for malignant tumors of bone. Prog Clin Biol Res. 1985;201:25–37.

    CAS  PubMed  Google Scholar 

  231. Wiley AL Jr, Wirtanen GW, Wu JP, Jaeschke W, Ansfield FJ, Ramirez G, Davis HL. Combined intra-arterial chemotherapy and radiotherapy with special reference to osteogenic sarcoma. Ann Clin Res. 1974;6:330–7.

    PubMed  Google Scholar 

  232. Denton JW, Dunham WK, Salter M, Urist MM, Balch CM. Preoperative regional chemotherapy and rapid-fraction irradiation for sarcomas of the soft tissue and bone. Surg Gynecol Obstet. 1984; 158:545–51.

    CAS  PubMed  Google Scholar 

  233. Lejeune FJ, Regnier R, Nogaret JM, Jabri M. Intra-arterial infusion of bromodeoxyuridine and radiotherapy in osteosarcoma and other bone malignancies. Rec Results Cancer Res. 1983;86:204–8.

    CAS  Google Scholar 

  234. Huvos AG. Bone Tumors. Diagnosis, Treatment and Prognosis. Philadelphia: W.B. Saunders; 1979.

    Google Scholar 

  235. Estrada-Aguilar J, Greenberg H, Walling A et al. Primary treatment of pelvic osteosarcoma: report of five cases. Cancer. 1992;69:1137–45.

    CAS  PubMed  Google Scholar 

  236. Hoekstra HJ, Sindelar WF, Kinsella TJ. Surgery with intraoperative radiotherapy for sarcomas of the pelvic girdle: a pilot experience. Int J Radiat Oncol Biol Phys. 1988;15:1013–16.

    CAS  PubMed  Google Scholar 

  237. Hoekstra HJ, Sindelar WF, Szabo BG, Kinsella TJ. Hemipelvetomy and intraoperative radiotherapy for bone and soft tissue sarcomas of the pelvic girdle. Radiother Oncol. 1995;37:160–3.

    Article  CAS  PubMed  Google Scholar 

  238. Carrie C, Breteau N, Negrier S et al. The role of fast neutron therapy in unresectable pelvic osteosarcoma: preliminary report. Med Pediatr Oncol. 1994;22:355–7.

    CAS  PubMed  Google Scholar 

  239. Masterson EL, Davis AM, Wunder JS, Bell RS. Hindquarter amputations for pelvic tumors–the importance of patient selection. Clin Orthop Rel Res. 1998;350:187–94.

    Google Scholar 

  240. O’Connor MI, Sim FH. Salvage of the limb in the treatment of malignant pelvic tumors. J Bone Joint Surg. 1989;17A:481–94.

    Google Scholar 

  241. Rosen G, Caparros B, Huvos AG et al. Preoperative chemotherapy for osteogenic sarcoma. Cancer. 1982;49:1221–30.

    CAS  PubMed  Google Scholar 

  242. Gradinger R, Rechl H, Hipp E. Pelvic osteosarcoma: resection, reconstruction, local control, and survival statistics. Clin Orthop Rel Res. 1991;20:149–58.

    Google Scholar 

  243. Aboulafia A, Malawer MM. Surgical management of pelvic and extremity osteosarcoma. Cancer. 1993;71: 3358–66.

    CAS  PubMed  Google Scholar 

  244. Lindstadt DE, Castro JR, Phillips TL. Neon ion radiotherapy: results of the phase I/II clinical trial. J Radiat Oncol Biol Phys. 1991;20:761–9.

    Google Scholar 

  245. Nowakowski VA, Castro JR, Petti PL et al. Charged particle radiotherapy of paraspinal tumors. Int J Radiat Oncol Biol Phys. 1992;22:295–303.

    CAS  PubMed  Google Scholar 

  246. Duncan W, Arnott SJ, Jack WJ. The Edinburgh experience of treating sarcomas of soft tissues and bone with neutron irradiation. Clin Radiol. 1986;37:317–20.

    Article  CAS  PubMed  Google Scholar 

  247. Cohen L, Hendrickson F, Mansell J et al. Response of sarcomas of bone and soft tissue to neutron beam therapy. Int J Radiat Oncol Biol Phys. 1984;10:821–4.

    CAS  PubMed  Google Scholar 

  248. Laramore GE, Griffin TW, Boespflug M et al. Fast neutron therapy for sarcomas of soft tissue, bone and cartilage. Am J Clin Oncol. 1989;12;320–6.

    CAS  PubMed  Google Scholar 

  249. Laramore GE, Griffin TW. Fast neutron radiotherapy: where have we been and where are we going? The jury is still out — regarding MAOR et al. Int J Radiat Oncol Biol Phys. 1995;32:879–82.

    CAS  PubMed  Google Scholar 

  250. Schwrz R, Krüll A, Heyer D et al. Present results of fast neutron therapy — the German experience. Acta Oncol. 1994;33:281–7.

    Google Scholar 

  251. Wambersie A, Richard F, Breteau N. Development of fast neutron therapy worldwide: radiobiological, clinical and technical aspects. Acta Oncol. 1994;33:261–74.

    CAS  PubMed  Google Scholar 

  252. Bacci, G, Avella M, Picci P et al. Metastatic patterns in osteosarcoma. Tumori. 1988;74:421–7.

    CAS  PubMed  Google Scholar 

  253. Newton KA, Barrett A. Prophylactic lung irradiation in the treatment of osteogenic sarcoma. Clin Radiol. 1978;29:493–6.

    Article  CAS  PubMed  Google Scholar 

  254. Rab GT, Ivins JC, Childs DS Jr, Cupps RE, Pritchard DJ. Elective whole lung irradiation in the treatment of osteogenic sarcoma. Cancer. 1976;38:939–42.

    CAS  PubMed  Google Scholar 

  255. Breur K, Cohen P, Schweisguth O, Hart AM. Irradiation of the lungs as an adjuvant therapy in the treatment of osteosarcoma of the limbs. An E.O.R.T.C. randomized study. Eur J Cancer. 1978;14:461–71.

    CAS  PubMed  Google Scholar 

  256. Breur K, Schweisguth O, Cohen P, Voute PA. Prophylactic irradiation of the lungs to prevent development of pulmonary metastases in patients with osteosarcoma of the limbs. Natl Cancer Inst Monogr. 1981;56:233–6.

    PubMed  Google Scholar 

  257. Burgers JM, van Glabbeke M, Busson A et al. Osteosarcoma of the limbs. Report of the EORTC-SIOP 03 trial 20781 investigating the value of adjuvant treatment with chemotherapy and/or prophylactic lung irradiation. Cancer. 1988;61:1024–31.

    CAS  PubMed  Google Scholar 

  258. Dunst J, Paulussen M, Jurgens H. Lung irradiation for Ewing’s sarcoma with pulmonary metastases at diagnosis: results of the CESS-studies. Strahlenther Onkol. 1993;169:621–3.

    CAS  PubMed  Google Scholar 

  259. Harwood AR, Krajbich JI, Fornasier VL. Radiotherapy of chondrosarcoma of bone. Cancer. 1980;45:2769–77.

    CAS  PubMed  Google Scholar 

  260. McNaney D, Lindberg RD, Ayala AG, Barkley HT, Hussey DH. Fifteen year radiotherapy experience with chondrosarcoma of bone. Int J Radiat Oncol Biol Phys. 1982;8:187–90.

    CAS  PubMed  Google Scholar 

  261. Schmitt G, Wambersie A. Review of the clinical results of fast neutron therapy. Radiother Oncol. 1990;17:47–56.

    CAS  PubMed  Google Scholar 

  262. Austin-Seymour M, Munzenrider J, Linggood R et al. Fractionated proton radiation therapy of cranial and intracranial tumors. Am J Clin Oncol. 1990;13:327–30.

    CAS  PubMed  Google Scholar 

  263. Austin-Seymour M, Munzenrider J, Goitein M et al. Fractionated proton radiation therapy of chordoma and low-grade chondrosarcoma of the base of the skull. J Neurosurg. 1989; 70:13–17.

    CAS  PubMed  Google Scholar 

  264. Sundaresan N, Galicich JH, Chu FCH, Huvos AG. Spinal chordomas. J Neurosurg. 1979;50:312–19.

    CAS  PubMed  Google Scholar 

  265. Reddy EK, Mansfield CM, Hartman GV. Chordoma. Int J Radiat Oncol Biol Phys. 1981;7:1709–11.

    CAS  PubMed  Google Scholar 

  266. Saxton JR Chordoma. Int J Radiat Oncol Biol Phys. 1981;7:913–15.

    CAS  PubMed  Google Scholar 

  267. Cummings BJ, Hodson DI, Bush RS. Chordoma: the results of megavoltage radiation therapy. Int J Radiat Oncol Biol Phys. 1983;9:633–42.

    CAS  PubMed  Google Scholar 

  268. Keisch ME, Garcia DM, Shibuya RB. Retrospective longterm follow-up analysis in 21 patients with chordomas of various sites treated at a single institution. J Neurosurg. 1991;75:374–7.

    CAS  PubMed  Google Scholar 

  269. Saunders WM, Castro JR, Chen GTY et al. Early results of ion beam radiation therapy for sacral chordoma. J Neurosurg. 1986;64:243–7.

    CAS  PubMed  Google Scholar 

  270. Schoenthaler R, Castro JR, Petti PL Baken-Brown K, Phillips TL. Charged particle irradiation of sacral chordomas. Int J Radiat Oncol Biol Phys. 1993;26:291–8.

    CAS  PubMed  Google Scholar 

  271. Spittle MF, Newton KA, Mackenzie DH. Liposarcoma: a review of 60 cases. Br J Cancer. 1970;24:696–704.

    CAS  PubMed  Google Scholar 

Download references

Authors

Rights and permissions

Reprints and permissions

Copyright information

© 2004 Kluwer Academic Publishers

About this chapter

Cite this chapter

Fuller, B.G. (2004). The Role of Radiation Therapy in the Treatment of Bone and Soft-tissue Sarcomas. In: Musculoskeletal Cancer Surgery. Springer, Dordrecht. https://doi.org/10.1007/0-306-48407-2_5

Download citation

  • DOI: https://doi.org/10.1007/0-306-48407-2_5

  • Publisher Name: Springer, Dordrecht

  • Print ISBN: 978-0-7923-6394-1

  • Online ISBN: 978-0-306-48407-0

  • eBook Packages: Springer Book Archive

Publish with us

Policies and ethics