The value of postoperative radiotherapy in childhood nonrhabdomyosarcoma soft tissue sarcoma

Objective. To determine the value of post-operative radiotherapy (RT) in the management of nonrhabdomyosarcoma soft tissue sarcoma (NRSTS) of childhood. Procedure. From 1964 to 2000, 62 children with a median age of 14 years were seen at the University of Iowa and underwent a wide local excision for non-metastatic NRSTS. Tumors were high grade in 36 (58%) and >5 cm in 24 (39%). Margins of resection were negative (Group I) in 37 (60%) and positive (Group II) in 25 (40%). Postoperative RT was delivered to 20 patients (32%); eight of 37 (22%) Group I and 12 of 25 (48%) Group II children received postoperative RT. Chemotherapy was employed in 19 patients (31 %). Median follow-up was 9.6 years. Results. The 5- and 10-year overall survival rates for Group I were 69 and 63% and for Group II were 66 and 60%. The 5- and 10-year local control rate was 66%. On multivariate analysis, size of tumor (P<0.001) and postoperative RT (P = 0.017) were prognostic factors for local control. All 13 Group I children with low grade, ≤5 cm tumors were locally controlled without RT. For Group II patients, 2- and 5-year local control rates were 92 and 82% with postoperative RT and 51 and 43% for no RT (P=0.0426). Conclusions. Local control was improved by the addition of postoperative RT in tumors with positive margins of resection.